Depression is a serious but treatable medical condition - a brain
disease - that can strike anyone, including men. In America alone,
over 6 million men have depression each year.
Whether
you're a company executive, a construction worker, a writer, a police
officer, or a student, whether you are rich or poor, surrounded by loved
ones or alone, you are not immune to depression. Some factors, however,
such as family history, undue stress, the loss of a loved one or other
serious illnesses can make you more vulnerable.
If left untreated,
depression can lead to personal, family and financial difficulties,
and, in some cases, end in suicide. With appropriate diagnosis and
treatment, however, most people recover. The darkness disappears, hope
for the future returns, energy and desire come back, and interest in
life becomes stronger than ever
Depression can strike anyone
regardless of age, ethnic background, socioeconomic status, or gender;
however, large scale research studies have found that depression is
about twice as common in women as in men. In the United States,
researchers estimate that in any given one year period, depressive
illnesses affect 12 percent of women (more than 12 million women) and
nearly 7 percent of men (more than six million men).3 But important
questions remain to be answered about the causes underlying this gender
difference.
We still do not know if depression is truly less common
among men, or if men are just less likely than women to recognize,
acknowledge, and seek help for depression.
Types of Depression
Just
like other illnesses, such as heart disease, depression comes in
different forms. This booklet briefly describes three of the most common
types of depressive disorders. However, within these types, there are
variations in the number of symptoms, their severity, and persistence.
Major
depression (or major depressive disorder) is manifested by a
combination of symptoms (see symptoms list below) that interferes with
the ability to work, study, sleep, eat, and enjoy once pleasurable
activities. A major depressive episode may occur only once; but more
commonly, several episodes may occur in a lifetime. Chronic major
depression may require a person to continue treatment indefinitely.
A
less severe type of depression, dysthymia (or dysthymic disorder),
involves long lasting, chronic symptoms that do not seriously disable,
but keep one from functioning well or feeling good. Many people with
dysthymia also experience major depressive episodes at some time in
their lives.
Depression
Persistent sad, anxious, or "empty" mood.
Feelings of hopelessness or pessimism.
Feelings of guilt, worthlessness, or helplessness.
Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
Decreased energy, fatigue; feeling "slowed down."
Difficulty concentrating, remembering, or making decisions.
Trouble sleeping, early morning awakening, or oversleeping.
Changes in appetite and/or weight.
Thoughts of death or suicide, or suicide attempts.
Restlessness or irritability.
Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.
Men and Depression
Researchers
estimate that at least six million men in the United States suffer from
a depressive disorder every year. Research and clinical evidence reveal
that while both women and men can develop the standard symptoms of
depression, they often experience depression differently and may have
different ways of coping with the symptoms. Men may be more willing to
acknowledge fatigue, irritability, loss of interest in work or hobbies,
and sleep disturbances rather than feelings of sadness, worthlessness,
and excessive guilt. Some researchers question whether the standard
definition of depression and the diagnostic tests based upon it
adequately capture the condition as it occurs in men.
Men are more
likely than women to report alcohol and drug abuse or dependence in
their lifetime;14 however, there is debate among researchers as to
whether substance use is a "symptom" of underlying depression in men or a
co occurring condition that more commonly develops in men.
Nevertheless, substance use can mask depression, making it harder to
recognize depression as a separate illness that needs treatment.
Instead
of acknowledging their feelings, asking for help, or seeking
appropriate treatment, men may turn to alcohol or drugs when they are
depressed, or become frustrated, discouraged, angry, irritable, and,
sometimes, violently abusive. Some men deal with depression by throwing
themselves compulsively into their work, attempting to hide their
depression from themselves, family, and friends. Other men may respond
to depression by engaging in reckless behavior, taking risks, and
putting themselves in harm's way.
More than four times as many men
as women die by suicide in the United States, even though women make
more suicide attempts during their lives. In addition to the fact that
men attempt suicide using methods that are generally more lethal than
those used by women, there may be other factors that protect women
against suicide death. In light of research indicating that suicide is
often associated with depression, the alarming suicide rate among men
may reflect the fact that men are less likely to seek treatment for
depression. Many men with depression do not obtain adequate diagnosis
and treatment that may be life saving.
