The Secrecy of Male Depression

Sadness isn't macho—but men do suffer from depression more frequently than we think. According to Statistics Canada, one in seven men will develop depression within six months of being unemployed. Men are three times as likely to commit suicide than women.

Silent and Depressed

Yet all too often, experts say, men fail to recognize the symptoms and get the treatment they need. "Men don't find it easy to ask for help," says Thomas Insel, MD, director of the National Institute of Mental Health (NIMH).  "That's a gene that must be on the Y chromosome."

The Depression Gender Gap

For years, a bedrock fact of modern mental health was that twice as many women as men suffer from depression. Yet it has recently come under attack from critics who, concerned about under-reporting of male depression, are raising the heretical question: Do men actually experience it as much as women do?

Harvard psychologist William Pollack, PhD, is leading the charge against the well-entrenched depression gender gap. Director of the Center for Men at McLean Hospital, Pollack argues that men's rate of depression may be nearly equal to women's. Just look at suicide rates, he says: Male suicides outnumber females four to one. That ratio "is way too high to say that men's depression numbers are so low," he notes.

Male Depression Looks Different

Pollack and others contend that male depression goes unrecognized because, unlike the female version, it often doesn't fit the textbook signs—at least in the early stages, when it's easiest to intervene. A full-bore clinical depression looks much the same in both sexes.

But in the prelude to a breakdown, "Men don't come in talking about feeling sad or depressed per se," says Sam Cochran, PhD, a psychologist at the University of Iowa and co-author of Deepening Psychotherapy With Men. "They come in complaining about problems at work or their performance on the job." Men are more apt to be irritable and angry. These emotions are not part of a classic diagnosis so many doctors miss the red flags.

"Men tend to act out" to avoid dealing with uncomfortable feelings, adds Fredric Rabinowitz, PhD, Cochran's co-author and a psychologist at the University of Redlands in California who works primarily with men. If they feel bad, they're apt to get into fights on the job or at home, withdraw from family and friends, become obsessed with work or hobbies. Most significantly, men often turn to drinking or drugs.

Hormones May Play a Role

Men may not experience those dramatic hormonal ebbs and flows that are attributed to female depression but researchers are starting to look at whether declining testosterone levels affect men's moods. Studies have found conflicting results.

Overlaps and Other Theories

Other researchers suspect that not all the same genes affect male and female depression. While there's substantial overlap, says Kenneth Kendler, MD, a psychiatrist at Virginia Commonwealth University, there also "are genes that appear to act specifically in men but not women, and in women but not men." A number of researchers are now on the hunt for those genes.

Whether or not it turns out that men suffer more than the statistics show, there's no question many men are depressed. And just like women, all the experts agree, the longer they go without getting help, the stronger the negative impact on their lives.

Luckily, treatments are largely gender-blind. Though the older tricyclic drugs, like amitriptyline and imipramine, are slightly less effective in women than men, there's no such problem with the newer antidepressants like Prozac and its ilk. Most studies show that the many types of psychotherapy available can be equally beneficial for men and women.