Depression is different for men – here’s how you can help


Men typically don’t get weepy or say they feel sad. They feel numb and complain of insomnia, stress or loss of energy

ELIZABETH BERNSTEIN   The Australian  20 Sept 2016

I am worried about a friend. He’s stopped responding reliably to texts and calls from his friends and seems irritable and edgy when we do see him. He complains of insomnia, no energy and lack of motivation. Ask him how he’s doing and he says, “I’m not myself.” “I’m drowning.”

He’s depressed. I don’t know how to help him.

Statistics show that men become depressed much less often than women do. In 2014, 4.8 per cent of men aged 18 or older in the US had at least one major depressive episode in the past year, compared with 8.2 per cent of women in the same age group, according to the National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration. [In Australia, around one in eleven people reported having depression or feelings of depression in 2014-15. Females reported a higher rate than males (10.4 per cent compared with 7.4 per cent), according to the ABS.]

But experts worry that these figures don’t tell the whole story. Men are much less likely than women to report feeling depressed or to seek treatment for depression.

Psychiatrists and health care professionals define major depressive disorder as five or more of the following symptoms present for two weeks: depressed mood most of the day, irritability, decreased interest or pleasure in most activities, significant change in weight or appetite, change in sleep, change in psychomotor activity such as either agitation or sluggishness, fatigue or loss of energy, feelings of guilt or worthlessness, changes in concentration and recurrent thoughts of death.

Women often internalise depression — focusing on the emotional symptoms, such as worthlessness or self-blame, experts say.

Men externalise it, concentrating on the physical ones. Men typically don’t get weepy or say they feel sad. They feel numb and complain of insomnia, stress or loss of energy. Often, they become irritable and angry.

Some men aren’t in touch with their feelings. But the larger problem is that men have been conditioned not to talk about them. “There is that sense that they should be in control of their emotions and that being depressed can be viewed as a sign of weakness,” says Jeffrey Borenstein, a psychiatrist and president of the Brain and Behaviour Research Foundation in New York. Men are expected to handle problems on their own, he says.

This sense of weakness can make depression worse for men, therapists say. “For women, depression is a signal for getting help, that something needs to be addressed in a fundamental way,” says Nando Pelusi, a clinical psychologist in New York. “For men, it’s a signal that they are a failure and are submitting to defeat.”

That sense of defeat is why depressed men typically withdraw and isolate, says Donald Malone, a psychiatrist and chairman of psychiatry and psychology at the Cleveland Clinic.

And this can wreak havoc on a man’s relationships, as loved ones, especially spouses, can feel hurt and rejected. Research shows that marital problems can cause depression in both men and women. But one classic study, published in 1997 in the journal Psychological Science, showed that while for women the marital problems often come first, for men depression comes first and then causes the marital problems. “The male response to depression is to push away, which can lead a partner to feel helpless and alone,” says Wendy Troxel, a psychologist and senior behavioural and social scientist at the Rand Corp., in Pittsburgh.

How can you help a man who is struggling from depression?

Normalise the situation.

Insist that this isn’t his fault and he isn’t alone. “Look up men and depression on the internet — you will be amazed at what you see,” says Michael Addis, professor of psychology at Clark University, in Worcester, Mass., and director of the Research Group on Men’s Wellbeing. Many accomplished men have suffered from depression, including Abraham Lincoln, Winston Churchill, Buzz Aldrin and Bruce Springsteen.

If you’ve suffered from depression open up about your struggle. Explain that depression is treatable and it is important to get help, just as you would with any other illness.

Speak carefully.

Don’t be critical. He’s already beating himself up emotionally. And don’t express worry or concern. This suggests you don’t think he can handle the situation on his own.

“Be sensitive to the way his depression feels profoundly humiliating to him,” says Joshua Coleman, a psychologist and senior fellow at the Council on Contemporary Families, a non-profit organisation based at the University of Texas at Austin that distributes research about American families.

Therapists say the word “we” can be very powerful: “We are in this together.” “We will find a treatment that works.”

Ditch the “D” word.

Research shows that men can be defensive about the word depression, and that those who are the most traditionally masculine resist it the most. In a 2013 study in the journal Psychology of Men & Masculinity, men who said they weren’t depressed admitted to having some symptoms, such as anxiety.

