Depression and Men

About this leaflet

This leaflet is for:

• any man who feels depressed
• anyone whose husband, partner, brother, father and male friend seems depressed.

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 can affect men, and how to get help.

Why is it important?

Depression can be very unpleasant and is a major reason for people taking time off work. Many - perhaps most - men who kill themselves have been depressed – so it can even be fatal. However, depression can be helped - the sooner the better.

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 weeks, months, or becomes very bad, you may find yourself stuck and unable to lift yourself out of it. It can start to affect every area of your life - and this is when you may need to get help. Depression is not a sign of weakness - it has affected many famous and successful men.

What about bipolar disorder (manic depression)?

Some people have severe depression - but also times when they become elated and over-active. These 'high' periods can be just as harmful as the periods of depression.  This used to be called manic depression, but is now bipolar disorder.

What are the signs of depression?

If you are depressed, you will probably notice some of the following:

In your mind, you:

• feel unhappy, miserable, down, depressed. The feeling 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
• lose interest in seeing people and lose touch with friends
• 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.

In your body, you may find that you:

• can’t get to sleep
• wake early in the morning and/or throughout the night
• lose interest in sex
• can’t eat and lose weight
• 'comfort eat' more and put on weight.

Other people may notice that you:

• make mistakes at work or just can't focus 
• seem unusually quiet and withdrawn
• worry about things more than usual
• are more irritable than usual
• complain about vague physical problems
• stop looking after yourself properly - you don't shave, wash your hair, look after your clothes
• stop looking after your home properly - you stop cooking, don't tidy, forget to change the sheets on your bed.

Anxiety

Some men also feel very anxious when they become depressed. You feel on edge all the time, worried, fearful, and may find it hard to go out or to face people.  Anxiety can often also cause physical symptoms - dry mouth, sweating, shakiness, palpitations, breathlessness, stomach churning and diarrhoea.

Is depression really different for men?

Different symptoms

There doesn't seem to be a completely separate type of ‘male depression’. However, some symptoms 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.

Different ways of coping

Men are diagnosed with depression less than women, but do seem to drink and use illegal drugs more heavily than women. It may be that, instead of talking, men use drugs and alcohol as 'self-medication' to cope with their depression.

Men’s attitudes and behaviour

Attitudes

• Some men are particularly competitive and concerned with power and success. If you are like this, it may be harder to tell someone that you feel fragile or that you need help. You may feel strongly that you have to do it on your own.
• You may also worry that if you do talk to your partner - or anyone else - about how you feel, they will not be sympathetic.

These attitudes can stop you from talking to your loved ones and doctors about how you're feeling - so you don't get the help that you need.

Personality

• Shy men seem to be more likely to become depressed.
• However, depression can happen to anyone, even powerful personalities. Winston Churchill called it "his black dog".

Behaviour

• Instead of talking about how you feel, you 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.
• You may also focus more on your work than your relationships or home life. This can cause conflicts with your wife or partners.

What makes men depressed?

Relationships

Trouble in a marriage or important relationship is the single thing most likely to make you depressed.

Communication style

A difference in communication 'style' can be a problem, particularly between a man and a woman. If a disagreement or argument makes you feel uncomfortable, you may just try not to talk about it. But if your partner still wants to discuss it, they can feel ignored. When they try to get you to talk about it, you feel nagged and will tend to withdraw further which can make your partner feel even more ignored.

Separation and divorce

• Men have traditionally seen themselves as being in charge of their families’ lives. However, women are more likely to start the process of separation and divorce.
• Depression is more common and more severe in men who are divorced. This may be because, as well as losing your main relationship:
  • you often lose touch with your children
  • you may have to move to live in a different place
  • you often find yourself short of money.

Pregnancy and children

• We have known for many years that some mothers become depressed after having a baby.  We now know that more than 1 in 10 fathers also have problems at that 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 becoming a parent will change your life more than almost any other thing. Suddenly, you have to spend much more of your time looking after your partner, and possibly other children.  You may get very tired.
• A new mother will tend to be less interested in sex for a number of months. Simple tiredness is the main problem, although it's easy to 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 have to re-balance the demands of home and work - there's a lot more to do at home and you just can't spend so much time at work.
• A new father is more likely to become depressed if his partner is depressed, if he isn't getting on with his partner, or if he is unemployed.
• If you get depressed at this time, it will affect your partner..

Work, unemployment and retirement

Work

Work can be stressful. If your work makes you depressed, you won't be able to cope as well.  Which makes you feel worse and less able to cope ... which makes you feel even worse.

Unemployment

After relationship difficulties, unemployment is the thing most likely to push a man into a serious depression.  Research has shown that up to 1 in 7 men who become unemployed will develop a depressive illness in the next 6 months.

Your work may be a large part of what makes you feel good about yourself.  If you lose your job, you may lose other things that are important to you, such as a company car. It can be hard to adjust to being at home and looking after the 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 control, especially if it takes a long time to find another job. And depression itself can make it harder to get another job.

