Men and Depression by Dr Lawrence Howells, Chartered Clinical Psychologist
When people are depressed they tend to feel down for the majority of the time. They find that things they used to enjoy are no longer as enjoyable. They may feel that they have little physical energy and little motivation to do things. People may experience difficulties sleeping, their eating patterns may change, and they may feel increasingly agitated or irritable. Depression is also commonly accompanied by a stream of negative thoughts, such as “I’m not good enough”, “What’s the point?”, or “I’m useless”. These negative thoughts are often thought of as anger turned in on the self. Another common symptom of depression is the tendency to withdraw from activities, other people, and the world in general. This may result from a lack of energy and motivation, thoughts about being useless or poor company, and because activities require more effort and are less enjoyable. Depressed people may also try to hide the depression and withdrawing from others is often an attempt at concealing.
These feelings, physical symptoms, thoughts, and behaviours tend to fit together to form vicious cycles of depression. A common cycle seen in depression is one in which low mood leads to a lack of motivation and energy, which then leads to a reduction in activity. Negative thoughts about this reduction in activity such as “I should be able to do more” or “Why am I being so pathetic?” lead in turn to lower mood and the vicious cycle continues.
Depression in Men
The main symptoms of depression, such as low mood, loss of enjoyment, negative thoughts, and increasing social withdrawal are common to both men and women. However, in depression, there are important differences between the sexes. Men are less likely than women to be diagnosed with depression. Given the symptoms of depression, men are also less likely to seek help for depression. Men are also more likely to take their own lives as a result of depression.
The reasons for these differences are thought to relate to social norms. Social norms represent the dos and don’ts of a society and are often unspoken but noticeable when broken. There are many social norms that relate to the role that men and women are expected to take in society; these are known as gender role norms.
Examples of gender role norms that relate to the ways in which men ought to behave in today’s society include the suppression of emotion (“boys don’t cry”) and the appearance of strength. Whilst many of these norms are relatively consistent over time, some do change; for example men have gradually become expected to be more involved in childcare. Different men may feel the impact of gender role norms in different ways, depending, for example, on their cultural / family background, their peer group, or their profession. Despite these variations, the evidence suggests that men, as a group, are greatly influenced by gender role norms. These influences are relevant to men’s depression in a number of ways, outlined below.
Men Concealing Depression
Gender role norms that are common across many societies of the world are those that define men as strong, as providers, and suggest that they do not openly express emotion. Given these norms, many men feel that depression is a sign of weakness and something that should be suppressed or hidden from others and even from themselves. The negative thoughts that men often experience reflect these gender role norms, for example “I’ll be ridiculed if people find out I’m depressed” or “I should be working, not sitting about feeling sorry for myself”. These gender role norms make it difficult for men to talk about depression and many men attempt to hide their depression and pretend that everything is OK. This reinforces the cycle of isolation from others seen so often in depression.
Whilst hiding depression may work for some of the time, it is difficult for anybody to hide their feelings completely. Suppressed feelings can spill out in other ways and depression in men can often be expressed as irritability, anger outbursts, greater risk taking, or aggression. Sometimes, rather than outwardly expressing these feelings, men may direct anger towards themselves and may present with an angry silence or a tendency to “beat themselves up”.
Men “Self-Medicating” and Depression
Another way in which men frequently attempt to cope with depression is to try to sort out the problems without needing to tell anybody. This is often called “self-medicating”. Alcohol is a commonly used method of trying to cope with depression. However, alcohol itself is a depressant and often becomes another part of the depressive cycle. It also often causes relational difficulties and problems at work (see below), which are also likely to worsen depressive symptoms. Illicit drug use is another way in which men may attempt to escape the feelings of depression, but again, this often worsens the situation in the longer term.
A more subtle way that many men cope with depression is by hiding at work. Working long hours may avoid conflict at home and may reduce the time available for thinking about problems. In the short term this behaviour is seen as socially acceptable and is often rewarded. However, it avoids the problem which may get worse (for example in a relationship), leading to increased stress and becoming part of the cycle of depression.
Men’s Reluctance to Seek Help
Gender role norms relating to men’s strength and resilience have a powerful impact on men’s attitudes towards seeking help. Men, in general, have negative attitudes towards seeking the help of another, be it a partner, friend, or professional. Whilst many men do eventually seek help, they often do so when the depression has become severe and they have run out of other options. When they do seek help, they often speak about depression in terms of its physical symptoms, such as difficulties sleeping or concentrating. Many men also require a great deal of support in asking for help and are often encouraged to seek professional help by their colleagues, friends or family.
Thoughts of suicide are a common phenomenon seen in depression. Suicidal thoughts often arise as a potential way out, an escape from the torment of depression. Sadly, people do sometimes kill themselves as a result of depression and men are at particularly high risk of suicide. It appears that the factors outlined above are important contributory factors to this risk.
