Article by:
Katie Hurley, LCSW
Everyone feels sad, irritable, or tired at times. Many people experience difficulty sleeping when they’re under stress. These are normal reactions to life stressors that typically pass within a few days.

Major depressive disorder is different. Though insomnia and fatigue are often the presenting complaints, people with depression experience depressed mood or loss of interest in normal daily activities for weeks at a time.

The 12-month prevalence of major depressive disorder is approximately 7%. Although women experience higher rates of depression (1.5-3-fold higher) beginning in early adolescence, men do experience depression.

Symptoms of Major Depressive Disorder

The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities. Other potential symptoms include:

• Significant weight loss when not dieting or weight gain and changes in appetite
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation (a clinical term for a condition that describes actions that have no purpose such as tapping fingers or toes; pacing a room, etc.) nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive guilt
• Impaired ability to think or concentrate, and/or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan

The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning.

Suicide Risk

The possibility of suicidal behavior exists at all times during a major depressive episode. The most consistent risk factor is a past history of attempts or threats, but it’s important to remember that most completed suicides are not preceded by unsuccessful suicides. Although women with depression are more likely to attempt suicide, men are more likely to die by suicide

Symptoms of depression in men

Different people experience different symptoms of depression, and symptoms for men can differ from symptoms for women. Men or more likely to feel very tired and irritable, lose interest in work, family, and/or hobbies, and have difficulty sleeping.

Men are likely to exhibit some of the following symptoms of depression:

• Feel sad or “empty”
• Feeling irritable, angry, hopeless, or anxious
• Loss of interest in work, family, or other hobbies or interests (including sex)
• Feeling very tired
• Difficulty concentrating
• Sleep disturbance (unable to sleep or sleeping too much)
• Changes in eating habits (overeating or not eating at all)
• Thoughts of suicide, suicide attempts
• Somatic complaints (aches or pains, headaches, digestive problems)
• Inability to meet daily responsibilities.

Treatment

A combination of medication and psychotherapy is effective for most people with depression. Changes in lifestyle can also help.

Lifestyle

In mild cases of depression, daily exercise improved eating habits, and a specific sleep routine can assist in alleviating some symptoms.

Psychotherapy

Psychotherapy, or “talk therapy,” is a general term that refers to treating depression by talking through your triggers and responses with a licensed mental health professional. There are different types of psychotherapy that can be effective in treating depression.

• Cognitive Behavioral Therapy (CBT): This short-term therapy works to replace negative and unproductive thought patterns with more realistic and useful ones. This treatment focuses on taking specific steps to manage and reduce symptoms.
• Interpersonal “talk” therapy: This attachment-focused therapy centers on resolving interpersonal problems and symptomatic recovery.
• Problem-solving therapy: This treatment helps people learn tools to effectively manage the negative effects of stressful life events.

Psychotherapy can help people with depression:

• Cope with a crisis
• Identify and replace negative beliefs
• Explore relationships and experiences and build positive connections
• Find adaptive ways to solve problems
• Identify issues that contribute to depression
• Set realistic goals
• Develop the ability to tolerate stress and distress.

Medication Management

Either a primary care physician or a psychiatrist can assist with medication management. Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) medications are both effective treatments for depression. Other possible medications include norepinephrine-dopamine reuptake inhibitors (NDRI), atypical antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOI).
Different people have different responses to medications. It’s important to work closely with your primary care physician or psychiatrist and report any side effects. Never stop taking antidepressant medication without consulting the prescribing doctor. Stopping treatment abruptly can produce withdrawal-like symptoms and cause a sudden worsening of depressive symptoms.

Hospitalization

Severe cases of depression can require hospitalization. Psychiatric care in a hospital setting helps patients stay safe until their mood improves, particularly in the case of suicidal thoughts or suicide attempts.

Male depression: Understanding the issues

Male depression is a serious medical condition, but many men try to ignore it or refuse treatment. Learn the signs and symptoms — and what to do.

By Mayo Clinic Staff

Do you feel irritable, isolated or withdrawn? Do you find yourself working all the time? Drinking too much? These unhealthy coping strategies may be clues that you have male depression.

Depression can affect men and women differently. When depression occurs in men, it may be masked by unhealthy coping behavior. For a number of reasons, male depression often goes undiagnosed and can have devastating consequences when it goes untreated. But male depression usually gets better with treatment.

