The Disease Men Won't Talk About

BY GAIL HULNICK

IAN MACCUTCHEON* had coped with many changes in the workplace during almost 25 years as a senior manager. So when his office went through a reorganization in 1996 and he began to feel unusually tired, he assumed it was just stress. He and his wife took a cottage vacation, and although MacCutcheon was normally an active person, playing sports and working hard, now he wanted only to sleep.

As the months passed, the fatigue continued. MacCutcheon began to feel that life had no purpose. He had no interest in anything or anybody. He could barely even summon the energy to get out of bed in the morning.

IAN MACCUTCHEON didn't recognize that he was going through his first episode of depression. His wife, Brenda, didn't think he was depressed either, because he seemed to be exhausted, not unhappy. "Women tend to associate depression with a persistent sadness," says Dr. Keith Dobson, director of clinical psychology at the University of Calgary. "But there are differences in the way men experience depression."

Depression afflicts more than 1.3 million Canadians. More women than men are diagnosed with the condition -- up to 21 percent of women and about 13 percent of men. But it is one of the most common mental illnesses suffered by men.

Researchers point out that statistics for this illness among males can be misleading. "What the numbers don't tell us is how many men are walking around with untreated depression," says Dr. Peter Bieling, assistant professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton. "It is tough enough to get men to go in for a medical checkup, never mind for mental-health concerns."

Men tend to think they can overcome the symptoms through willpower or strength of character. Many also feel that there is a stigma surrounding depression and do not want to admit they need help. "Depression is a far more private affair for men," says Bieling. "They tell fewer people and they may hold back details about episodes of depression."

"The blues are only one of the two most prevalent symptoms of depression," says Dobson. "Men are more likely to exhibit the other one -- loss of interest in usual activities or pleasure." Depressed women usually turn to other people for support and want to talk about their feelings. But men, says Bieling, "may be more impulsive, snappish, impatient. The veneer of social interaction takes energy, and men with depression are often too exhausted to maintain it."

University student Trevor Watson* suffered from severe anxiety in social situations. At 18, he moved away from home, and his negativity and unhappiness grew. His sleep was disturbed, he felt tired all the time, he lost interest in everything and he wanted to be alone. Watson concealed his feelings from his friends and family, and then he started to drink, making the problem worse. Eventually, he sought help and was prescribed antidepressants.

But Watson's symptoms did not completely clear up. Years later, while switching medications and going through a breakup with his girlfriend, he had a nervous breakdown and had to be hospitalized. When he was released, he moved back home and went into cognitive behavioural therapy. The main approach was to examine, with a psychologist's help, the relationship between how he was feeling and what he was thinking -- analyzing whether it was a realistic thought based on fact or a feeling based on imagination. He was encouraged to confront his fears and look at the results. Watson is much better now, carrying a full course load in university and taking a renewed interest in life.

WHAT CAUSES male depression? There is no simple, single answer. "Depressed and suicidal men often have a chemical imbalance in the brain, with reduced levels of serotonin, norepinephrine and dopamine, the neurotransmitters that carry signals from one nerve ending to another," says Dr. Meir Steiner, professor of psychiatry and behavioural neurosciences at McMaster University and the author of books on depression. Genetics play a major role, and so do hormones.

Just as hormones and the reproductive cycle are connected with female depression, doctors say some male depression may have a hormonal basis. According to Steiner, testosterone deficiency may bring on fatigue, lack of initiative and sexual difficulties -- effects that may contribute to male depression.

Related Links The following links are for informational and educational use only. Reader's Digest does not endorse or guarantee any infomation contained therein. Grief and Loss Resources for male depression OnHealth A case study Just Take the Pills, Guys One man's experience WebMD Signs, coping, and dealing with depression Canadian Mental Health Association Fast facts about mental health Canadian Health Network Articles on depression Depression.com Tools and information Canadian Centre for Addiction and Mental Health Understanding and treating depression Internet Mental Health Magazine articles on treatments

Brain chemistry and hormones aren't the only explanations, however. "Men may have depression because of a loss event, like retirement or the death of a loved one," says Dobson. "Certain behaviour patterns can lead to depression: the tendency to avoid people, for example. And living with a role model, like a depressed mother or father, can bring on the condition. So can negative thoughts and beliefs. Men often are disappointed about not reaching their goals and that may leave them vulnerable to depression."

