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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 retirement'loss of an important role, loss of self esteem'that 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 disorders'which include post traumatic stress disorder (PTSD), obsessive compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder'commonly 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 liquor'or 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 depression'help 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.