Online NewsLetter

Depression: His & Hers

Although depression is diagnosed
more often in women, there is
increasing awareness that men
are commonly affected but may
deny or minimize symptoms.

Research and clinical evidence reveal that while both women and men can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms.

Men are more likely to acknowledge having fatigue, irritability, loss of interest in once–pleasurable activities, and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.

Men are more likely than women to turn to alcohol or drugs when they are depressed, or they can become frustrated, discouraged, irritable, angry and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or engage in reckless, risky behavior. And even though more women attempt suicide, many more men die by suicide in the United States.

Approximately twelve percent of the patients seen by a primary care physician have major depression. Recognizing that these patients--particularly male patients--have deprpession may be difficult as other medical conditions may also be present and have similar symptoms. In addition, the rate of depression secondary to some other disorder is high.  In women, depression often coexists with eating disorders. Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, also sometimes accompany depression. Women are more prone than men to having a coexisting anxiety disorder.

Not only can depression co-occur with substance abuse, anxiety disorders or personality disorders, but it is also seen with heart disease, diabetes, stroke, cancer, HIV/AIDS, Parkinson’s disease, thyroid problems and multiple sclerosis, and may even make symptoms of the illness worse. Studies have shown that both men and women who have depression in addition to a serious medical illness tend to have more severe symptoms of both illnesses. They also have more difficulty adapting to their medical condition, and more medical costs than those who do not have coexisting depression.

Depression can be a risk factor for other illnesses, can impair the ability to participate in treatment, or can be stimulated by the stress of such illnesses. Research has shown that treating the depression along with the coexisting illness will help ease both conditions.

Depression is more common among women than among men. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women’s higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the “baby blues,” but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes. Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

Many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.

More research is needed to understand all aspects of depression in men, including how men respond to stress and feelings associated with depression, how to make men more comfortable acknowledging these feelings and getting the help they need, and how to train physicians to better recognize and treat depression in men. Family members, friends, and employee assistance professionals in the workplace also can play important roles in recognizing depressive symptoms in men and helping them get treatment.

To assure that both men and women who have depression are diagnosed and receive appropriate treatment, the U.S. Preventive Services Task Force has issued new depression screening recommendations encouraging primary care physicians to routinely screen their adult patients for depression.

In addition to feeling down or hopeless and disinterested in once pleasurable activities, the patient must say “yes” to at least four of the following additional symptoms to qualify for a major depression:
Significant weight loss or gain, or decrease or increase in appetite
Disturbances in sleep pattern
Noticeable agitation or slowness
Fatigue or loss of energy
Inappropriate feelings of worthlessness or guilt
Diminished ability to concentrate or make decisions
Recurrent thoughts of death or suicide

These symptoms must persist for at least two weeks and must be accompanied by noticeable impairment in social relationships and work functioning. A patient with minor depression would have two to four of these symptoms and would find it difficult to appear to function normally.

If depression is suspected, a thorough physical examination to rule out other causes of the depressive symptoms should be the next step. Certain medications as well as some medical conditions such as a viral infection, hypothyroidism, or low testosterone level in men can cause the same symptoms as depression. Once these are ruled out a psychological examination should follow.

Depressive illnesses, even the most severe cases, are highly treatable disorders. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that a recurrence of the depression can be prevented. The most common treatment methods are medication and psychotherapy or a combination of the two. With appropriate diagnosis and treatment, the darkness disappears, hope for the future returns, and energy and interest in life becomes stronger.

Information for this article
provided by the NIMH website

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Last modified: Tuesday, April 22, 2014

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