Men are more likely to mix alcohol and depression. "Depressed men may drink to lighten their mood," says Dobson, "but heavy drinking can bring on or worsen their symptoms."

Young men seem to be at particular risk for depression. "It seems to be increasing among this group," says Bieling. "Maybe because their generation is more honest about mental disorders and seeks treatment, or maybe it's the pressure to succeed in today's world."

Marlene Moretti, a psychology professor at Simon Fraser University in Burnaby, B.C., says research suggests that boys are encouraged from an early age to be more independent than is healthy. "When boys go out to their peer world, they may not feel they can turn to their parents for help," Moretti says. "Parents misunderstand this as detachment, but really the boy is growing up and needs his parents' emotional support even more."

The risks of untreated depression can be profound. "Eighty percent of successful suicide attempts are carried out by people who are depressed," says Steiner. In his 1995 book, In the Jaws of the Black Dogs: a Memoir of Depression, John Bentley Mays, author and art critic for the National Post, gives an account of his lifelong battle with depression and his contemplation of suicide. "First, as always, came the desolation of spirit, the self-hatred and self-blaming. Then, abruptly [the dogs] stopped worrying my flesh and spirit, and began to weave round me the spell of their weird peace. Into that circle of peace began to come sweet thoughts of death, the real strategizing of self-destruction." Despite the seeming severity of his illness, a combination of antidepressants and psychotherapy helped Mays pierce the spell and maintain some stability over almost three decades.

Besides suicide, depression can shorten men's lives in other ways as well. A 40-year Johns Hopkins University study found that men who have suffered from depression have more than double the risk of developing heart disease.

A Swedish study showed that even after excluding suicide, depressive disorders were associated with death rates on a par with those for cancer, diabetes and heart disease. Another long-term study, published in the American Journal of Psychiatry, indicated that the bodies of depressed men seem to age at an accelerated rate.

Recognizing the Symptoms

A temporary downturn in mood in response to unhappy events is common, even appropriate. In depression, however, the duration and intensity of the mood is much greater than a passing episode of feeling down. Watch out for these symptoms: an irritable or sad mood that continues for two weeks or more, or an inability to enjoy the things that usually give pleasure.

Depression is especially likely if either of the above is accompanied by four or more of the following:

• excessive sleepiness or insomnia;
• appetite or weight changes;
• fatigue, lethargy or apathy;
• feelings of excessive or inappropriate guilt, worthlessness or hopelessness;
• forgetfulness, indecisiveness or lack of concentration;
• thoughts of, or attempts at, committing suicide.

If you want to talk to a mental-health professional, contact your doctor, your local hospital or a mental-health organization. If someone you know is talking about death or suicide, take him to a hospital emergency room immediately.

Treatments That Work

Men with depression may improve with cognitive behavioural therapy or interpersonal psychotherapy. Doctors usually prescribe antidepressants as well. Paxil, Prozac, Zoloft, Serazone, Celexa and Luvox are effective in helping the mood-adjusting neurotransmitters like serotonin that circulate within the brain.

If the depression is traced to testosterone deficiency, hormone-replacement therapy can help. But Dr. Leo Winter, professor of urology at McMaster University, warns that testosterone injections should not be considered in any other cases, because the treatment can stimulate possibly harmful side effects.

DEPRESSION is an illness, just like heart disease or diabetes. It isn't a "women's problem" and it isn't a sign of weakness. It can be treated successfully, once a man steps forward and tells someone about it. Ian MacCutcheon remembers asking his counsellor if he would ever regain the same passion and energy he'd once had. The counsellor told him he would, but that conquering depression is a gradual process. Ian is well on his way. "I feel much better than I did four years ago," he says. "At least now I'm not exhausted after cutting the grass!"

*Names have been changed to protect privacy.

PHOTO: © RICHARD LEE