When most of us think of depression, we think of intense sadness and tearfulness, but in men, the signs and symptoms associated with depression can be different.
While low mood, impaired sleep, decreased pleasure in activities that used to be enjoyed, low energy, appetite changes, hopelessness, decreased memory and concentration, and suicidal thoughts can be associated with depression, men may present differently. Examples of other presentations include:
Physical symptoms – Men may report more physical ailments related to the depression and stress they are experiencing. Some of the more common complaints include stomach problems, headaches, an increase in physical pain, and sexual dysfunction.
Substance use – It is not uncommon for men to use tools such as alcohol and drugs to deal with uncomfortable feelings associated with depression. This may actually be the preferred way to deal with the symptoms since drinking or drug use doesn’t require having to share what is going on with anyone.
Unfortunately, alcohol is a depressant and heavy use can worsen depression. Illicit drug use can also have negative effects on mood during either intoxication or withdrawal states.
Anger – Most men are programmed by what society says they should be. They grow up hearing that they should be tough and not show emotions, that crying is for girls, and that real men don’t talk about their feelings.
As a result, it is not uncommon for men to exhibit an increase in anger and rage to deal with the sadness they feel due to depression. This can be seen in the form of verbal abuse, increased physical aggression, or an increase in controlling behavior.
Avoidance – For most men, talking about their depression or having to answer the dreaded “what is wrong with you?” is the last thing they want to deal with. This can lead to them being distant and withdrawn from those they are closest to. They may even find other activities to engage in to try to avoid having to deal with their depression or having to deal with family and friends such as working more.
Addressing depression in men is tricky and must be approached from a variety of directions. This process should start with a good physical exam, especially in our more seasoned gentlemen. Just as menopause can affect ladies as they age, testosterone levels can affect men as they age, and low levels can have a negative effect on mood.
Other lab tests should be run as well to check for thyroid dysfunction or certain vitamin deficiencies that could be contributing to low mood. Once you have ruled or addressed any other physical concerns it is time to consider treatment strategy.
For mild depression, psychotherapy alone can be beneficial, but for those with moderate to severe depression, the combination of medication and psychotherapy is often recommended.
Actually getting our men into treatment is a whole different problem. While this is a problem in all men, Black men are not seeking services as often as White men. According to the CDC’s Racial and Ethnic Disparities in Men’s Use of Mental Health Treatments, Black and Hispanic men are less likely to seek treatment than White men with similar symptoms.
Black men have historically been reluctant to seek treatment for a variety of reasons including mistrust of the healthcare system, trouble finding psychiatrists and therapists that they can relate to, access to services and stigma to name a few. As a result, we see Black men enter treatment later when their symptoms are more severe and more difficult to get a handle on.
Ignoring our mental health problems has not been an effective strategy so far and it is time that we start to do something about it. If you are having difficulty accessing services, check out the SAMHSA treatment locator where you can find services in your area and BlackDoctor.org to the Find a Doctor section where you can find culturally competent physicians who can help you identify any treatment needs.
Dr. Nicole Washington is a board-certified psychiatrist, speaker, author and host of The C-Suite Confidant, a biweekly podcast covering topics pertinent to mental wellness for the high performer. She enjoys educating others on all things mental wellness in hopes of decreasing the stigma associated with mental health issues.
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