Depression in Men: How do We Fix what We Cannot Talk About?

It is recognised that there is a worldwide epidemic of depression, yet we are struggling to help men seek and receive the help they need. Male depression is at an all time high, with 30.6% of men experiencing depression at some point in their lives (APA), yet men seek help for depression at half the rate of women (Call & Shaffer, 2018). Given these facts, it is alarming that men are four times more likely to die from suicide than women.

Why the discrepancy? Our culture has shaped a reality which makes it difficult for men to recognise and accept the validity of their depression, let alone seek help for it. The perception that we have cultivated is that men should be self-reliant, strong, in control of their emotions and immune to the fragility associated with psychological difficulties. Even writing this article, I struggled to find fitting photos of men, while photos of women "looking depressed" were numerous.

Another significant reason for the delay in men seeking help for depression, is that depression looks different in men versus women. Overall, men are more like to identify and report the physical symptoms of depression. This means that depression is often overlooked in healthcare settings or misdiagnosed.

Below are some of the common symptoms experienced by men:

• Physical symptoms: digestive issues, stomach pain, headaches

• Corresponding physical anxiety symptoms like heart palpitations, dry mouth, clammy hands, sweating

• Exhaustion and disengagement from family and friends

• Increased irritability

• Short temper and anger

• Increase in risk taking behavior (ie: spending, affairs, dangerous driving)

• Difficulty sleeping and/or waking up

• Loss of interest in hobbies

• Aggression

• Increase in impulsive behavior and feelings of loss of control over behavior.

Furthermore, when they do seek help, men tend to minimze the extent of their depression and delay seeking help. Delays in seeking help, mean that people tend to seek ways to cope with their depression and negative emotions. However, since men are gendered to minimze and compartmentalize emotions, research shows that they are more likely to turn to unhealthy coping strategies such as:

• Alcohol and drugs as self medication

• Working to an extreme and excessive level

• Seeking to spend more time away from the home or changing their lifestyle

As you can imagine, family members have difficulty understanding what is going on with their loved one as they are affected by increases in anger, irritability and disengagement, as well as confusion by the increase in their partner or parent's use of work and/or substance use. Paired with the difficulty identifying and speaking about emotions that are a hallmark of depression, and relationships become collaterol damage and an exacerbating factor of depression.

What can you do to Help as a Friend or Family Member?

Try to understand the complete picture and context of where he is coming from. Anger, irritability, increased avoidance etc are all factors that lead to distance in a family. Try to step back and understand whether these negative behaviors are in fact a reflection of something deeper.

Have a non-judgmental and open conversation with your partner, friend or family member. Remember that some things may be difficult for you to hear as well, and that while there is a time to manage your own reactions, you are here in support at this time. During your conversation, it may be helpful to provide resources for therapists and most importantly, to emphasize that depression is an illness, like any other medical illness. If someone had diabetes, they would not withold from insulin as some often do from help with depression.

In addition, encouraging social connection, exercise, a healthy diet, continuing to participate in activities that use to bring him joy, spending time in the sunlight and outdoors, or joining a support group of other men experiencing depression are all significant steps to aid in depression.

Things to Keep in Mind: The Risk Factors that Lead to Depression

Overall, men are more likely to become depressed with age, particularly around the age of 40-50. In fact, white divorced men of age 85 and older have the highest rates of suicide of any demographic.

Below are the most significant risk factors to male depression:

• Physical health problems: of note, sexual dysfunction and related sense of loss of competence/emasculation

• The birth of a new child: often men are unsupported in this life transition and many feel ill equipped to manage the changes in their relationship, responsibilities and sense of identity. Post partum male depression is real and even more underecognized.

• Changes in relationship and living situation. Men who are divorced and lack social connection continue to rise in risk of depression over the course of the lifetime.

• History of physical, emotional or sexual abuse.

• Drug or alcohol abuse.

• Loss of employment

It is also important to note that depression does not solely arise from environmental factors. Genetics, biology and hormones also play a role in forming a vulnerability to depression.

If you or a loved in is experiencing depression, please reach out to me to book a session over Zoom or in person. I can be reached by WhatsApp at +60125472408 or at Cassandra@Mindwell.biz. I am a Clinical Psychologist with a Doctorate in Clinical Psychology who sees both individuals and couples in Mont Kiara, KL, Malaysia.

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