Introduction
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:
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
- loose interest in sex
- can’t eat
- loose 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. 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.
Relationships
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.
Sex
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’.
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 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.
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 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.
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 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.
Further reading
Support groups and organisations
Aware
Tel: 00 353 890 303 302
an Irish organisation that assists and supports those
suffering from depression and their families in Ireland. A helpline
is available as well as support groups, lectures, and current
research on depression.
Helpline: 0800 58 58 58 Lines open 5pm – 3am.
The campaign against living miserably is about fighting
depression amongst young men. Calls to the helpline are
free (from landlines) and confidential (see policies). A minicom
service is available on 0800 027 2982. There is also a language
line facility operational on the line from 5pm until 11pm.
Depression
AlIiance
Information, support and understanding for people who suffer
with depression and for relatives who want to help. Self help
groups, information, and awareness raising for depression
Tel: 020 7388 4449; fax: 020 7388 4477
Provides an independent and authoritative voice for male
health and tackles issues affecting the health and well-being of
boys and men in England and Wales. Organises the annual National
Men’s Health Week.
Tel: 028 9024 7027
Helpline: 028 9023 7779
Provides one-to-one counselling on a range of issues.
Mental
Health Forum
A community where members can get mutual support, and
discuss mental health policy and service development issues. This
forum serves people experiencing mental health issues, their
friends or relatives, and people working in the mental health field
(from support worker to service manager and from nurses to
psychologists and psychiatrists).
Mind info line: 0845 766 0163 (Mon- Fri, 9.15- 5.15)
Offers confidential help on mental health issues and publishes
a wide range of literature on all aspects of mental health.
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.
Runs courses and produces literature on the subject of
retirement for employees and employers. Produces a newsletter
dedicated to mid-life and retirement planning.
Derry/Londonderry Tel: 028 7128 3030; fax: 028 7128 3060;
email: as above.
Aims to address the physical, mental and emotional health of
gay and bisexual men in Northern Ireland.
References
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
http://www.nice.org.uk/page.aspx?o=235213
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
Produced by the Royal College of Psychiatrists' Public
Education Editorial Sub-Committee.
Series Editor: Dr Philip Timms
Expert: Dr David Baldwin
Last update: January 2008
© January 2008. Royal College of Psychiatrists.
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