Psych Central


Men and Depression: Not Just the Same Sad FaceFeeling Down?

Scenario 1: Joan, a 32-year-old working mother of two young children

Joan arrives in therapy complaining that over the past six to eight months she has experienced growing feelings of both sadness and fatigue. She admits to frequent crying jags over what she accurately describes as relatively minor incidents. She also reports difficulty falling asleep, usually because she’s worrying that her children need more from her than time allows. As a result she is fatigued, easily prompted to tears, spaced out, and increasingly forgetful. The final straw for Joan was when she inadvertently locked her toddler son in the family car with the keys inside (requiring a visit from the local AAA truck to free both her son and her SUV). The following day, after a long talk with her husband, who encouraged her to seek help for her general unhappiness, she reached out to a local psychotherapist. After reviewing Joan’s history and stated symptoms over the course of several sessions, Joan’s therapist diagnosed her as being in the middle of a moderate depressive episode. The therapist gave her a referral for medication evaluation, and continued to work with her in therapy – focusing on helping her to better manage stress and to feel more confident as a mother.

Scenario 2: Gary, a 34-year-old working father of two young children

Gary arrives in therapy and says that he has been drinking alcohol more heavily than usual over the past six to eight months while simultaneously struggling with his temper. He says that he has also been sleeping less, which leaves him short-tempered, spaced out, and forgetful. He says his moods can shift quickly from fatigue and listlessness to rage, and that he is almost constantly stressed out. Hanging his head and tearful while speaking, he says that lately he feels, whenever his wife asks him to do something, as if he wants to “find a way to shut her up.” The final straw for Gary was when he verbally threatened his wife after she nagged him yet again about their finances, suggesting that he either ask for a raise or find a second job. The following day Gary sought help from a local psychotherapist. After reviewing Gary’s history and stated symptoms, the therapist rendered a diagnosis of Substance Use Disorder (alcohol) and Impulse Control Disorder NOS (related to Gary’s feelings of rage and his desire to lash out at his wife). The therapist suggested Gary attend weekly AA meetings and sign up for a 12-week anger management course.

She is Sad, But He Seems Mean

If you’re like me, you’re probably wondering why Joan was diagnosed with and treated for depression, while Gary was diagnosed with addiction and anger issues and then sent packing. The sad truth here is that Gary’s diagnoses result from the fact that most mental health clinicians are taught to assess adult depressive symptoms through a female-centric lens, meaning depressed men are often therapeutically shorted. In other words, depression is typically viewed – both culturally and within the therapeutic ranks – as a female disease. So when men demonstrate adult depressive symptoms such as emotional lability, tearfulness, anhedonia, procrastination, lethargy, isolation, and the like they are often perceived not as depressed, but as weak, lazy, undisciplined, inadequate, and vulnerable – traits that are not always culturally acceptable in men. Let’s face it, men are expected to be strong, to carry their own weight, and to just get over it – whatever “it” might be. Because of this, many depressed men, instead of being treated specifically and directly for their depression, are asked to “cowboy up” in AA, anger management, and other venues that only indirectly address their true disorder.

When similar symptoms show up in adult women, those symptoms tend to be much more readily interpreted and accepted as emotional challenges rather than character flaws (weakness, vulnerability, etc.) The prevailing view seems to be that when women feel sad, it’s OK, because they’re women, but when men feel sad they should tough it out on their own. Essentially, men are taught from womb to tomb that it is better to figure things out for themselves than to ask for help, and if they are going to display their depression they should do it in “manly” ways like drinking heavily and hitting people. In other words, men tend to “act out” when they feel down, whereas women tend to “act in” (eating disorders, hoarding, self-harm such as cutting or burning, and the like). Sadly, more often than not depressed men are left to find their own way forward, oftentimes attempting to self-soothe their mood instability, self-esteem issues, and feelings of malaise through substance abuse, workaholism, sexual acting out, rage, and other overtly destructive behaviors.

The common misperception of depression as a female disease doesn’t mean that men don’t suffer from it every bit as often as women. It merely means that male depression can be harder to diagnose because men often hide or refuse to discuss their feelings of fragility, uselessness, and despondency. Rather than seeking help and openly talking about their emotions, men are more likely to self-medicate with substances and escapist behaviors, or to defend against their feelings by expressing and reacting with irritability, anger, and even outright hostility.

Sadly, unrecognized and/or untreated depression in men can have devastating consequences. For instance, men are four times more likely than women to commit suicide, even though women attempt suicide more often than men. In part this is because men tend to use more lethal methods, such as guns. It may also be that women, who are not constrained by the rules of being a man (one of which is never asking for assistance), attempt suicide more as a cry for help than as an actual stab at death.

After twenty-plus years spent actively treating men with histories of trauma and neglect who struggle as adults with various forms of acting out – drug and alcohol abuse, sexual compulsivity and promiscuity, compulsive gambling, verbal abuse, physical abuse, and the like – it is no surprise to me that there is often much more going on than meets the eye, and oftentimes these men are, more than anything else, attempting to self-regulate their moderate to severe depression. As such, it is refreshing to see new research coming to light regarding men and depression, confirming the idea that men and women are equally susceptible to depression, although their symptoms often manifest in very different ways.

