This leaflet is for any man who is depressed, their friends and their family. Men seem to suffer from depression just as often as women, but they are less likely to ask for help. This leaflet gives some basic facts about depression, how it affects men in particular, and how to get help.
Why is it important?
Depression causes a huge amount of suffering. It is a major reason for people taking time off work. Many people who kill themselves have been depressed – so it is potentially fatal. However, it is easy to treat, and this is best done as early as possible.
What’s the difference between just feeling miserable and being depressed?
Everyone has times in their lives when they feel down or depressed. It is usually for a good reason, does not dominate your life and does not last for a long time. However, if the depression goes on for a long time, or becomes very severe, you may find yourself stuck and unable to lift yourself out of the depression. This is what doctors call a ‘depressive illness’. Some people suffer from manic depression (also called bipolar affective disorder). They have periods of bad depression, but also times of great ‘elation’ and over activity. These can be just as harmful as the periods of depression. (See our leaflet on Manic Depression/Bipolar disorder).
What are the signs and syptoms?
If you are depressed, you will probably notice some of the following:
- feel unhappy, miserable, down, depressed. It just won’t go away and can be worse at a particular time of day, often first thing in the morning.
- can’t enjoy anything.
- can’t concentrate properly.
- feel guilty about things that have nothing to do with you.
- become pessimistic.
- start to feel hopeless, and perhaps even suicidal.
- can’t get to sleep, and wake early in the morning and/or throughout the night
- loose interest in sex
- can’t eat
- Lose weight
Other people may notice that you:
- perform less well at work.
- seem unusually quiet and unable to talk about things.
- worry about things more than usual.
- are more irritable than usual.
- complain more about vague physical problems.
- are not looking after yourself properly – you may not bother to shave, wash your hair, look after your clothes.
How is depression different for men?
There is no evidence for a completely separate type of ‘male depression’. However, there is evidence that some symptoms of depression are more common in men than in women. These include:
- sudden anger
- increased loss of control
- greater risk-taking
Men are also more likely to commit suicide.
Men seem to suffer from depression just as often as women, but are less likely to ask for help. It may also be that men try to deal with their depression by using drugs and alcohol. This might account for the fact that, although men are diagnosed as having depression less than women, they abuse drugs and alcohol rather more.
Men’s attitudes and behaviour
Compared with women, men tend to be more competitive and concerned with power and success. Most men don’t like to admit that they feel fragile or that they need help. They feel that they should rely on themselves, and that it is somehow weak to have to depend on someone else, even for a short time. So they are less likely to talk about their feelings with their friends, loved ones or their doctors. This may be why they don’t get the help they need.
This traditional view of how men should be – always tough and self-reliant – is also held by some women. Some men worry that, if they talk about their feelings of depression, their partner may reject them. Even professionals may share this view, and do not spot depression in men as often as they should.
How do men cope?
Instead of talking about how they feel, men may use alcohol or drugs to feel better. This usually makes things worse, certainly in the long run. Your work will suffer and alcohol often leads to irresponsible, unpleasant or dangerous behaviour. Men may also focus more on their work than their relationships or home life. This can cause conflicts with your wife or partner. All of these things make depression more likely.
For married men, research has shown that trouble in a marriage or long-term relationship is the single most common problem associated with depression. Men can’t cope with disagreements as well as women. Arguments actually make men feel very physically uncomfortable. They try to avoid arguments or difficult discussions. The partner will want to talk about a problem, but he will do his best to avoid it. The partner then feels ignored and tries to talk about it more, which makes the man feel he is being nagged. So, he withdraws further, which makes his partner feel even more ignored and so on … This vicious circle can destroy a relationship.
Separation and divorce
Men have traditionally seen themselves as being in control of their families’ lives. However, the process of separation and divorce is most often started by women. Of all men, those who are divorced are most likely to kill themselves, probably because depression is more common and more severe in this group. This may be because, as well as losing their main relationship:
- they often lose touch with their children
- they may have to move to live in a different place
- they often find themselves short of money.
- These are stressful events in themselves, quite apart from the stress of the break-up, and may bring on depression.