What Triggers Depression in Men?
Difficulties in a marriage or important relationship are common triggers for depression in men. The tendency to withdraw from people and the difficulty that people, particularly men, have in talking about the way that they feel all put a strain on relationships. In addition, the physical symptoms of depression, the lack of motivation, the loss of enjoyment, and the loss of libido all have an impact on relationships. The ways in which men attempt to cope with the depression often make matters worse, for example using alcohol or drugs, or working long hours.
The ending of a significant relationship is also a particularly difficult time for men. Not only is it a difficult time in itself, but there is a reduction in the support available for men to cope with this life change. Men often lose not only the relationship with their partner, but perhaps also proximity with their children, their home, or financial security. Men often do not have close friends in whom they can confide and so this can be a particularly difficult and lonely time. It is perhaps unsurprising then, that depression is more common and more severe in men who are divorced.
The addition of a child to a relationship is another life change that may trigger depression. Many women suffer with depression following childbirth and it is also fairly common in men. This is perhaps unsurprising given the major life changes that the arrival of a child brings.
Work is an important part of life for many men, providing a sense of purpose, achievement, and self-respect, as well as providing social interaction, money, and something to do on a daily basis. Men who are unemployed, who are made redundant, or who have recently retired are losing a great many important roles in life all at once and are therefore particularly at risk of depression.
What should I do if I think I am Depressed?
As mentioned above, one of the most common and most important cycles in depression is one of social isolation. People who are depressed often have negative thoughts about their ability to interact with others, or other people’s desire to interact with them. Often there are negative thoughts about being depressed and, as a result, being different from others. These thoughts make people feel lonely and sap their energy, making it more likely they will withdraw further from others and more likely that they will continue to have such negative thoughts. In men, these cycles are further reinforced by gender role norms stressing that men should remain strong and keep their feelings to themselves.
All of these things can make it difficult to be open about your problems and to speak to somebody about how you feel. Nevertheless, this is what you need to do. Speaking to somebody about things can make you feel a little less isolated, a little less alone, and can help you think about what might be helpful for you. Who you decide to speak to will depend very much on you. You may choose to speak to a partner, close friend, relative, or spiritual leader. Alternatively, you may prefer to speak to somebody who is outside your circle of relationships, a General Practitioner or a Psychologist, for example. It is important that, whoever you choose to speak to, is somebody you feel comfortable with and somebody who can think with you about what will be helpful.
What should I do if I suspect that somebody I know is Depressed?
The cycle of isolation from others is a common cycle seen in depression. Depressed people, particularly depressed men, withdraw from others and may appear not to want to talk. However, they may communicate their feelings in other ways, for example through increased irritability, risk-taking, or alcohol intake (see above).
It is best to try to talk to men about how they are feeling in a gentle, calm, and supportive way. Whilst many men will find talking about their feelings in this way difficult, they are likely to be aware of how they are feeling and that they are struggling. It may be helpful to broach such topics by talking briefly about them and then leaving the subject for a while. Persistent requests to open up and talk about things may reinforce negative thoughts about being weak and useless. It may also be helpful to help men feel less alone in their depression by directing them to resources such as this one. Providing ongoing support to men and helping them to consider their options, and perhaps even attend initial appointments may be helpful in helping men to get the help that they need.
If you have any concerns about the welfare of anybody you know, it is best to ask them directly how they are feeling. Asking people about suicide does not put ideas into their heads or make them more likely to go through with it. It is often a relief to talk about it with somebody who cares.
What Treatments are there for Depression?
There are two main types of treatment for depression. The first is medication and the second is psychological therapy.
Medication is not generally recommended where depression levels are mild, but is recommended, in combination with psychological therapy, for moderate to severe depression. General Practitioners are often able to prescribe medication to treat the symptoms of depression, but may refer to other services when the depression is severe or where there are complications.
Psychological therapy is recommended for mild depression, and, in combination with medication, also for moderate and severe depression. Talking to somebody about feelings, however, is often a challenge. Men, in particular, are often not used to talking in this way and it is a difficult decision to take. Nevertheless, it is often an important and necessary step in helping men to overcome depression. Many psychologists are also aware of the particular difficulties faced by men with depression and these issues can be discussed. For these reasons, sometimes men find it helpful to speak to a male psychologist.
The first aim of psychological therapy is to help people better understand their difficulties. This understanding may focus on links between thoughts, feelings, and behaviours, or may focus on relationships with others, for example. It may focus primarily on the present difficulties, or it may incorporate earlier life experiences in order to understand the problems. The understanding or formulation of the difficulties is the starting point for thinking about future psychological work. In men, this formulation may incorporate the gender role norms that are so often a part of men’s depressive cycles.