Men and DepressionResearch and clinical evidence reveal that while both men and women usually experience many of the same standard symptoms of depression, they often differ in the way they express or show these symptoms Otherwise:

• severity, course, duration• rates of recovery and recurrence • response to treatment

Men = Women

Incidence of Depression

• Conventional wisdom = women are about twice as likely to report being depressed

• Current thought = we don’t know the true incidence of depression in men because they are much less likely than women to recognize, acknowledge, and seek help for depression

Why depression is different for men

Traditional MasculinityMen are socialized from early childhood to be:• Strong• Successful• Capable of handling problems on their own• Able to restrict their emotions and deny pain

Why depression is different for men

• Men tend to feel that they should rely only on themselves and it is somehow weak to have to depend on someone else

• Men are less likely to talk about their feelings with their loved ones, friends, or their doctors

Depression: Gender Differences

Depression: Gender Differences

Men are from Mars, Women are from VenusChapter 3: Men go to their caves and women talk

“Men go to their caves to solve problems alone. If he can’t find a solution then he does something to forget

his problems …”

When faced with stress:

Depression: Gender Differences

Men are from Mars, Women are from Venus

Chapter 3: Men go to their caves and women talk

When faced with stress:“Women seek out someone they trust and then talk

about it …”

Depression: Gender Differences

Feminine Depression direct expression of feelings

“acting in” behaviors (crying, insomnia)Masculine Depression (1) disconnection from feelings

(2) “acting out” + (3) externalized behaviors (lashing out)

There is an overlap between male and female expression of depression

Depression: Gender Differences

Disconnection from feelings = “crawling into the cave”:• Withdrawal from relationships – family/spouse/coworkers

• “I can do it myself syndrome” = “I’m not lost, I can find my own way”

• Neglect of personal physical/emotional (health) needs• “Emotional numbing” limited ability to verbally express

emotional distress

I don’t know what I’m feeling!

Depression: Gender Differences

“Acting Out” behaviors = doing something to “forget” their feelings:

• Preoccupation/obsession with work or sports• Overeating• Gambling• Alcohol/substance use or abuse• Internet addiction• Shift in interest in sex – increase or decrease• Reckless, risky behavior accidents

These behaviors have in common: mood buffers, escapes,

distractions, or self-esteem enhancers

Winston Churchill

Winston Churchill referred to his depression as his “Black Dog.” He attempted to chase away his depression with compulsive overwork and large amounts of brandy*.

* Historians have never considered Churchill to be an alcoholic

Depression: Gender Differences

Externalized behaviors (“lashing out”):• Emotional bullying• Angry/irritable/argumentative increased conflict with

others• Perceived threats to self-esteem blaming others

focused on failure as provider/protector• Some forms of violence and domestic abuse

Depression: Gender Differences

Because the depressive origins of “acting out” and “lashing out” behavior is not well understood, these behaviors are often seen as “character flaws” (being a “jerk”) rather than symptoms of depression – and solutions are often punitive and misguided.

Depression: Gender Differences

Accepting HelpPrecipitating factors or events:

Loss of a significant relationship Loss of employment or role status Coercion by a third-party – spouse, partner, employer

Summary

• Depression is more than unhappiness→ affects the entire family→ in most cases it is a chronic, relapsing illness

• Edinburgh Postnatal Depression Scale or Whooley Questions for screening

• Depression is often masked by somatic symptoms• 20 + antidepressants – they all work

→ Fluoxetine (Prozac) is probably best choice during pregnancy if definitely not breast feeding

→ Sertraline (Zoloft) is probably best choice during pregnancy if breast feeding

→ Zoloft and Paxil appear safest during breastfeeding

Summary

• Taper SSRI/SNRI to avoid discontinuation syndrome• Remission of depression is goal of treatment

→ 2-4 different drugs or combinations may be required

→ substitute if no response by 6 weeks

• Treat for 6-9 months after remission for first episode→ two (or more episodes) – treat for 2 years (or more)

• Psychotherapy has similar efficacy to drug therapy for mild/moderate depression

Summary

• Fathers are vulnerable to peripartum depression→ Fathers can be a significant resource in preventing,

treating, or buffering the consequence to children of maternal peripartum depression

→ Fathers can become depressed for the same reasons (and different reasons) that mothers become depressed

→ Men tend to significantly differ from women in the way they express depression