The first step is seeing it for what it is.
It’s the dead of winter. You wake up in darkness and go home in darkness. You find yourself more irritable, short tempered. Your energy and enthusiasm for things you typically enjoy starts to fade. Food selection gets skewed, in some cases comfort eating takes place, and others a tendency to miss meals may occur.
You may find yourself feeling a sense of existential angst. Maybe, you even find yourself becoming tearful with mild provocation. Your interest in sex may diminish. Your ability to fall asleep and stay asleep may be disrupted. Often times, men slip into depression with atypical symptoms. They may not experience the overwhelming sense of sadness and tearfulness that is classically associated with depression.
Causes of depression:
As best we can understand it, depression is a disorder of neurochemistry. Somehow the chemicals that communicate an impulse from one nerve to the other become imbalanced. These chemicals are known as “neurotransmitters “. They travel across the synapse- that is the small gap between one nerve and the next – in order to maintain a continuous, balanced, neurological state.
Neurochemicals such as norepinephrine, serotonin, dopamine and others must be produced and balanced in order to maintain optimum mood. This complicated system of neurochemistry can be thrown out of balance by many factors. Certain drugs are known to deplete neurochemicals in a way that promotes depression.
Traumatic injuries to the head, even if they don’t rise to the level of a concussion can also have an effect on neurochemistry. Depressed mood can complicate a post head trauma patient and require medical therapy.
Persistent psychological stress can ultimately exhaust norepinephrine and serotonin in our brains, ultimately making us more likely to experience depressive symptoms as our body has difficulty maintaining healthy levels in the face of overwhelming demand.
Chronic sleep deprivation, like that sometime seen in third shift workers, can also predispose us towards imbalanced chemistry.
Deprivation from inadequate exposure to sunlight and fresh air is another manageable risk factor for depression.It also seems that our brains thrive on social interaction. Prolonged isolation can tilt neurochemistry towards depression.
If you recognize the symptoms in yourself or a loved one, how should you respond?
First a word of caution on suicide; as men, we tend to take action and have a higher rate of success at this desperate act. A passive hope for a calm termination of life can sometimes accompany depression. This is typically captured by the feeling that it wouldn’t be so bad if you didn’t wake up the next morning. However, if this passive
thought turns to an active plan, that’s a sign of severe depression that requires immediate attention with professional help.
Assuming such is not your state, you may be suffering from a more mild form of the disorder. Sometimes termed “adjustment disorder ” this term refers to a reaction to negative events. Death, divorce, loss of income or status to name a few. These events often are followed by a cycle of depression typically lasting up to six months from which we can recover with our own initiative in most cases.
Another mild form of depression is “seasonal affective disorder” better known as the winter blues.
When you know the symptoms of depression, you start by treating it like any other illness. You must have three square meals a day. You must physically use your body every day, either going to the gym or pursuing vigorous physical activities. It is important to attempt to sleep well. Avoid things that disrupt your sleep cycle. Social interaction is essential. A tendency toward isolation can amplify depression. Pursue these activities even if you don’t feel like it. Consider them as treatment for your illness. Have faith that what you are suffering is transient. It will get better.
At what point should you consider professional help?
I recall a patient I encountered while I was practicing medicine in the army. By the time I saw him, he had been to multiple specialist seeking a resolution for his “chronic sinus pain”. He had been on multiple antibiotics, he even had several sinus surgeries performed with no relief. Over the course of taking his history, I began to notice some signs of depression within him. Trouble sleeping, strain with his wife, short temperedness, raised the suspicion that his chronic pain may have been a manifestation of depression.
After explaining my theory to him, he was willing to try a cycle of antidepressant medication. He came back several weeks later, his pain fully resolved. His wife, who was also my patient, thanked me for giving her back the man she had married.
In some cases, pharmacologic therapy can help to improve the neurochemical imbalance that is at the root of depression. Consider it like a tow truck pulling you out of a rut. Once you are safely back on the road, it becomes possible to maintain that pathway. This is where pharmacotherapy can combine with counseling to achieve the best outcome.
If you start to lose functional ability, it’s time to seek help.Missing work, significant weight gain, domestic stress,chronic pain, are signals that it’s time to seek help. Becoming tearful in your car on the way home may be a tolerable symptom, becoming tearful in the middle of a workday in front of colleagues or customers becomes a red flag for immediate help.
If you do seek consultation with your physician, be slow to embrace antidepressant medications. Many of these drugs can dull your response to all stimuli, good and bad. If overwhelming emotion and tearfulness are afflicting you and interfering with your function, these medications may have a role. If your symptoms are less severe, I would recommend avoiding drug therapy. Too often, I’ve seen patients start an antidepressant drugs lose their edge, become more dependent on the comfort the pharmacology brings and therefore avoid developing their own innate coping skills.
