Most people think of depression as a woman’s problem. That is true to a point. Depression tends to affect women twice as much as men. Men are less likely to get treatment. Research shows that this lack of getting treatment can have devastating consequences for men.
Men with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his particular illness. There is no single known cause of depression. Depression is caused from a combination of genetic, biochemical, environmental and psychological factors.
Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once pleasurable activities and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.
Men are more likely than women to turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, irritable, angry and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends or engage in reckless, risky behavior. And even though more women attempt suicide, many more men die by suicide in the United States.
Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitter chemicals that brain cells use to communicate appear to be out of balance. But these images do not reveal why the depression has occurred.
Some types of depression tend to run in families, suggesting a genetic link. Depression can occur in people without family histories of depression also. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental and other factors.
In addition, trauma, loss of a loved one, a difficult relationship or any stressful situation may trigger a depressive episode. Depressive episodes may occur with or without an obvious trigger.
Persistent sad, anxious or “empty” feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness and/or helplessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early–morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
Depression often co-exists with other illnesses. These illnesses may precede the depression, cause it or be a consequence of it. The co–exists of other illnesses and depression differs for every person and situation. Both the depression and these other co–occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression. People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)–funded study, researchers found that more than 40% of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.
Alcohol and other substance abuse or dependence may also co–occur with depression. Research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.
Depression also often co–exists with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson’s disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition and more medical costs than those who do not have co–existing depression. Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.
Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.
Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood but they are unsure of the exact ways in which they work.
The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclics–named for their chemical structure–and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. Medications affect everyone differently–no one–size–fits–all approach to medication exists. Therefore, for some people, tricyclics or MAOIs may be the best choice.
If one medication does not work, patients should be open to trying another. NIMH–funded research has shown that patients who did not get well after taking a first medication increased their chances of becoming symptom–free after they switched to a different medication or added another medication to their existing one.
Sometimes stimulants, anti–anxiety medications, or other medications are used in conjunction with an antidepressant, especially if the patient has a co–existing mental or physical disorder. However, neither anti–anxiety medications nor stimulants are effective against depression when taken alone. Both should be taken only under a doctor’s close supervision.
Several types of psychotherapy or “talk therapy” can help people with depression. Some treatments are short–term (10 to 20 weeks) and other regimens are longer term, depending on the needs of the individual. Two main types of psychotherapies–cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.
There’s no sure way to prevent depression.
A few tips that may help:
Control your stress
Count on family and friends in times of crisis, to help a weather rough phase in your life
Get treatment at the first sign of a problem to help prevent depression from worsening
Stay in a long-term treatment program after treatment
Get enough sleep
Plan your day