Depression in Men

Is Depression in Men Different Than in Women?
The symptoms of male depression are not commonly recognized. Every year, depression affects more that 19 million Americans, but men account for only about one in 10 diagnosed cases. Because of this, depression was once considered a "woman's disease," linked to hormones and premenstrual syndrome. The lingering stereotype of depression being a female condition may prevent some men from recognizing its symptoms and seeking appropriate treatment.
In reality, depression affects both sexes, disrupting relationships and interfering with work and daily activities. The symptoms of depression are similar for both men and women, but they tend to be expressed differently. The most common symptoms of depression include low self-esteem, suicidal thoughts, loss of interest in usually pleasurable activities, fatigue, changes in appetite, sleep disturbances, apathy and sexual problems, including reduced sex drive.
There are several reasons why the symptoms of depression in men are not commonly recognized:
- Men tend to deny having problems because they are supposed to "be strong."
- American culture suggests that expressing emotion is largely a feminine trait. As a result, men who are depressed are more likely to talk about the physical symptoms of their depression, such as feeling tired, rather than those related to emotions.
- Depression can affect sexual desire and performance. Men often are unwilling to admit to problems with their sexuality -- mistakenly feeling that the problems are related to their manhood, when in fact they are caused by a medical problem such as depression.
- The observable symptoms of male depression are not as well understood as those in women. Men are less likely to show "typical" signs of depression, such as crying, sadness, loss of interest in previously enjoyable activities, or verbally expressing thoughts of suicide. Instead, men are more likely to keep their feelings hidden, but may become more irritable and aggressive.
For these reasons, many men -- as well as doctors and other healthcare professionals -- fail to recognize the problem as depression. Some mental healthcare professionals suggest that if the symptoms of depression were expanded to include anger, blame, lashing out and abuse of alcohol, more men might be diagnosed with depression and treated appropriately.
Depression in men can have devastating consequences. The Centers for Disease Control and Prevention report that men in the U.S. are about four times more likely than women to commit suicide. A staggering 75-80% of all people who commit suicide in the U.S. are men. Though more women attempt suicide, more men are successful at actually ending their lives. This may be due to the fact that men tend to use more lethal methods of committing suicide, for example using a gun rather than taking an overdose.

Why is Depression Different in Men?
Understanding how men in our society are brought up to behave is particularly important in identifying and treating their depression. Depression in men often can be traced to cultural expectations. Men are supposed to be successful. They should restrain their emotions. They must be in control. These cultural expectations can mask some of the true symptoms of depression, forcing men to express aggression and anger (viewed as more acceptable "tough guy" behavior) instead.
In addition, men generally have a harder time dealing with the stigma of depression. They tend to deal with their symptoms with a macho attitude or by drinking alcohol. This attitude still pervades many male-dominated institutions, such as the military and athletics, where men are taught that "toughness" means putting up with physical pain and admitting to emotional distress is taboo. Rather than seek help, which means admitting to what they perceive as a weakness, men are more likely to deal with their depression by drinking heavily or committing suicide.
Special Consideration -- Bereavement
Men also tend to deal with the loss of a loved one differently than women. This may also be related to their belief that men must be strong in the face of adversity, and that showing emotion is a sign of weakness. Men tend to assume full responsibility for their bereavement and suppress their grief. Studies show that this suppression can increase the time it takes to grieve and lead to complications such as escalating anger, aggressiveness and substance abuse. Physical symptoms may include increased cholesterol levels, ulcers, high blood pressure, and pain.
Because they feel unable to openly express their feelings, many men deal with grief by taking on more activities -- such as working overtime or going on business trips -- to occupy their time. They may become involved in risk-taking behavior, such as dangerous sports or compulsive sexual activity. Some addictive behaviors, such as over consumption of alcohol or other drug abuse, can escalate as the result of suppressed grief.
Can Depression in Men Be Treated?
More than 80% of people with depression -- both men and women -- can be treated successfully with antidepressant medication, psychotherapy or a combination of both.
Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.