Male depression signs and symptoms

Depression signs and symptoms can differ in men and women. Men also tend to use different coping skills — both healthy and unhealthy — than women do. It isn’t clear why men and women may experience depression differently. It likely involves a number of factors, including brain chemistry, hormones and life experiences.

Like women with depression, men with depression may:

• Feel sad, hopeless or empty
• Feel extremely tired
• Have difficulty sleeping or sleep too much
• Not get pleasure from activities usually enjoyed

Other behaviors in men that could be signs of depression — but not recognized as such — include:

• Escapist behavior, such as spending a lot of time at work or on sports
• Physical symptoms, such as headaches, digestive problems and pain
• Problems with alcohol or drug use
• Controlling, violent or abusive behavior
• Irritability or inappropriate anger
• Risky behavior, such as reckless driving

Because these behaviors could be signs of or might overlap with other mental health issues, or may be associated with medical conditions, professional help is the key to an accurate diagnosis and appropriate treatment.

Male depression often goes undiagnosed

Men with depression often aren’t diagnosed for several reasons, including:

• Failure to recognize depression. You may think that feeling sad or emotional is always the main symptom of depression. But for many men, that isn’t the primary symptom. For example, headaches, digestive problems, tiredness, irritability or long-term pain can sometimes indicate depression. So can feeling isolated and seeking distraction to avoid dealing with feelings or relationships.
• Downplaying signs and symptoms. You may not recognize how much your symptoms affect you, or you may not want to admit to yourself or to anyone else that you’re depressed. But ignoring, suppressing or masking depression with unhealthy behavior will only worsen the negative emotions.
• Reluctance to discuss depression symptoms. You may not be open to talking about your feelings with family or friends, let alone with a doctor or mental health professional. Like many men, you may have learned to emphasize self-control. You may think it’s not manly to express feelings and emotions associated with depression, and you try to suppress them.
• Resisting mental health treatment. Even if you suspect you have depression, you may avoid diagnosis or refuse treatment. You may avoid getting help because you’re worried that the stigma of depression could damage your career or cause family and friends to lose respect for you.

Male depression and suicide

Although women attempt suicide more often than men do, men are more likely to complete suicide. That’s because men:

• Use methods that are more likely to cause death, such as guns
• May act more impulsively on suicidal thoughts
• Show fewer warning signs, such as talking about suicide

If you have suicidal thoughts

If you think you may hurt yourself or attempt suicide, get help right now:

• Call 911 or your local emergency number immediately.
• Call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat on suicidepreventionlifeline.org/chat.

If you’re feeling suicidal, but you aren’t immediately thinking of hurting yourself, seek help:

• Reach out to a close friend or loved one — even though it may be hard to talk about your feelings.
• Contact a minister, spiritual leader or someone in your faith community.
• Consider joining a men’s health group that deals with depression.
• Call a suicide crisis center hotline.
• Make an appointment with your doctor, other primary care provider or mental health professional.

Get help when you need it

Asking for help can be hard for men. But without treatment, depression is unlikely to go away, and it may get worse. Untreated depression can make you and the people close to you miserable. It can cause problems in every aspect of your life, including your health, career, relationships and personal safety.

Depression, even if it’s severe, usually improves with medications or psychological counseling (psychotherapy) or both. If you or someone close to you thinks you may be depressed, talk to your doctor or a mental health professional. It’s a sign of strength to ask for advice or seek help when you need it.

Male depression and coping skills

Treatment, including psychotherapy, with a mental health professional can help you learn healthy coping skills. These may include:

• Goals. Set realistic goals and prioritize tasks.
• Support. Seek out emotional support from a partner or family or friends. Learn strategies for making social connections so that you can get involved in social activities.
• Coping. Learn ways to manage stress, such as meditation and mindfulness, and develop problem-solving skills.
• Decisions. Delay making important decisions, such as changing jobs, until your depression symptoms improve.
• Activities. Engage in activities you typically enjoy, such as ball games, fishing or a hobby.
• Health. Try to stick to a regular schedule and make healthy lifestyle choices, including healthy eating and regular physical activity, to help promote better mental health.

Many effective treatments are available for depression. So don’t try to tough out male depression on your own — the consequences could be devastating.