Men and depression

At every age, men have worse health than women and a higher death rate. They also have a higher — often much higher — risk of many psychiatric disorders, including schizophrenia, alcoholism, drug addiction, and autism. So it is remarkable that the rate of diagnosed depression is much lower in men almost everywhere in the world. In the United States, about half as many men as women become seriously depressed at some time in their lives. Men suffer less major depression, less dysthymia (chronic mild to moderate depression), and probably less bipolar depression (although the rate of bipolar disorder is the same in both sexes).

The reasons for this difference are not entirely clear. The main risk factors for an episode of depression are the same in both sexes: certain personality traits, drug and alcohol abuse, acute and chronic stress, traumatic experiences including child abuse, a family history of depression, and a previous depressive episode. One theory suggests that the hormones that are found in women but not men may play a role.

The relatively low rate of depression in men could be an illusion. It’s often said that men don’t like to admit, even to themselves, that they are depressed. They may feel that it is weak or unmanly to show despair or self-doubt; they may fear what might happen if employers or colleagues found out. So they withdraw into silent misery or develop a “male depression syndrome” in which the disorder masquerades as anger, irritability, alcoholism, or drug abuse. Because they do not seek treatment, the story goes, their depression is never diagnosed or recorded.

In two ways, both related to the high male death rate, depression can be said to be an even more serious matter for men than for women. Depression is a key risk factor for suicide, and men commit suicide four times more often than women — up to 10 times more often in seniors. One reason may be men’s reluctance to convey their feelings and seek help when they are in despair.

Another mortal concern for men with depression is cardiovascular disease. Depression affects blood pressure, blood clotting, and the immune system. It’s a well-known risk factor for coronary heart disease, heart attacks, and stroke. Men are especially vulnerable because they develop these diseases at a higher rate and at an earlier age than women.

The most important thing others can do for a man who shows signs of depression is to help him contact a physician or mental health professional and if necessary accompany him to treatment and encourage him to continue until his symptoms begin to improve. The treatment itself is the same for both sexes — talking with a therapist about problems and taking antidepressants for symptoms. The talk may take the form of psychotherapy, support groups, or marital counseling.

Antidepressants are equally effective and have similar side effects in both sexes, but one of those side effects, occurring in up to 50% of users, has special implications for men. The most widely used antidepressants, the selective serotonin reuptake inhibitors (SSRIs), tend to diminish sexual interest, desire, performance, and satisfaction and the capacity to reach an orgasm. In men, that often means the drugs prevent or delay erection or ejaculation.

Sexual side effects, like other antidepressant side effects, may fade with time. For some men, the reduction in anxiety and delay of orgasm may actually help them enjoy sex more. So one solution is to wait awhile to see how it affects sexual functioning over a period of months. Other options are to reduce the dose and switch to a different kind of antidepressant, often bupropion (Wellbutrin).

Making sure the depression is being treated, however, is the first concern. It is crucial to see through whatever difficulties may arise in treatment, because depression itself is generally associated with greater risks than the treatments. In many cases, treatment can be life saving. And treatment can also make that life much more worth living.

How have you seen men express their moods differently from women? And how do they get the help they need? From experience, what has the best way to encourage a man to get treatment?The field of mental health is rapidly evolving, and whether your interest is professional or personal, staying informed about these mental health issues is no easy job. The Harvard Mental Health Letter is a source of mental health news you can trust…and it comes directly from the more than 8,000 doctors and researchers at Harvard Medical School. 

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