Depression in Older Men
Men
must cope with several kinds of stress as they age. If they have been
the primary wage earners for their families and have identified heavily
with their jobs, they may feel stress upon retirementloss of an
important role, loss of self esteemthat can lead to depression.
Similarly, the loss of friends and family and the onset of other health
problems can trigger depression.
Depression is not a normal part
of aging. Depression is an illness that can be effectively treated,
thereby decreasing unnecessary suffering, improving the chances for
recovery from other illnesses, and prolonging productive life. However,
health care professionals may miss depressive symptoms in older
patients. Older adults may be reluctant to discuss feelings of sadness
or grief, or loss of interest in pleasurable activities.
They may
complain primarily of physical symptoms. It may be difficult to discern a
co occurring depressive disorder in patients who present with other
illnesses, such as heart disease, stroke, or cancer, which may cause
depressive symptoms or may be treated with medications that have side
effects that cause depression. If a depressive illness is diagnosed,
treatment with appropriate medication and/or brief psychotherapy can
help older adults manage both diseases, thus enhancing survival and
quality of life.
Identifying and treating depression in older
adults is critical. There is a common misperception that suicide rates
are highest among the young, but it is older white males who suffer the
highest rate. Over 70 percent of older suicide victims visit their
primary care physician within the month of their death; many have a
depressive illness that goes undetected during these visits. This fact
has led to research efforts to determine how to best improve physicians'
abilities to detect and treat depression in older adults.
Approximately
80 percent of older adults with depression improve when they receive
treatment with antidepressant medication, psychotherapy, or a
combination of both. In addition, research has shown that a combination
of psychotherapy and antidepressant medication is highly effective for
reducing recurrences of depression among older adults. Psychotherapy
alone has been shown to prolong periods of good health free from
depression, and is particularly useful for older patients who cannot or
will not take medication.18 Improved recognition and treatment of
depression in later life will make those years more enjoyable and
fulfilling for the depressed elderly person, and his family and
caregivers.
A depressive disorder is not the same as a passing blue mood.
Depression
can strike anyone regardless of age, ethnic background, socioeconomic
status, or gender; however, large scale research studies have found that
depression is about twice as common in women as in men.In the United
States, researchers estimate that in any given one year period,
depressive illnesses affect 12 percent of women (more than 12 million
women) and nearly 7 percent of men (more than six million men) But
important questions remain to be answered about the causes underlying
this gender difference. We still do not know if depression is truly less
common among men, or if men are just less likely than women to
recognize, acknowledge, and seek help for depression.
Symptoms of Depression
Not
everyone who is depressed or manic experiences every symptom. Some
people experience only a few; some people suffer many. The severity of
symptoms varies among individuals and also over time.
Depression
Persistent sad, anxious, or "empty" mood.
Feelings of hopelessness or pessimism.
Feelings of guilt, worthlessness, or helplessness.
Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
Decreased energy, fatigue; feeling "slowed down."
Difficulty concentrating, remembering, or making decisions.
Trouble sleeping, early morning awakening, or oversleeping.
Changes in appetite and/or weight.
Thoughts of death or suicide, or suicide attempts.
Restlessness or irritability.
Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.
Depression
can coexist with other illnesses. In such cases, it is important that
the depression and each co occurring illness be appropriately diagnosed
and treated.
Research has shown that anxiety disorderswhich
include post traumatic stress disorder (PTSD), obsessive compulsive
disorder, panic disorder, social phobia, and generalized anxiety
disordercommonly accompany depression. Depression is especially
prevalent among people with PTSD, a debilitating condition that can
develop after exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened.
Traumatic events that
can trigger PTSD include violent personal assaults such as rape or
mugging, natural disasters, accidents, terrorism, and military combat.
PTSD symptoms include: re experiencing the traumatic event in the form
of flashback episodes, memories, or nightmares; emotional numbness;
sleep disturbances; irritability; outbursts of anger; intense guilt; and
avoidance of any reminders or thoughts of the ordeal. In one NIMH
supported study, more than 40 percent of people with PTSD also had
depression when evaluated at one month and four months following the
traumatic event.
