About this leaflet
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.
It covers:
- some basic
facts about depression
- how it
affects men in particular
- 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
bipolar disorder (also called manic depression). 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.
What are the signs and
symptoms?
If you are depressed, you
will probably notice some of the following:
Mind
You:
- 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.
Body
You:
- can’t get
to sleep, and wake early in the morning and/or throughout the
night
- lose
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:
-
irritability
- sudden
anger
- increased
loss of control
- greater
risk-taking
-
aggression.
Men are also more likely to
commit suicide.
Getting help
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. 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.
Relationships
For married men, research
has shown that trouble in a marriage or long-term relationship is
the single most common problem linked to depression. Men can’t cope
with disagreements as well as women. Arguments make them 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 even 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.
As well as losing your main
relationship, you may
- lose touch with your
children
- have to move to live in a
different place
- find yourself short of
money.
These are stressful events
in themselves, quite apart from the stress of the break-up, and
they may bring on depression.
Sex
When men are depressed, they
feel less good about their bodies and less sexy. Many go off sex
completely. Several studies have shown 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.
Some antidepressants also
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 very depressed after having a baby. It is
only recently that we have come to realise that more than 1 in 10
fathers also suffer psychological problems during this time. This
shouldn’t really be surprising. 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:
- your
partner is depressed
- you aren’t
getting on with your partner
- you are
unemployed.
This isn’t
important just from the father’s point of view. It will affect the
mother and may affect how the baby grows and develops in the first
few months.
Unemployment and
retirement
Leaving work, for any
reason, can be stressful. Studies have 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
- don’t have
a close relationship
- 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
Some research shows that gay
men appear to suffer from depression more than straight men. This
could be linked to the stress of ‘coming out’, or discrimination
experienced by gay men, such physical or verbal attacks.
Suicide
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 these ideas seriously.
For a man who is 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.
Violence
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.
Helping men
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 GPs 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 they 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 may be reluctant to
consider psychotherapy (talking
treatments). However, it is a powerful way of relieving depression
and works well for many men.
Helping
yourself
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 GP 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
the 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.
Further reading
The Mind: A User’s Guide (2007). Editor R
Persaud.
Further help
Aware:
Tel: 00 353 1890 303 302
Organisation in Ireland that
assists and supports those suffering from depression and their
families. A helpline is available as well as support groups,
lectures, and current research on depression.
CALM Campaign against Living
Miserably
Helpline: 0800 58 58 58;
open Sat. to Tues. 5.00m to midnight.
Campaign about fighting
depression amongst young men.
Depression
Alliance
Depression Alliance does not
currently run a helpline but you can call for an information pack
on 0845 123 23 20; email: information@depressionalliance.org.
The Bipolar
Organisation
Provides support, advice and
information for people with bipolar disorder, their friends and
carers. email: mdf@mdf.org.uk
Men’s Health
Forum
Charity that provides an
independent and authoritative voice for male health in England and
Wales and tackles the issues and inequalities affecting the health
and well-being of men and boys.
Men to Men
An innovative group looking
to challenge society's and men's own view of the role of men.
Mental Health
Forum
A community where members
can get mutual support, and discuss mental health policy and
service development issues.
Samaritans
Helpline: 08457 909090 (UK)
or 1850 609090 (Eire); email: jo@samaritans.org
Samaritans is a registered
charity based in the UK and Republic of Ireland that provides
confidential emotional support to any person who is suicidal or
despairing.
The Life
Academy
Runs courses and produces
literature on the subject of retirement for employees and
employers.
References
Thase, F.E. Natural history
and preventative treatment of recurrent mood disorders. Annual
Review of Medicine (1999)
NICE clinical guideline 90 Depression in adults: full guidance -
interim proof copy. 28 October 2009
Bjerkeset O. Gender
differences in the association of mixed anxiety and depression with
suicide. The British Journal of Psychiatry (2008) 192: 474-475.
Branney P. and White A. Big
boys don’t cry: depression and men. Advances in Psychiatric
Treatment (2008) 14: 256-262.
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
Ryan J., Carriere I. and
Ritchie K. Late-life depression and mortality: influence of gender
and antidepressant use. The British Journal of Psychiatry (2008)
192: 12-18
Warner J et al. Rates and
predictors of mental illness in gay men, lesbians and bisexual men
and women: results from a survey based in England and Wales. The
British Journal of Psychiatry (2004) 185: 479-485.
Produced by the Royal College of Psychiatrists' Public
Education Editorial Sub-Committee.
Series Editor: Dr Philip Timms
Expert: Dr David Baldwin
Last update: February 2010
Review date: February 2012
© January 2008. Royal College of Psychiatrists.
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