When men are depressed, they feel less good about their bodies and less sexy. Many go off sex completely. Several recent studies suggest that, in spite of this, men who are depressed have intercourse just as often, but they don’t feel as satisfied as usual. A few depressed men actually report an increase in sexual drive and intercourse, possibly as a way of trying to make themselves feel better. Another problem may be that some antidepressant drugs reduce sex-drive in a small number of men. However, the good news is that, as the depression improves, so will sexual desire, performance and satisfaction.
It’s worth remembering that it can happen the other way round. Impotence (difficulty in getting or keeping an erection) can bring about depression. Again, this is a problem for which it is usually possible to find effective help.
Pregnancy and children
We have known for many years that some mothers feel severely depressed after having a baby. It is only recently that we have realised that more than 1 in 10 fathers also suffer psychological problems during this time. This shouldn’t really be surprising. We know that major events in people’s lives, even good ones like moving house, can make you depressed. And this particular event changes your life more than any other. Suddenly, you have to spend much more of your time looking after your partner, and possibly other children, and you may be very tired.
On an intimate level, new mothers tend to be less interested in sex for a number of months. Simple tiredness is the main problem, although you may take it personally and feel that you are being rejected. You may have to adjust, perhaps for the first time, to taking second place in your partner’s affections. You may also find that you can’t spend so much time at work.
New fathers are more likely to become depressed if their partner is depressed, if they aren’t getting on with their partner, or if they are unemployed. This isn’t important just from the father’s point of view. It will affect the mother and may have an impact on how the baby grows and develops in the first few months.
Unemployment and retirement
Leaving work, for any reason, can be stressful. Recent research has shown that up to 1 in 7 men who become unemployed will develop a depressive illness in the next 6 months.
After relationship difficulties, unemployment is the thing most likely to push a man into a serious depression – work is often the main source of a man’s sense of worth and self-esteem. You may lose the signs of your success, such as the company car. You may have to adjust to being at home, looking after children, while your wife or partner becomes the bread-winner.
From a position of being in control, you may face a future over which you have little, especially if it takes a long time to find another job.
You are more likely to become depressed if you are shy, if you don’t have a close relationship or if you don’t manage to find another job. Depression itself can make it harder to get another job.
Even retiring from work at the usual age can be difficult for many men, especially if your partner continues to work. It can be hard to adjust to losing the structure of your day and your contact with colleagues.
Gay men and depression
On the whole, gay men do not suffer from depression any more than straight men. However, it seems that gay teenagers and young adults are more likely to become depressed, possibly due to the stress of ‘coming out’.
Men are around 3 times more likely to kill themselves than women. Suicide is commonest among men who are separated, widowed or divorced and is more likely if someone is a heavy drinker.
Over the last few years, men have become more likely to kill themselves, particularly those aged between 16 and 24 years and those between 39 and 54 years. We don’t yet know the reason for this.
We do know that around half the people who kill themselves will have seen their GP in the previous 4 weeks – although not necessarily to discuss their emotional state. However, fewer men than women will have seen their GP in the year before their suicide. We also know that about 2 out of 3 people who kill themselves will have talked about it to friends or family.
Asking someone if he is feeling suicidal will not put the idea into his head or make it more likely that he will kill himself. Even if someone is not very good at talking about how he is feeling, it is important to ask if you have any suspicion – and to take such ideas seriously.
For a man who feels suicidal, there is nothing more demoralising than to feel that others do not take him seriously. He will often have taken some time to pluck up the courage to tell anyone about it.
If you find yourself feeling so bad that you have thought about suicide, it can be a great relief to talk about it.
Some studies have shown that men who commit violent crimes are more likely to get depressed than men who don’t. However, we don’t know if the depression makes their violence more likely, or if it’s just the way they lead their lives.
Many men find it difficult to ask for help when they are depressed – it can feel unmanly and weak. It may be easier for men to ask for help if those who give that help take into account men’s special needs.
Men who are depressed are more likely to talk about the physical symptoms of their depression than the emotional and psychological ones. This may be one reason why doctors sometimes don’t diagnose it. If you are feeling wretched, don’t hold back – tell your GP.
It can help to see depression as a result of chemical changes in the brain and/or as the inevitable cost of living in a demanding and difficult world. It is nothing to do with being weak or unmanly and it can be helped. Both talking and medication can be important ways to help you get better.
