Depression is a serious but treatable medical condition.  Over 6 million men in America have depression each year.  However, this number is likely higher as many go unreported due to men not seeing a clinician; the signs and symptoms are often much different in men than in women and frequently go unrecognized and untreated, leading to personal, family and financial difficulties, and, in some cases, end in suicide.   In fact, even though women are twice as likely to have depression, men are four times as likely to commit suicide. 

For men, depression also increases the risk of the divorce and having children who become depressed and also impacts work by making people less productive, limiting earning potential, and increasing the risk of losing their job.  Luckily, most people recover with appropriate diagnosis and treatment.

It is common for many men to learn during childhood to overvalue independence and self-control.  They are taught not to express pain, weakness, uncertainty, helplessness and sadness.  Many men tend to see illness, particularly emotional illness, as a threat to their masculinity.  This can lead to denying or hiding their symptoms until something forces them to seek medical attention such as a job loss, catastrophic event, or the insistence of a loved one or intimate partner.

When they do seek medical attention, depressed men will typically focus more on physical complaints than on emotional suffering and can include headaches, digestive problems and chronic pain.  The link between the physical symptoms and emotional ones can often be missed.

Signs and Symptoms:

It is important to keep in mind that not everyone who has depression experiences every symptom; some men may only have a few of the symptoms.  Also, the severity of the symptoms will vary over time.  According to the National Institute of Mental Health, some common signs and symptoms of depression for both men and women include:

• Persistent sad, anxious, or “empty” mood. One of the most common symptoms of depression is a constant and overwhelming feeling of sadness, but feelings of emptiness, being apathetic or numb may also be present. Anxiety also often accompanies depression that may be intense like being in great danger.
• Feelings of hopelessness, pessimism.  When people are depressed, they often can’t see their way out and may feel like there is no light at the end of the tunnel. They may start losing hope that things will improve or for life getting any better.
• Feelings of guilt, worthlessness, helplessness.  Depressed individuals may think that it’s a personal failure or their fault that they aren’t happier or more productive, but such feelings are direct symptoms of the illness.
• Loss of interest or please in hobbies and activities.  People suffering from depression might lose interest in everything and not want to do anything or see anyone.  Things that once brought pleasure may now just be perceived as one more burden to deal with.  This can lead to lost interest in sex.  However, some may use sex excessively as an escape like alcohol or drugs.  
• Decreased energy, fatigue, being “slowed down”.  Thinking, reactions and even movements may become slower or seem slower in depressed people.  This slowness is complicated by fatigue and feeling overwhelmingly tired much of the time.
• Difficulty concentrating, remembering, making decisions.  Depression can affect the ability to think clearly, concentrate, remember things, make decisions and perform complicated tasks. 
• Difficulty sleeping, early-morning awakening, or oversleeping.  Sleep disturbances are common symptoms of depression with a “good night’s sleep” seeming virtually impossible. Many people complain of waking up in the middle of the night with their mind racing, wondering how they are going to overcome all of the obstacles before them. Others do little other than sleep but never feel rested. In both cases, the built up fatigue can aggravate every other aspect of depression.
• Appetite and/or weight changes.  Depression affects the appetite in one way or another. Often, people lose interest in eating because the food has no taste. When anxiety is high, people may not be able to eat. In some cases, however, they will overeat out of frustration or misery.
• Thoughts of death or suicide; suicide attempts.  When suffering from depression, thoughts of suicide are often common. If there is no relief over a long period of time, suicide can feel like the only way to end the pain.
• Restlessness, irritability.  Depressed individuals may feel like they can never relax, and never feel rested. It’s not surprising that they would feel angry, irritable, never peaceful. Men may manifest that irritability by lashing out at the people around them, having a volatile temper, not being able to sit still, and perhaps even feeling angry at themselves for not being able to pull out of it on their own.
• Persistent physical symptoms.  The stress, tension and fatigue of depression can often manifest themselves as physical symptoms. People may experience stomachaches, indigestion, constant headaches, tightness in the chest, difficulty breathing, etc. It is always possible that these symptoms indicate another medical condition so it is important in either case that you consult a physician. The symptoms are real and need to be treated.

While the above symptoms can be found in both men and women, many symptoms of men with depression will differ.  Unlike women, depressed men are less likely to have bouts of crying.  They are more likely to:

• Complain of fatigue
• Take serious risks (i.e. reckless driving, extramarital sex)
• Become angry and frustrated
• Behave violently
• Avoid family, friends and pleasurable activities
• Lose interest in work, hobbies and sex

Other Associated Conditions and Causes:

It is common for men with depression to have a history of alcohol or drug abuse, which can make it more difficult to diagnose. Depression has been found to have a strong association with post-traumatic stress disorder (PTSD), which can occur after traumatic events such as a natural disaster, accident, assault, or military combat.

Men with depression can also experience a loss of libido.  Sometimes this also includes erective dysfunction (ED).  If ED is due to a physical cause, it can take such a great emotional toll on a man that it causes depression.

A common trigger of depression is job stress that can include:  not having control in decisions that affect their responsibilities, lack of job security, poor communication and conflict-resolution methods with colleagues, unreasonable and relentless performance demands, wages that don’t match the responsibility, and excessive work hours and time spent away from home and family.  Men can also tend to feel more threatened than women do by rapid social, political and economic change.  For men, such changes can result in a loss of status and identity which increases their risk for depression and other mental illness.

Coping Strategies:

If you think you have depression, it is important to seek medical care.  With effective treatment, you may notice subtle physical improvements in sleep and appetite before your mood improves.  Over time, the feelings of helplessness, hopelessness, and worthlessness may gradually fade with the realization that they are due to your depression as opposed to your actual life circumstances.

According to the Mayo Clinic, here are some things you can do in the meantime to speed your recovery:

• Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
• Break large tasks into small ones, set priorities, and do what you can as you can.
• Spend time with people in whom you can confide.
• Engage in pleasurable activities such as mild exercise, going to a movie or ballgame, or participating in religious or social events.
• Let your family and friends help you.
• Avoid making important decisions such as changing jobs or getting married or divorced until after the depression lifts.
• Remember, positive thinking replaces negative thinking.
• Try exercise; aerobic exercise raises levels of mood-enhancing chemicals in the brain and can boost self-esteem through the physical benefit it provides.  Yoga may also help relieve symptoms by reducing tension and anger.  Click here for more information on the connection between exercise and emotional health

Sources:  National Institute of Mental Health; Mayo Clinic, www.mayoclinic.com