Substance use disorders (abuse or dependence)
also frequently co occur with depressive disorders. Research has
revealed that people with alcoholism are almost twice as likely as those
without alcoholism to also suffer from major depression. In addition,
more than half of people with bipolar disorder type I (with severe
mania) have a co occurring substance use disorder.
Men and Depression
Researchers
estimate that at least six million men in the United States suffer from
a depressive disorder every year. Research and clinical evidence reveal
that while both women and men can develop the standard symptoms of
depression, they often experience depression differently and may have
different ways of coping with the symptoms. Men may be more willing to
acknowledge fatigue, irritability, loss of interest in work or hobbies,
and sleep disturbances rather than feelings of sadness, worthlessness,
and excessive guilt. Some researchers question whether the standard
definition of depression and the diagnostic tests based upon it
adequately capture the condition as it occurs in men.
Men are more
likely than women to report alcohol and drug abuse or dependence in
their lifetime; however, there is debate among researchers as to whether
substance use is a "symptom" of underlying depression in men or a co
occurring condition that more commonly develops in men. Nevertheless,
substance use can mask depression, making it harder to recognize
depression as a separate illness that needs treatment.
Instead of
acknowledging their feelings, asking for help, or seeking appropriate
treatment, men may turn to alcohol or drugs when they are depressed, or
become frustrated, discouraged, angry, irritable, and, sometimes,
violently abusive. Some men deal with depression by throwing themselves
compulsively into their work, attempting to hide their depression from
themselves, family, and friends. Other men may respond to depression by
engaging in reckless behavior, taking risks, and putting themselves in
harm's way.
More than four times as many men as women die by
suicide in the United States, even though women make more suicide
attempts during their lives. In addition to the fact that men attempt
suicide using methods that are generally more lethal than those used by
women, there may be other factors that protect women against suicide
death. In light of research indicating that suicide is often associated
with depression,17 the alarming suicide rate among men may reflect the
fact that men are less likely to seek treatment for depression. Many men
with depression do not obtain adequate diagnosis and treatment that may
be life saving.
More research is needed to understand all aspects
of depression in men, including how men respond to stress and feelings
associated with depression, how to make men more comfortable
acknowledging these feelings and getting the help they need, and how to
train physicians to better recognize and treat depression in men. Family
members, friends, and employee assistance professionals in the
workplace also can play important roles in recognizing depressive
symptoms in men and helping them get treatment.
The first step to
getting appropriate treatment for depression is a physical examination
by a physician. Certain medications as well as some medical conditions
such as a viral infection, thyroid disorder, or low testosterone level
can cause the same symptoms as depression, and the physician should rule
out these possibilities through examination, interview, and lab tests.
If no such cause of the depressive symptoms is found, the physician
should do a psychological evaluation or refer the patient to a mental
health professional.
A good diagnostic evaluation will include a
complete history of symptoms: i.e., when they started, how long they
have lasted, their severity, and whether the patient had them before
and, if so, if the symptoms were treated and what treatment was given.
The doctor should ask about alcohol and drug use, and if the patient has
thoughts about death or suicide. Further, a history should include
questions about whether other family members have had a depressive
illness and, if treated, what treatments they may have received and if
they were effective. Last, a diagnostic evaluation should include a
mental status examination to determine if speech, thought patterns, or
memory has been affected, as sometimes happens with depressive
disorders.
Treatment choice will depend on the patient's
diagnosis, severity of symptoms, and preference. There are a variety of
treatments, including medications and short term psychotherapies (i.e.,
"talk" therapies), that have proven effective for depressive disorders.
In general, severe depressive illnesses, particularly those that are
recurrent, will require a combination of treatments for the best
outcome.
Alcohol including wine, beer, and hard liquoror street
drugs may reduce the effectiveness of antidepressants and should be
avoided. However, doctors may permit people who have not had a problem
with alcohol abuse or dependence to use a modest amount of alcohol while
taking one of the newer antidepressants.
Questions about any medication prescribed, or problems that may be related to it, should be discussed with your doctor.
How to Help Yourself if You Are Depressed
Depressive
disorders can make one feel exhausted, worthless, helpless, and
hopeless. It is important to realize that these negative views are part
of the depression and do not accurately reflect the actual
circumstances. Negative thinking fades as treatment begins to take
effect. In the meantime: Engage in mild exercise. Go to a movie, a
ballgame, or participate in religious, social, or other activities.