If a depressed man is married, or in a steady relationship – straight or gay – his partner should be involved so that she/he can understand what is happening. This will make it less likely for the depression to interfere with their relationship.
Some men don’t feel comfortable talking about themselves, and so may be reluctant to consider psychotherapy. However, it is a powerful way of relieving depression and works well for many men.
Don’t bottle things up – if you’ve had a major upset in your life, try to tell someone how you feel about it.
Keep active – get out of doors and take some exercise, even if it’s only a walk. This will help to keep you physically fit and you will sleep better. It can also help you not to dwell on painful thoughts and feelings.
Eat properly – you may not feel very hungry, but you should eat a balanced diet, with lots of fruit and vegetables. It’s easy to lose weight and run low on vitamins when you are depressed.
Avoid alcohol and drugs – alcohol may make you feel better for a couple of hours, but it will make you more depressed in the long run. The same goes for street drugs, particularly amphetamines, cocaine and ecstasy.
Don’t get upset if you can’t sleep – do something restful that you enjoy, like listening to the radio or watching television. Use relaxation techniques – if you feel tense all the time, try exercise, yoga, massage, aromatherapy etc.
Do something you enjoy – set some time aside regularly each week to do something you really enjoy – exercise, reading, a hobby.
Check out your lifestyle – a lot of people who have depression are perfectionists and tend to drive themselves too hard. You may need to set yourself more realistic targets and reduce your workload.
Take a break – this may be easier said than done, but it can be really helpful to get away and out of your normal routine for a few days. Even a few hours can be helpful.
Read about depression – there are now many books and websites about depression. Not only can they help you to cope, but they may also help friends and relatives to understand what you are going through.
Remember, in the long run, depression can be helpful – some people come out of it stronger and coping better than before. You may see situations and relationships more clearly, and may now have the strength and wisdom to make important decisions and changes that you were avoiding before.
Finding more help
- The best place to start is your general practitioner, who can go over your options and discuss any worries you have about confidentiality. Many men are concerned that information held by their family doctors may need to be given in medical reports, and so may damage their chances in work. It’s important to remember that, in the UK, it is illegal for an employer to fire you – or not hire you – solely because you have a diagnosis of a certain disorder. Their only grounds for this are that your condition (whatever it is) will actually interfere with your ability to do the job. Even if it does interfere to some extent, under the Disability Discrimination Act, an employer is expected to make reasonable adjustments to ensure that someone with a recognised condition – including depression – can be supported in their job rather than dismissed.
- Depression may be due to physical illness, so you need to get a proper physical check-up. If you are already having treatment for a physical illness, your GP will need to know
- Any worries about confidentiality should be discussed with your GP.
- If you really feel that you can’t talk about it with anyone you know, try Samaritans 24 hour telephone helpline. This will allow you to discuss things anonymously.
- Depression can be as much of an illness as pneumonia or breaking your leg. You shouldn’t feel embarrassed or ashamed about it. The most important thing to remember is to ask for the help you need, when you need it.
- If you need more information, or to talk to somebody confidentially, the following lists of publications and other organisations may be helpful.
Remember – depression is common, it is treatable and you are entitled to the help you need.
Thase, F.E. Natural history and preventative treatment of recurrent mood disorders. Annual Review of Medicine (1999);
NICE Clinical guideline 23 Depression – Management of depression in primary and secondary care. December 2004 National Institute for Clinical Excellence, London
Anderson, I.M., et al. Effectiveness of antidepressants: evidence based guidelines for treating depressive disorders with antidepressants. Journal of Psychopharmacology (2000) 14 (1):3-20.
Haddad, P., Lejoyeux, M., & Young, A., Problems stopping: antidepressant discontinuation reactions. British Medical Journal (1998) 316:1105-1106.
Luoma, J., Martin, C.E., & Pearson, J.L. Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry (2002) 159:6 909-916
Moller-Leimkuhler, A.M., Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders (September 2002) Vol. 71, Issues 1-3:1-9
Winkler, D. et al. Gender differences in the psychopathology of depressed inpatients. European Archives of Psychiatry and Clinical Neurosciences (2003) 254, 209-214
Ramchandani P., Stein A., Evans J., O’Connor T.G., Paternal depression in the postnatal period and child development: a prospective population study. The Lancet (25 June 2005) Vol. 365, Issue 9478:2201-2205