If drug therapy is required, you may want to consider the herbal remedy St. John’s Wort. This has been shown to have antidepressant value. Within the antidepressant class, Wellbutrin is known to have fewer blunting side effects, less weight gain and no adverse effects on sexual function. Paxil is to be avoided, (it carries a risk of weight gain and sexual dysfunction).
If drug therapy is started, you can expect affect to set in between two and four weeks. In some cases, upward titration of dose will be required. The total cycle of treatment will typically span between six and 18 months. Be sure your doctor is checking you for hypothyroidism as well as low testosterone levels. Either condition can make depression more difficult to cope with.
Being depressed is inevitable in the course of every man’s life. Learning how to remain functional, despite the depression is an essential skill. Knowing when to seek physician’s care and consider medication can be essential to better living. Remember, other people are counting on you. You can become a role model on how to deport yourself through difficult times simply by persevering.
All men will navigate through cycles of depression in the course of their lives. Your ability to sustain yourself will serve you well as you walk through each season of your life.
Photo—chrisleishman/Flickr
I’m glad to see articles on depression in men, which needs much more awareness and effort toward ending the stigma and shame that keeps so many from getting help. There are many good suggestions here for men who are struggling. I really hope to see more of how to respond when you recognize those symptoms in a loved one, which is asked here, but not explored. I see depression manifest differently in two men who both have the manly-man, who can handle things just fine themselves mindset. One is old school, raised with the men-don’t-talk-about-these-things attitude which was expected of… Read more »
Stephen,
Thanks for your fine article. Too often men are under-diagnosed and often go untreated for depression. As you note there are numerous signs and symptoms that are often overlooked. I did a research study on the differences between male and female depression. Happy to share if you’re interested. People can contact me here or through my website at http://www.MenAlive.com
Thank you for your interest in this topic and your good work helping to understand depression in men.
Hi dr.Stephen You sound like a friendly man,and I do not want to stop any man from seeking professional help when in distress. Not even with the use of drugs if necessary,but i want to know more. So I did a short search about Wellbutrin and found among others this one: Wellbutrin not legal in the UK. I understand the dangers here may be largely for women,but still. And look at this website for “Wellbutrin Lawyers”: http://www.wellbutrinlawyers.com/indianapolis-wellbutrin-lawyers/ How can I recommend my man to use antidepressants when I so often read that the long term effects are increased risk for… Read more »
In some cases depression is an isolated episode within a persons life span. Unfortunately there are also many cases where it will reoccur like other chronic relapsing illnesses. It’s true that anti-depressants, like other medications, carry side effects both known and yet to be revealed. Medications should only be used when other treatments have failed, and only if the benefits outweigh the risks. Untreated depression can lead to a fatal outcome.
Hi
May I ask what you mean by carefully monitored medication ?
For how long do you keep your patients on antidepressants in general?
And how do you help your patients the day they should stop using the drugs?
And do you inform them of all the long term consequences like the increased risk for dementia later on?
Suicide is the seventh leading cause of death in males. It’s also how my older brother died. It isn’t enough to ask somebody you think might be depressed to see a doctor. We also need to work to ensure that comprehensive mental health care is actually available when needed. What we have available now are a network of doctors that are trained to hand you pills and do little else. Therapy and social services are either unavailable or prohibitively expensive for much of the population. It’s not working.
I agree with Brian- although I was pleased to read that the doctor did speak of exercise, sleep, diet and socializing and he did recommend that medication ought to be a last resort. The article was well written, and I got the impression that Stephen Petteruti’s clients are fortunate to have him as their doctor.
I appreciate the article on men and depression and found the information useful but was very surprised by how little consideration was giving to counseling and alternative ways of overcoming depression in this article. I realize the article was written by a physician but giving counseling only one mention in the article seems incredibly limited. There was also no mention of exercise and how for mild and moderate levels of depression, the research has found exercise to be as good if not better than medication. This article is very good at describing a psychopharmacological approach but there are many ways… Read more »
Thank you for your thoughtful comments. A non pharmacological approach is always the safest path to choose. It also represents the foundation for all other treatments. As I mentioned in my article, healthy nutritional, physical, and social activity is critical to mental well-being.
Counseling is an almost universally enhancing intervention. Unfortunately for many patients time and money represent true barriers. Judicious use of carefully monitored medications can make a true difference in the quality of life for men and their families. My hope is to break down inhibitions that sometimes prevent strong men from seeking the help they need.