Beating back the blues

When afflicted with depression, men "may become frustrated, discouraged, angry, irritable, and abusive" or "engage in irresponsible behavior.... It often takes courage to ask for help."

AS I HAVE SEEN MEN who were patients, volunteers in clinical research, and others going about their daily lives, I have learned a great deal about men and depression. In 2002, the National Institute of Mental Health began a national campaign entitled "Real Men Real Depression." This documentary series of books and television public service spots has highlighted some of the ways men first become aware of the symptoms of depression and how it often takes courage to ask for help.

Men consistently rank lower than women in their rates of consultation about anxiety and depression, in their willingness to confide their problems to others, and in acknowledging the need for help. Men sometimes delay seeking assistance until their condition reaches a crisis. Depression can be very dangerous. Although roughly twice as many women as men are diagnosed each year with the condition, men are four times more likely to commit suicide. (Twice as many women as men also are diagnosed with various anxiety difficulties, with the exception of social anxiety disorder, which afflicts both sexes equally.)

Although most people equate women with depression and expect to see sad moods and weeping, men have depression, too. They of ten experience it differently than women and often have dissimilar ways of coping. For instance, men are more likely to acknowledge fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances than sensations of sadness, worthlessness, and excessive guilt.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are afflicted, or they may, become frustrated, discouraged, angary, irritable, and abusive. Some throw themselves compulsively into their work, attempting to hide their condition from themselves, family, and friends; others may engage in irresponsible behavior--crossing a street against the light or driving recklessly.

Men turn to alcohol and drugs more often than women when they are depressed, though in some cases the depression may arise from the substance abuse rather than vice versa. Nevertheless, recreational drugs can mask depression, making it harder to recognize as a separate illness that requires treatment.

Men may fail to seek help when they need it out of mistaken ideas about what psychotherapy entails. Where once the image was of lying on a couch endlessly talking about one's past, the modern forms--such as cognitive-behavioral, interpersonal, and family therapies--are quite structured, goal directed, and results oriented. Sessions focus on gaining insight into current problems and dysfunctional relationships rather than spending a lot of time reviewing the past. Of course, personal history often is extremely relevant to current difficulties, and sometimes patterns of behavior or belief formed in childhood really do affect one's present state of mind.

Men may fear taking psychoactive medication for many reasons, thinking thai they will be changed by the drugs into a less effective person, unable to address and resolve the various situations in their lives. Or they dread having to take medication long term. There are a number of drugs used today to help fight depression and anxiety. Sometimes, a physician will try, a variety of antidepressants before finding the most effective one (or combination) for an individual. Moreover, it can take time to achieve the dosage needed to help the patient feel better.

Men also should realize they are not alone--roughly 12,000,000 suffer from depression each year, and millions more wrestle with anxiety disorders. At times, men do not even realize they are depressed until another person points it out. Mental health professionals of all types are familiar with these symptoms and any fears an individual might have about admitting to a problem will evaporate quickly on the first visit. It is both wise and courageous for a man to seek help. By seizing control of life in this way, he greatly increases the chances that he and his loved ones will be spared the misery and tragedy that so often accompany unacknowledged psychological illness.

Cause & Effect

In addition to the general risk factors for anxiety and depression, such as having a family history of either disorder and experiencing high and sustained levels of stress, certain risk factors are particularly pertinent to men.

* Combat Exposure: Traumatic wartime experiences may predispose a person to later depression as well as anxiety disorders, particularly posttraumatic stress disorder.

* Child Abuse: Although girls are more likely to be sexually abused than boys, sexual abuse of males does occur and can have devastating psychological consequences, in part because of the lingering stigma surrounding homosexuality. In addition, boys often suffer more frequent or severe physical abuse than girls do.