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David Baxter

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Men and Depression
by Deborah Gray
Tuesday, May 29, 2007

Soon after I created my website Wing of Madness in 1995, I wrote an article about women and depression. At that time it was believed that women suffer from depression about twice as often as men do, although no one was sure why. Some hypotheses posed biological reasons, such as greater incidence of sexual assault and abuse and role in society.

I was never completely comfortable with the idea that more women than men were depressed. It didn't seem to make sense to me. For one thing, most of the famous people with depression who came to mind (for me, at least) were men. Winston Churchill, Mike Wallace, Abraham Lincoln, Robin Williams and Terry Bradshaw, to name a few. Not that famous women didn't come to mind, but I couldn't come up with that many more women than men, if I could come up with more at all.

The other thing that bothered me, as it always does, is that there was no clear reason why women would experience depression so much more than men. I admit that I like to have reasons for things; I don't want there to be unknowns when it comes to something like depression. And all the explanations for the disparity were vague at best. There were no hypotheses that had held up under examination as far as a definitive study.

And then there was the question of reporting. Some medical professionals suspected that the reason for the large gap was not that fewer men were depressed, but that they had more trouble talking to their doctors about mental or emotional problems. But since there were no studies to support this hypothesis, the idea didn't gain much of a foothold until recently.

In the last few years, attitudes have begun to change about the prevalance of depression in men with the advent of some new ideas. The mental health community is beginning to use these to challenge the long-standing beliefs about men and depression.

The most important new idea, in my mind, is that depression actually manifests itself differently in men than in women. While women tend to exhibit the classic symptoms of sadness and loss of interest in previously enjoyed activities, men tend to more frequently exhibit less classic symptoms like anger, irritability and abuse of alcohol.

Because men's depressive symptoms don't fit the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the bible for mental health professionals, it's very possible that many men who should be diagnosed with depression are not.

Along with the failure of the medical community to recognize the depression symptoms that are largely unique to men, there are some other barriers to diagnosis of depression in men:

  • Cultural expectations can compel men to mask their depression. Expressing emotions is seen as a feminine trait in the American culture.
  • Men use different language to express their depression. Men are much more likely to say that they're "stressed" or "burnt out" than they're "depressed." A man I know would insist after a weekend of binge drinking that he was just "in a funk."
  • Instead of seeking treatment, men are more likely than women to cope with their depression with alcohol and drug abuse, risk-taking behavior or workaholism. Since medical professionals and the public at large don't tend to associate the last two behaviors with depression, this is probably a factor in why depression in men is less frequently diagnosed.
  • According to the Centers for Disease Control and Prevention men are less likely than women to seek help for any medical problem.
It seems entirely plausible that instead of men suffering from depression much less frequently than women, they are in fact underdiagnosed.

And they need to be diagnosed. We're now beginning to realize that the myth that men don't suffer from depression as often as women is not only far off the mark, but it's an extremely dangerous one. According to the Centers for Disease Control and Prevention (CDC) men are four times more likely than women to die from suicide; it's the eighth leading cause of death for men in the U.S.

Unlike some, I don't believe that there should be a separate category for male depression, but I think that the current criteria should be expanded to include the symptoms that men are more likely to have.

Another thing to consider is that human personalities, male and female, exist on a continuum. Who's to say that there aren't also some women whose depression is being missed because their symptoms aren't classic?

Fortunately, medical professionals can use their own judgement and not rely exclusively on the DSM IV for diagnosis. Hopefully, more and more of them will do this till the depression criteria are updated to recognize that yes, men and women are different.
 

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men's depressive symptoms don't fit the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV

While women tend to exhibit the classic symptoms of sadness and loss of interest in previously enjoyed activities, men tend to more frequently exhibit less classic symptoms like anger, irritability and abuse of alcohol.

DSM-IV Criteria
According to the DSM-IV, a person who suffers from a major depressive disorder must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period.

This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood.

A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition.

Major depressive disorder cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder. Further, the symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

This disorder is characterized by the presence of the majority of these symptoms:

? depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
(In children and adolescents, this may be characterized as an irritable mood.)
? markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
? significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
? insomnia or hypersomnia nearly every day
? psychomotor agitation or retardation nearly every day
? fatigue or loss of energy nearly every day
? feelings of worthlessness or excessive or inappropriate guilt nearly every day
? diminished ability to think or concentrate, or indecisiveness, nearly every day
? recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
 

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