Retirement

You may even find it hard if you retire at the usual time, especially if your partner carries on working. Although life may be less stressful, you may miss the structure of your day, your social life with colleagues and the sense that you make a difference.

What other problems can depression cause?

Problems with sex

• When men are depressed, they feel less good about their bodies and less sexy.  Many go off sex completely.
• Some men who are depressed have intercourse just as often, but they don't feel as satisfied as usual.
• A few depressed men seem to have sex more often, perhaps as a way of trying to make themselves feel better.
• Some antidepressant drugs can reduce your sex-drive.

The good news is that, as the depression improves, your sexual desire, performance and satisfaction will return.

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, there are effective ways to help this.

Suicide

• Men are around 3 times more likely to kill themselves than women.
• Suicide is commonest among men who are separated, widowed or divorced.
• It is more likely if you drink heavily.

Talking helps. If you feel so bad that you have thought about suicide, it can be a relief to talk about it.

If you're worried that a man you know might be suicidal

Even if he is not very good at talking about how he is feeling, it is important to ask if you have any suspicion - and to take him 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 ask a man if he is feeling suicidal, you will not put the idea into his head or make it more likely that he will kill himself.

Helping men

• Many men find it difficult to ask for help when they are depressed. It can help to see depression as a result of chemical changes in the brain and/or as the result of living in a demanding and stressful world.  It is nothing to do with being weak or having failed.
• Men can get help more easily if people recognise their particular needs. For instance, a man who is depressed is more likely to talk about his physical symptoms than his feelings.  This may be one reason why doctors sometimes don't recognise depression in men.
• If a depressed man is in a steady relationship, his partner should usually be involved. They need to understand what is happening.

Helping yourself

• Talk to someone – if you’ve had a major upset in your life, don't bottle things up. Try to tell someone how you feel about it. If you don't feel you can talk to anyone, try writing down how you feel.
• Keep active – get out of doors and take some exercise, even if it’s only a walk during your lunch-break at work. This will help to keep you physically fit and 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 try to 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 - or to eat too much junk food and put on weight you don't want.
• Avoid alcohol and drugs – alcohol can 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. If you feel tense all the time, try exercise, yoga, massage, aromatherapy etc.
• Do something you enjoy – take some regular time to do something you really enjoy – exercise, reading, a hobby.
• Check out your lifestyle –  you may be a perfectionist who drives yourself too hard. Try to set yourself more realistic targets and reduce your workload. You may need to be kinder to yourself.
• Take a break – 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. They help you to cope and also help friends and relatives to understand what you are going through.
• Join a support group - it can be hard to help yourself when you're depressed. Talking with other men in a similar situation can help. Have a look at the list of organisations at the end of this leaflet.

How do I get help?

Depression can be as much an illness as pneumonia or breaking your leg. Don't feel embarassed or ashamed about it.  The most important thing is to ask for the help you need, when you need it.

Go to your GP

Try to find a doctor in the practice that you feel comfortable with, and who you can see regularly.

What about confidentiality?

You may be concerned about the information in your medical records.  Will it damage your chances at work if your doctor has to mention it in a report? In the UK, the Disability Discrimination Act means that it is illegal for an employer to fire you - or not hire you - just because you have a certain diagnosis.  They can only refuse you a job if your condition (whatever it is) will actually interfere with your ability to do the job.  Even if it does interfere to some extent, an employer is expected to make reasonable adjustments to ensure that you can be supported in your job.

What will my GP do?

Depending on how bad you feel, your circumstances and whether you have physical symptoms, your GP may suggest:

You may not like the idea of talking to someone or having psychotherapy. You may not like the idea of taking antidepressant medication. However, both can help depression. You may find it hard to work out what's right for you when you are feeling down. Talk it through with your friends and family, and your doctor.

You can find out more information on treatment in our main leaflet on depression.

Your GP can also give you a proper physical check-up.  This is because some physical illnesses can cause depression. If you are already having treatment for a physical illness, your GP will need to know about it.

What if I can't go to my GP?

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT for short) can be used:

• in severe depression, if the person's life is at risk and they need urgent treatment
• in moderate or severe depression, when no other treatment has helped.

ECT involves passing an electric current through the brain, so is always given in hospital under general anaesthetic. Some people have memory problems after ECT. See our leaflet on ECT for more information.

Finally, keep hopeful:

• it may be hard to believe, but you will feel better;
• some people come out of depression stronger than they were before.  You may find that you see situations and relationships more clearly than before;
• some people continue to have periods of depression but learn to live with them;
• remember that depression is common, it can be helped and you are entitled to the help you need.

Further reading

The Mind: A User’s Guide (2007). Editor R Persaud.

Reading Well Agency: Books on PrescriptionReading Well Books on Prescription helps you manage your well-being using self-help reading. The scheme is endorsed by health professionals, including the Royal College of Psychiatrists, and is supported by public libraries.

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

• National Institute for Health and Care Excellence: Clinical guideline 90 Depression in adults: full guidance. October 2009.
• National Institute for Health and Care Excellence: TA59 Electroconvulsive therapy (ECT) guidance 2010.
• 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.