Men have depression – and it’s more common than once thought. Nearly one in three men will suffer from a depressive episode in their lifetime. This makes depression almost as common in men as in women.1 However, more concerning is the suicide rate of men, which is three to four times higher than for women.2,3 For men, increased risk of death by suicide appears to have two major peaks in life – 40 to 50 year olds and 80+ yr olds. (https://suicideprevention.ca/understanding/suicide-and-high-risk-groups/)
Guys, it’s time to get familiar with this illness that has an impact so many of us.

What are the symptoms of depression?

Here are the most common symptoms:

  • Depressed mood for the majority of the day, most days
  • Low interest in activities
  • Weight loss (five percent of body weight in one month)
  • Changes in sleep (too much or too little)
  • Fatigue
  • Feelings of worthlessness
  • Difficulty concentrating
  • Suicidal thoughts

But depression doesn’t necessarily stop with the symptoms described above. People are unique and depression can look very different from one person to the next. To highlight the variability of illness, here are some examples of different types of depression.
– Atypical depression can have brightened mood with positive events, weight gain and increased sleep. Arms and legs can feel heavy.
– A second type of depression is depression combined with anxiety symptoms. The individual feels keyed up, restless and fearful that something awful could happen.
– A third type of depression includes such melancholic symptoms as a complete loss of pleasure in all activity; the mood is worse in the morning. The individual may experience feelings of guilt and drastic weight loss.
– Severe forms of depression may include psychotic symptoms, where an individual loses touch with reality and experiences hearing voices or feeling exceptionally paranoid.
-Persistent depressive disorder is a milder form of depression that lasts two years or longer with less impact on daily function.
Depression is complex. Unfortunately, men are less likely than women to seek help, which makes it even more complicated.

Why do men mask depression?

Stigma. Emasculation. Vulnerability. Powerlessness.
These are just a few factors that stop men from seeking help for depression.4 Social constructs of masculinity greatly impedes seeking help for physical and mental help in men. Furthermore, men may have difficulty accepting their depression which can lead to avoidance of acknowledging their feelings. Instead, men are more prone to engage in detrimental behaviours such as substance abuse, overwork, aggression and risk taking.

What causes depression?

Depression is just “all in your head”…. Just change how you think. Right?
Wrong.
Depression is medical condition caused by an imbalance of chemicals in the brain called neurotransmitters. It is also associated with changes in the structure of the brain as well as chronic inflammation in the body. The three main neurotransmitters relevant in depression are serotonin, norepinephrine and dopamine. Most commonly used antidepressant treatments work to boost these neurotransmitter levels.

Risk factors for depression

Depression is a combination of your genetics (the traits you are born with) and the environment (job, abuse, relationships and family). If depression runs in your family, you are at greater risk of developing it. Both negative and positive life events can impact mood including job loss, relationship difficulties, death, marriage and a growing family. Other illnesses, both mental and physical, increase the risk of depression. Major changes in physical health, including cardiovascular disease, stroke or a cancer diagnosis, are additional risk factors. Some medical conditions, such as thyroid disease, can mimic depression. A general medical check-up should be performed prior to starting depression treatment to rule out possible medical conditions that may have similar symptoms.

What can be done?

Despite a reluctance to seek professional help for their mental health concerns, men can initiate change simply by taking the bull by the horns by reaching out and seeking help from a doctor or therapist.
There are other positive changes that men can undertake, including:

  1. Lifestyle changes
    Sleep. Nutrition. Exercise.These are the three areas that you tackle right from the start.6 Not feeling motivated? Feeling overwhelmed? Make small changes and keep building on that. Go for a 15-minute walk at lunch three times a week and build up from there. Turn off the TV and other electronic devices 30 minutes before bedtime in order to enhance sleep. For mild to moderate depression, light therapy, exercise and Omega-3 fatty acids from supplements, seafood or certain nuts and vegetables help to improve your general mood. Cut back or stop the recreational use of substances like alcohol and cannabis.If change is queen, consistency is king.Give yourself at least one month of consistently optimizing your lifestyle and health to see if it helps boost your mood. If you need help making these changes, connect with your health care professional for additional resources to steer you in the right direction.
  2. Psychotherapy
    Talk therapy often involves face-to-face interactions with a clinician but can also be available online or through self-help books.6 Hence, having insufficient time to meet someone is not a good excuse.The most common therapy known for depression is Cognitive Behavioural Therapy (CBT). This is a structured 12-to-16 weeks of therapy that looks at both negative thought patterns and behaviours that perpetuate depression. Other forms of therapy that have been beneficial for depression include interpersonal therapy, which focuses on relationship patterns, mindfulness and dynamic therapy.
  3. Medication
    You may have heard of antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), or Cipralex (escitalopram), to name just a few. These medications all work on the serotonin imbalance in the brain. Antidepressants are usually well tolerated and should be started and monitored by your family physician or psychiatrist. Initial common side effects may include headache, nausea and mild sleep changes. These generally go away after a few weeks of starting the medication. Antidepressants can also cause sexual dysfunction resulting in delayed orgasm in men. Don’t despair if the first antidepressant doesn’t work for you. In a large cohort study, 50 percent of people needed a trial of two antidepressants before experiencing a positive response.The typical duration to stay on an antidepressant is six to 12 months. This should be reviewed with your doctor as longer treatment may be beneficial.

When should I see my doctor?

See your family physician if you are experiencing a change in mood, feel more stressed than usual, or if you are just not yourself. Depression is treatable and talking about it with your doctor is the first step.
References
1) Martin, L., Neighbors, H., Griffith, D. (2013). The experience of symptoms of depression in men vs women. JAMA Psychiatry. 70 (10): 110-1106.
2) Men and depression. 2015. 46(11): 13. Accessed September 14, 2017. URL: http://www.apa.org/monitor/2015/12/numbers.aspx
3) Navaneelan T. Suicide rates: an overview. Statistics Canada Catalogue no. 82-624-X. Accessed September 14, 2017. URL: http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11696-eng.htm
4) Cleary, A. (2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science & Medicine, 74(4), 498-505.
5) Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.
6) Lam RW, Kennedy SH, Parikh SV, MacQueen GM, Milev RV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder.