Article: Signs of Depression in Men

The following article "Men: Don't Ignore the Signs of Depression" was published by Harvard Medical School. The signs of depression in men often look different than the signs of depression in women.

Harvard Men's Health Watch

Men: Don't ignore signs of depression

Published: December, 2013

Anger or aches and pains can hide underlying depression. Seek prompt treatment to protect your heart and mind.

Most people think of depression as persistent sadness or "down" feeling. But the blues can come in different colors in men. Depression may also show itself as irritability and angry outbursts, or physical aches and pains. "A man with depression is more likely to practice denial of feelings, often trying to mask them with other behaviors," says Dr. Gregory Fricchione, director of the Division of Psychiatry and Medicine at Harvard-affiliated Massachusetts General Hospital.
A doctor can offer options for treating depression, such as antidepressant medications or counseling, but only if men ask for help. For mild to moderate depression, antidepressant medication, in combination with talk therapy such as cognitive behavior therapy or interpersonal therapy, can start to turn things around within a few months. Then, regular exercise can help to keep your mood afloat.

Depression and Gender
Everyone's moods swing up and down, but in major or clinical depression, negative thoughts and feelings persist daily for weeks to months. Along with it may come insomnia, changes in appetite, low energy and fatigue, difficulty concentrating, and loss of interest in things that used to provide pleasure, including sex. Depression may trigger morbid or even suicidal thoughts.
Quite a bit of research has focused on how depression may look differently in men and women. According to the conventional wisdom, depression is more common in women than in men. But is that because men and their physicians are not picking up on nontraditional symptoms?
A recent study in JAMA Psychiatry decided to take a look. Researchers examined results from a national mental health survey and found that men with depression, compared with depressed women, more often reported angry outbursts, aggression, substance abuse, and risk-taking behavior. But when the differences were taken into account, the survey found depression in men and women at the same rate—roughly a third of adults.

Typical signs of depression

• Feeling sad or "empty"
• Feeling hopeless, irritable, anxious,
  or angry
• Loss of interest in work, family,
  or once-pleasurable activities, including sex
• Feeling very tired
• Not being able to concentrate
  or remember details
• Not being able to sleep,
  or sleeping too much
• Overeating, or not wanting to eat at all
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems
• Inability to meet the responsibilities of work, caring for family, or other important activities.

Source: National Institute of Mental Health

Unmasking Depression
Dr. Fricchione says that in men, depression may be hidden or "masked" by a variety of behaviors. These include:
Anger: Irritability, hypersensitivity, loss of sense of humor, anger, verbal abuse of loved ones. A man urged by his spouse to seek "anger management" counseling may turn out to be suffering from depression.
Physical symptoms: Low back pain, headaches, insomnia, sexual dysfunction, stomach and digestive problems. These physical symptoms may persist despite conventional medical treatments.
Compulsive behaviors: Increasing intake of alcohol, abuse of drugs, compulsive gambling.
Recklessness: Indulging in escapist or risky behaviors, such as reckless driving or unsafe sex.
Treatment: How it worksFor some, depression comes with a stigma or feelings of embarrassment and shame. But untreated depression is risky. It could get worse, so don't just grimace and bear it.
Your doctor can prescribe an antidepressant medication and refer you for talk therapy. Both are about equally effective for mild to moderate depression. Severe depression usually requires medication to see a change, as it is unlikely to improve with counseling alone.
If the medication seems to make no difference after a few months, your doctor may raise the dose or try a different drug. Make sure to report any new side effects from the drug immediately.
Once things start to turn around, don't stop taking the medication too soon. The risk of relapse is greatest in the first few months after a depressive episode. If depression does come back, it could be harder to treat next time.
To keep your mood up, good nutrition and healthy sleep can make a real difference. In people with mild depression, regular exercise can work just as well as a medication. It also may help you sleep better and boost your energy.