Last week the media reported the sad and unanticipated deaths of two men. Derek Boogaard of the Rangers died from an accidental overdose of the drug oxycodone mixed with alcohol and retired lieutenant, John A. Garcia, a 23-year veteran of FDNY who not only responded to 9/11 but responded and lost two of his men in the Deutsche Bank Fire. died by suicide.

One can’t help but wonder if the tragic deaths reflect the danger of hidden depression in men.  Increasingly we have become aware that although women are twice as likely to be diagnosed with depression, many men, beyond the 10-17% diagnosed, may also be suffering with depression.

Depression May Be More Deadly for Men

What makes depression in men so dangerous? It too often goes unrecognized and untreated because it is masked by physical complaints, substance abuse, anger and other stealth symptoms.

• Undiagnosed depression is the leading cause of suicide. Men are four times more likely to die by suicide than women.
• Depression is highly associated with cardiovascular disease, heart attack and stroke. Men develop these diseases at a higher rate and earlier age than women.
• Depression is the most common disorder suffered in conjunction with post-traumatic stress disorder (Ursano, Grieger, and Mccarroll, 1996)
• In a recent RAND Corporation study, one in five veterans of Iraq and Afghanistan reported symptoms of combat stress or major depression. In turn, service members with such problems more often report heavy drinking or illicit drug use.
• National Highway Traffic Safety Administration (NHTSA) statistics reveal that the number of boomer-aged men dying behind the wheel rose from 2000 to 2009. Analysis showed men are three times as likely to be intoxicated when getting into a fatal accident as women.

Why is Depression So Well Hidden in Men?

A mix of biological and cultural factors often conspire to keep men and those who love them from recognizing and addressing their depression.

Different Symptom Patterns

Given that women are twice as likely to suffer with depression as men, there is a tendency, even in clinical diagnosis to associate depression with symptoms more likely reported by women as sadness and hopelessness, trouble sleeping, changes in appetite, loss of interest in people and activities, and suicidal thoughts.

According to the STAR-D study, there are physical differences in the overall pattern of depression symptoms between men and women which may go unnoticed:

Whereas both men and women may report low mood as a symptom of depression, women are more likely to gain weight, men more likely to lose weight; women report symptoms associated with anxiety, men report symptoms associated with obsessive –compulsive disorder; women feel less energetic, men feel agitated; and men are more likely to develop alcohol or substance abuse in conjunction with major depression.

Differences in Handling Feelings

In his cross-cultural research on depression, Jules Angst MD found that both men and women reported stress as a cause of their depression. Whereas women cited family as the primary source of stress, men were more likely to cite work and unemployment.

• Whereas women choose to share and disclose their stress as a way of seeking help, men are far less likely to disclose stress to others. More common in men than women, depression is often reflected in stress headaches, stomach problems and chronic pain – Something missed by men as well as the people around them.
• Also more common in men is the masking of feelings with anger, irritability or changes in behavior as becoming controlling and in some cases abusive or violent- It is unlikely that a partner will move closer to support someone whose pain is hidden by angry put-downs or abuse.

Impact of Culture on Men and Depression

Recognizing depression and  the feelings associated with it is culturally more difficult for men than women.

Marianne Legato MD, expert in gender-specific medicine, notes

“I have long been convinced that depression is underreported, underdiagnosed, and underetreated in men, largely because of the way they’re socialized.”

Men are taught directly and indirectly not to cry in sadness or pain. The message internalized by too many is not to talk about feelings- not to talk about depression. As one marine, who had tragically covered his pain with alcohol described,

“I was trying to be the tough marine I was trained to be — not to talk about problems, not to cry,”…“I imprisoned myself in my own mind.”

Dangerous Self-Medications

• Rather than seek help, men have a tendency to self-medicate or avoid the anguish, sadness, guilt or self-doubt associated with depression with sexual acting out, alcohol or substance abuse, risky behaviors like reckless driving, escapist behaviors such as internet addiction, porn or being overly involved in work or sports.
• The result is an escalation of emotional pain desperately driving more avoidance, risk, substances, suicidal thinking and a downward spiral of personal, family,and job functioning.
• Self-medication for depression puts men and those around them in harm’s way.

The Right to Recover

Unlike other illnesses there is a tendency to associate depression with weakness, vulnerability, laziness and withholding. There is a tendency to feel shame and self–blame even as one is suffering.

The reality is that 19 million Americans suffer from depression. They suffer physically and emotionally.

Men and women don’t cause their own depression – be it a function of genetic predisposition, hormones, stress, loss, disappointment, grief or trauma – they suffer with an illness that can and should be treated.

Men often suffer alone. If they stop to consider that their physical symptoms and behaviors might hide depression- they may be able to step out of danger.

If they reach for the help of a partner, a buddy,their primary physician, a mental health professional, or a spiritual caregiver- they will have taken the first step.

Additional References

Ursano, R., Grieger, McCarroll.1996. Prevention of posttraumatic stress: consultation, training and early treatment. In Traumatic Stress: The Effects of Overwhelming Experience on Mind, body and Society, (Eds) B. a van der Kolk, A. C. McFarlane, and Weisaeth. New York: Guilford Press.

Photo by Alan Turkus, available under a Creative Commons attribution license.

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    Last reviewed: 3 Aug 2011