Did he mention he had insomnia? No energy? Encourage him to seek help for the symptom he is describing. Seeing a primary-care physician is a good start.

Ask about suicide.

Men are about four times as likely as women to die from a suicide attempt, even though women attempt suicide more often. They use more lethal means.

Don’t be shy about asking a man if he has thoughts of hurting himself. Experts also recommend asking if he has a gun and offering to hang on to it until he feels better. “It’s like holding on to a friend’s car keys when he’s drunk,” says Rand’s Dr. Troxel.

Suggest a therapy that focuses on behaviour changes.

Many men don’t want to talk. And they believe a therapist is going to tell them what they already believe: “You are a loser.”

There are several types of psychotherapy that have been shown to successfully treat depression and that focus on changing one’s behaviour. These include Cognitive Behavioural Therapy, which helps a person change his thoughts, and Behavioural Activation, which helps him become more engaged in his day-to-day life. These may be more comfortable to many men.

Encourage him to do what he does well.

Activities a man excels at can produce a sense of mastery and satisfaction, says Dr. Troxel. If they are physical activities, they will produce endorphins. If they are social activities, they will give him a boost of the feel-good hormone, oxytocin.

Men also typically gain a sense of accomplishment from getting tasks done. But depression can make even a simple chore feel overwhelming. Dr. Troxel recommends breaking projects into smaller pieces to make them more achievable and to foster an immediate sense of accomplishment.

Express your limits.

It is important to realise that you don’t need to be on the receiving side of a depressed man’s anger or blame — or be the only one showing up for the relationship. If you are reaching your limit, say that clearly. “I care about you. I am there for you. But I need you to get help.”

If your husband is depressed and you feel helpless, consider getting therapy for yourself. Therapy can also help you understand what is happening, and how you can better help.

Don’t give up.

Be persistent, even if he is pushing you away. “People do get better with treatment,” says Dr. Borenstein.

The Wall Street Journal

Australian readers seeking support and information about depression can contact the Depression Helpline (from 8am to midnight) on 0800 111 757.

Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.

Original article here

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Online program to help men with depression

Australian Associated Press  September 15, 2016

With men more reluctant than women to seek help for depression or suicidal thoughts, the Black Dog Institute hopes an online program can help with specific coping strategies.

Developed for the institute’s My Compass website, which helps people improve their mental health, the Man Central program helps men identify early warning signs of depression, monitors their moods and provides tips on how to cope.

Dr Kristine Kafer, a clinical psychologist and consultant with the institute, said men’s depression tends to be hidden and isn’t always picked up by traditional screening tools.

The online program was based on research carried out in 2014 that explored common risk factors for men having suicidal behaviour and how to intervene in their downward spiral.

It also identified a “tool box” of strategies men use to cope when they feel sad and ones they use to stop the “black dog” creeping up on them.

Common coping mechanisms included taking time out, doing something they enjoy, keeping busy, exercising and spending time with a pet.

To prevent depression, men liked to eat healthily, keep busy and maintain a sense of humour.

Dr Kafer said the research found ideas about masculinity and stoicism often meant many men blamed themselves and felt ashamed if they were depressed.

They were reluctant to ask someone for help, believing they should be able to cope.

Dr Kafer says what happens is that many men withdraw and sometimes take to overworking or drugs and alcohol to cope.

“It’s this kind of spiral that leads to suicidal ideation (suicidal thoughts),” she told AAP. “Once you add in a stressful life event it all compounds.”

Dr Kafer said the Man Central program aims to identify if men are in a downward spiral toward depression.

“It teaches really helpful skills about being in tune and monitoring early warning signs and what to do about that,” said Dr Kafer ahead of an address to the Australian Psychological Society’s congress in Melbourne on Thursday.

A four-week trial of the program among 215 men in 2015 found more than half learnt skills to deal with problems that might arise in the future or felt more in control of their moods.

They also reported reductions in symptoms of depression and improvements in work and social functioning after using the program.

Australian readers seeking support and information about depression can contact the Depression Helpline (from 8am to midnight) on 0800 111 757.

Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.

Original article here

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