Depression in Men

A man's depression symptoms often differ from a woman's – and studies show that guys are less likely to confess to feeling depressed. For these reasons, emotional problems can be harder to spot in men. Here's what to look for.

Depression is often considered a woman’s disease. But with the National Institute of Mental Health estimating that nearly 6 million U.S. men have depression each year, it’s clear this mental health condition has no gender bias.

Still, research shows that males are less likely to open up about depression — or seek treatment — than their female counterparts. This disparity may be based on the “tough guy” mentality, an idea among some men that depression is a weakness. One study from the University of Akron found that a man was less likely to see a therapist for depression if he agreed with “traditional” gender roles, ones like “men can handle whatever comes their way.”

Men also tend to express different symptoms of depression than women, and they cope with depression in different ways. For instance, men are more likely to abuse drugs and alcohol to deal with depression. They may be ashamed of feeling depressed, and may behave recklessly, as well as show anger or aggression in response to depression.

Male Depression: Why the Gender Gap?

The difference between male depression and female depression may have both biological and social causes, according to Kathleen Franco, MD, professor of medicine and psychiatry at Cleveland Clinic Lerner College of Medicine in Ohio.

Women are diagnosed with depression about twice as often as men. "This difference in prevalence begins in adolescence. Postpartum and perimenopausal periods are also reported as vulnerable stages for women," says Dr. Franco. Although there may be hormonal influences that make women more prone to depression, men may also be less likely to admit to depression or seek help.

"What I remember the most about being depressed was feeling that I wasn't good enough. I felt angry and frustrated and medicated my feelings with alcohol. I didn't think of myself as being depressed. I just wanted to stop feeling the pain," recalls David Hanley of West Hartford, Conn.

What Depression Symptoms Look Like in Men

Male depression has many of the same basic symptoms as female depression. However, men may be more willing to acknowledge symptoms such as fatigue, irritability, loss of interest in social and work activities, and changes in sleep or eating habits than symptoms of sadness, emptiness, guilt, or worthlessness. Some common reactions to male depression include:

• Alcohol and drug abuse. Men are more likely to turn to drugs or alcohol to numb their symptoms of depression than to ask for help.In fact, one recent government report found that drug-related suicide attempts in males were up 55 percent between 2005 and 2009.
• Violence. The combination of alcohol, anger, and frustration may lead to abusive and violent behavior more frequently in male depression.
• Reckless behavior. "When I was very depressed I lost interest in my life. I just didn't care anymore," says Hanley. This attitude may cause many men to behave recklessly and dangerously.
• Suicide. Suicide is commonly associated with depression. Although more women attempt suicide, men are four times more likely than women to die by suicide in the United States.

Male Depression Through the Lifespan

Male depression is being increasingly recognized in boys and adolescents. Before the age of 14, depression is diagnosed as frequently in boys as in girls. Research shows that depression is occurring earlier today than in the past. If untreated, depression in youth can lead to more serious depression as an adult. Adolescent male depression also carries higher risks for suicide and substance abuse. Symptoms can include frequent illness, disruptive behavior, mood swings, and trouble at school.

For many older men, the combination of the loss of friends and family, loss of the self-esteem that goes along with work, chronic illness, and the reluctance to ask for help can be a deadly combination. The highest rate of suicide associated with male depression is in men over the age of 85. In 70 percent of cases, these men had been seen by a doctor within a month of their deaths. It's important to stress that depression is not a normal part of aging.

Male Depression: Diagnosis and Treatment

If you, a friend, or a loved one has male depression, the most important thing you can do is to get help from a doctor. The doctor will first do a complete medical evaluation to make sure there are no other treatable causes of depression such as infection, thyroid disorder, or low testosterone levels that may cause depression symptoms. The next step is a complete psychological evaluation.

If male depression is diagnosed, it is important to remember that depression is a treatable disease. More than 80 percent of the time, male depression gets better with treatment. The best treatment involves some combination of medication and talk therapy. "Medication, cognitive-behavioral therapy (CBT) and interpersonal therapy can be extremely beneficial. Many physicians recommend a combination such as CBT and medication for best long term results," says Franco.

Many men have stress in their lives and often deal with difficult issues, but living with depression is not the answer. It takes courage to ask for help, but remember that when you suffer, others suffer along with you. Untreated depression can ruin families.

"Before getting into treatment, I wondered if this was the best I was ever going to feel. I don't worry anymore if people know I have been treated for depression. I'm just happy to be better. I did what I needed to do to get my life back. My rewards are right here every day in my wife, children, and grandchildren," says Hanley.