Signs of Male Depression

The underlying feelings of sadness and anxiety in those who struggle with depression are the same for both men and women, yet men are much less likely to talk about their issues in terms of emotional illness, and their depressive symptoms typically manifest differently. Common signs of male depression include:

  • Irritability, Anger, Hostility: Acting out with anger is a coping mechanism for men. It is a way to act as if they are in control even though they feel out of control. Men may also become irritable or hostile when their depression has caused them to withdraw and isolate and they feel pressured by friends or family to rejoin the living.
  • Substance Abuse: Research indicates 30 to 50 percent of alcoholics suffer from major depression. Typically, addiction and depression feed one another, especially when the drug of choice is a depressant such as alcohol. Depressed men in particular are vulnerable to addiction because, in an attempt to fix their “sadness problem” without assistance they turn to the most readily available medication, which is usually alcohol or an illicit substance.
  • Compulsive Sex, Spending, Gambling, or Video Gaming: Much like substances of abuse, emotionally intense behaviors can be used compulsively in a futile attempt to ward off sadness.
  • Chronic Headaches, Stomachaches, Backaches: Depression often manifests physically, perhaps more so in men than women because men tend to internalize their problems and suffer in silence. Essentially, the stress and anxiety caused by intolerable but unacknowledged sadness results in physical pain.
  • Sexual Dysfunction: Depression and erectile dysfunction often manifest simultaneously. Interestingly, one can lead to the other. Depression makes it much more difficult to perform sexually, and the inability to perform sexually can feed depression. Complicating matters is the fact that sexual dysfunction is a common side-effect of many antidepressants.
  • Issues with Sleep: Depressed people, men and women alike, tend to either sleep too much or too little. They can’t get to sleep, they can’t stay asleep, or they can’t wake up. Sleep issues are one of the few symptoms of depression that men are usually willing to talk to doctor about. As such, men reporting issues with sleep should always be questioned about other potential symptoms of depression.
  • Fatigue: Constantly feeling tired, regardless of how much sleep a person is or is not getting, may be indicative of a deeper physical problem. More often, however, it is a symptom of depression. Like sleep issues, fatigue is a topic men will often broach with their doctor or a therapist. As such, men reporting issues with fatigue should always be questioned about other potential symptoms of depression.
  • Isolation, Withdrawal, and Loss of Interest: Depressed people feel sad and unworthy, and, as such, they tend to pull away from friends and loved ones. They also lose interest in previously enjoyable activities such as exercise, hobbies, and creative endeavors.
  • Indecision and Difficulty Concentrating: Depression often fills the mind with negative thoughts, and these thoughts can make it difficult to focus on important or even insignificant matters, and to make even basic decisions. Sometimes very simple tasks such as paying bills can become incredibly difficult, even if there’s plenty of money in the bank.
  • Stress and Anxiety: Feeling stressed out and anxious can cause depression, and it can also be a symptom of depression. Stress and anxiety are things that most men will willingly talk about. As such, men who report stress and/or anxiety should always be questioned about other potential symptoms of depression.
  • Suicidal Ideation: As mentioned above, women are more likely than men to attempt suicide, but men are much more likely to succeed. Older men are the highest risk group. It should be noted here that depression is NOT a normal part of aging, nor should it ever be treated as such.

No matter the outward symptoms of depression, men will likely downplay and minimize them, avoiding looking directly at the ways in which they and those around them are affected by their illness. Simply put, men are much less likely than women to openly discuss difficult feelings, especially sadness, because expressing or admitting to emotions other than humor, anger, and passion can be thought of as unmanly. Even men who may suspect or know that they are suffering from depression will sometimes avoid diagnosis and treatment, worried that the stigma of depression might label them as weak and potentially damage their relationships and career. However, ignoring, suppressing, and covering up depression will not make it go away. In fact, it generally exacerbates the situation.

Dealing with Male Depression

Depression can be the inevitable result of a neurochemical imbalance, or it can be caused by external factors such as job loss, sexual dysfunction, divorce, addiction, physical illness, debt and other financial stress, the death or illness of a loved one, and even male menopause. The good news is that 80 percent or more of the people with depression, both male and female, can be treated successfully with psychotherapy, pharmaceuticals, or a combination thereof. But only if they are willing to seek professional assistance, which depressed men are often reluctant to do. As such, it is incumbent on healing professionals to recognize the ways in which depression manifests in men, paying special attention to the issues men are most likely to report such as sleep problems, fatigue, headaches, stomachaches, backaches, stress, and anxiety. Male patients reporting these symptoms should always be questioned further, keeping in mind the idea that their answers will likely be constrained by the “man box” that tells them they should never admit to weakness or a need for help.

In short, therapists who regularly work with adult males need to remain aware of the ways that men sometimes “atypically” express their depressive symptoms and the high likelihood that men struggling with depression often feel too ashamed or self-hating to admit it. Instead, they tend to report stress, anxiety, physical pain, problems at work, fears about finances, externalized problems, and disintegrating relationships. Some will lean into unhealthy (but nonetheless manly) coping mechanisms such as substance abuse and/or compulsive behaviors as ways to dissociate and avoid. Almost certainly these men will be irritable, angry, and even downright hostile – if not in therapy, then elsewhere. It is up to the clinician to recognize these and other signs of male depression and to then carefully peel back the layers, exposing the deeper issue and facilitating the healing process.

For more information about men and depression, I recommend Terrence Real’s I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, along with Helping Men Recover, by Dr. Stephanie Covington, Dan Griffin, and Rick Dauer.

 

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, the Times of London, and the Today Show, among many others.

 

 


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    Last reviewed: 7 Nov 2013

APA Reference
Weiss LCSW, R. (2013). Men and Depression: Not Just the Same Sad Face. Psych Central. Retrieved on April 24, 2014, from http://blogs.psychcentral.com/sex/2013/11/men-and-depression-not-just-the-same-sad-face/

 

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