Q&A: Men Need Help for Depression

Each year in the United States more than 6 million men are overwhelmed by depression, with many going untreated. Depression is diagnosed when someone feels low or hopeless for weeks at a time. Sam Cochran, Ph.D., director of the University Counseling Service at the University of Iowa and a past president of the Society for the Psychological Study of Men and Masculinity of the American Psychological Association, discusses the symptoms and special issues facing men with depression.

What is depression?

Sam Cochran: In general, depression is a common and serious mood disorder, characterized by a depressed mood, withdrawal from usual activities and low mood or sadness.

Cochran: The symptoms are actually very similar. The basic criteria of depression -- a loss of pleasure, depressed mood, and problems with sleeping and eating are really quite the same for both men and women.

But how feelings of depression are expressed can be different. Unlike women, men are often irritable, angry and have interpersonal conflicts. Depression in men can co-occur with alcohol and drug problems, too.

Men tend to act out their anger more so, even leading up to domestic violence and other kinds of abuse.

How would a man describe his symptoms?

Cochran: Men say they have difficulty functioning. They feel they aren't fulfilling society's notions of success for men by having that good job and material goods. Some men who get depressed associate their feelings with not achieving their goals or functioning as well as they should. Women tend to talk about their feelings. Men focus on how they are functioning at work. They don't talk about feeling sad. But they know something is wrong with them.

Why don't men get help?

Cochran: Typically, our culture tends to push men in the direction of denying anything is wrong. So they won't get help, and the problem goes unrecognized.

When men do get help, it's often couched in saying: "Help me, Doc. I can't function. I can't think straight. I am not getting my work done."

How many men compared with women actually get help?

Cochran: About half as many men as women get help. Men tend to get help when there are physical problems such as not sleeping, a common symptom of depression.

Are health care providers looking for this problem in men?

Cochran: Generally, there might be a trend to not regularly look for it in men and so men often remain undiagnosed. Men don't present their symptoms in the same way as women. They just say they can't function.

Physicians have the same gender lens as the rest of society. They tend to think that men don't get depressed. However, doctors are starting to recognize it more often in men.

If we do diagnose more men with depression, will crime rates and other kinds of violence decrease?

Cochran: We haven't quite connected the dots. A lot of what we see in domestic violence and other forms of abuse that cause a general wreckage in the community are probably done by men who have mood disorders. A lot can be done to help these men. It makes sense that treating more men with depression would help reduce crime rates.

How long do men usually suffer?

Cochran: Depression tends to recur, making it seem like it comes and goes. And its level of intensity does vary. Some men can limp along for years. It's not a progressive downward spiral like cancer is. Over time, the "ups" tend to be fewer and the "downs" seem to be worse.

It takes a long time to get to point where they get help. Women are much more attuned to their bodies and tend to be quicker to realize they need help.

Are men more likely to commit suicide?

Cochran: Even though suicide attempt rates are similar, men are more likely to succeed. They tend to use more lethal means such as a gun, although plenty of women use guns, too. It's tough to really know why they are more successful at it.

It could be a by-product of how we count and diagnose depression. More women who are depressed are usually caught sooner. Men are more likely to progress to a point where they feel hopeless and sad. When this level of depression is not treated, the depression exacerbates the risk of suicide.

Men are also more socialized toward violence and may resort to more violent means. Men in the movies are more likely to have guns to solve their problems.

Some people think men are just more violent by nature. I don't agree with that. It's much more an environmental factor than biological. I believe our culture is probably the most to blame.

Why is it important to focus on men?

Cochran: Depression is the common cold of mental health. It's good that we are starting to focus on this issue. Hopefully, the National Institute of Mental Health's (NIMH) campaign to raise awareness of the problem of depression in men will help more men experiencing these symptoms or encourage someone with a loved one to urge them to seek help rather than going it alone.

What should I do if I know a man with depression?

Cochran: Don't ignore it. In a gentle and friendly way, bring it up. Just say something like: "You don't seem to have energy. Are you OK? Do you feel OK? Why don't you get checked out?" If you say that you think the man is depressed, you might scare him. Remember that many people, including men, think men don't get depression.

Also, visit NIMH's Web site (listed below).

Don't hesitate to speak up. It's also important to see a medical doctor in case it's something other than depression. Problems with the thyroid can create symptoms similar to depression. Getting a medical evaluation is the best way to parse this out.

What if I am the one suffering? How do I get help?

Cochran: Definitely don't ignore it. Don't wait to get help. There are many good psychological treatments. If you need a referral, start with a family physician that you know and trust. Ask for their advice and guidance. The important thing is not to ignore it, particularly if it's causing problems in your life such as getting negative feedback from your employer, conflict in your marriage or family, you don't seem as energetic or friends seem to avoid you.

Related Articles Understanding Depression Types of Depression More Than Just the Blues Treating Depression Types of Psychotherapy

External Sources The National Institute of Mental Health - Real Men, Real Depression American Psychological Association

This article was reviewed and updated June 2007.

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