Set realistic goals and assume a reasonable amount of responsibility.
Break large tasks into small ones, set some priorities, and do what you can as you can.
Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
Participate in activities that may make you feel better.
Expect your mood to improve gradually, not immediately. Feeling
better takes time. Often during treatment of depression, sleep and
appetite will begin to improve before depressed mood lifts.
Postpone
important decisions. Before deciding to make a significant
transition-change jobs, get married or divorced-discuss it with others
who know you well and have a more objective view of your situation.
Do not expect to 'snap out of' a depression. But do expect to feel a little better day by day.
Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
Let your family and friends help you.
How Family and Friends Can Help
The
most important thing anyone can do for a man who may have depression is
to help him get to a doctor for a diagnostic evaluation and treatment.
First, try to talk to him about depressionhelp him understand that
depression is a common illness among men and is nothing to be ashamed
about. Perhaps share this booklet with him. Then encourage him to see a
doctor to determine the cause of his symptoms and obtain appropriate
treatment.
Occasionally, you may need to make an appointment for
the depressed person and accompany him to the doctor. Once he is in
treatment, you may continue to help by encouraging him to stay with
treatment until symptoms begin to lift (several weeks) or to seek
different treatment if no improvement occurs. This may also mean
monitoring whether he is taking prescribed medication and/or attending
therapy sessions. Encourage him to be honest with the doctor about his
use of alcohol and prescription or recreational drugs, and to follow the
doctor's orders about the use of these substances while on
antidepressant medication.
The second most important thing is to
offer emotional support to the depressed person. This involves
understanding, patience, affection, and encouragement. Engage him in
conversation and listen carefully. Do not disparage the feelings he may
express, but point out realities and offer hope. Do not ignore remarks
about suicide. Report them to the depressed person's doctor. In an
emergency, call 911. Invite him for walks, outings, to the movies, and
other activities. Be gently insistent if your invitation is refused.
Encourage participation in some activities that once gave pleasure, such
as hobbies, sports, religious or cultural activities, but do not push
him to undertake too much too soon. The depressed person needs diversion
and company, but too many demands can increase feelings of failure.
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.
Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Religious leaders/counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University or medical school affiliated programs
State hospital outpatient clinics
Social service agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
Conclusion
A
man can experience depression in many different ways. He may be grumpy
or irritable, or have lost his sense of humor. He might drink too much
or abuse drugs. It may be that he physically or verbally abuses his wife
and his kids. He might work all the time, or compulsively seek thrills
in high risk behavior. Or, he may seem isolated, withdrawn, and no
longer interested in the people or activities he used to enjoy.
Perhaps
this man sounds like you. If so, it is important to understand that
there is a brain disorder called depression that may be underlying these
feelings and behaviors. It's real: scientists have developed sensitive
imaging devices that enable us to see depression in the brain. And it's
treatable: more than 80 percent of those suffering from depression
respond to existing treatments, and new ones are continually becoming
available and helping more people. Talk to a healthcare provider about
how you are feeling, and ask for help.
Or perhaps this man sound
like someone you care about. Try to talk to him, or to someone who has a
chance of getting through to him. Help him to understand that
depression is a common illness among men and is nothing to be ashamed
about. Encourage him to see a doctor and get an evaluation for
depression.
For most men with depression, life doesn't have to be
so dark and hopeless. Life is hard enough as it is; and treating
depression can free up vital resources to cope with life's challenges
effectively. When a man is depressed, he's not the only one who suffers.
His depression also darkens the lives of his family, his friends,
virtually everyone close to him. Getting him into treatment can send
ripples of healing and hope into all of those lives.
Depression is
a real illness; it is treatable; and men can have it. It takes courage
to ask for help, but help can make all the difference.
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Leading Psychiatrists are calling Arthur a 'walking
miracle'-After 15 years in mental institutions, absorbing inhumane shock
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With Much Love,
Arthur Buchanan
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Out of Darkness & Into the Light
43 Oakwood Ave. Suite 1012
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http://www.out-of-darkness.com
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