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5 Things This Psychiatrist Wants Men to Know About Depression

5 Things This Psychiatrist Wants Men to Know About Depression

Men die by suicide four times as often as women, so it’s crucial to get help when you need it.

Although some research suggests that rates of depression in men and women are roughly the same, experts believe that men are less likely to seek the help they need. This is concerning, especially when you consider that men commit suicide at substantially higher rates than women.

Marek Hirsch, MD, is a psychiatrist at Memorial Hospital in Jacksonville, Florida who specializes in treating men with depression and other mental health issues. He wants men to know that it’s important to seek help for mental health issues, and that there are a number of treatment options available.

Depression signs may be hard to discern
It can sometimes be difficult to pick up on the symptoms of depression in men because those signs often mimic stereotypical “guy” behaviors. Aside from classic symptoms such as low mood, sadness or anxiety, men with depression may exhibit anger, irritability or aggression or may abuse drugs or alcohol. Depression signs may also manifest physically in the form of tiredness, headaches, body aches, chest pain or increased heart rate.

Subtle signs like these can make it difficult for men to recognize in themselves that they may need help. But to understand what’s going on inside, it often helps to look outside. “It usually comes from feedback from the world around you,” says Dr. Hirsch.

For example, you may be losing assignments at work because you're always snapping at people, or not getting jobs because you can’t get out of bed. It’s also important to take heed if friends or loved ones give you direct feedback you’re not accustomed to, such as, “Why are you always so angry?” or “Maybe you should take a few nights off from drinking.”

“When you hear that kind of thing, it’s a good idea to see a specialist to get an objective viewpoint,” Hirsch says. “There's a time and a place to be angry and irritable or sad, but when the mood or the behavior is getting in your way, it’s a problem.”

Getting treatment doesn’t mean you’ll be on drugs for life
You might think that being treated for depression means getting on antidepressants, and that once you start, you’ll be taking meds for life.

It’s true that antidepressant treatment can be more efficient than psychotherapy, because the drugs often take less time to have an effect. “But I don't know one psychiatrist out there who would ever not recommend that a patient be in therapy,” Hirsch says. “It's well established that a combination of antidepressants and psychotherapy is the best treatment approach.”

If you start out by seeing a psychiatrist—a medical doctor who can write prescriptions—odds are, he’s going to recommend you enter therapy. In some practices, a psychiatrist will conduct the therapy himself; in others, he’ll work in tandem with psychologists or licensed clinical social workers who perform talk therapy.

There are also cases were a psychiatrist might decide right away that a patient doesn’t need a prescription.

“My goal is to not have people on medicine,” says Hirsch. Diet, nutrition and exercise can also support therapy, and some research suggests that exercise may also help relieve symptoms of depression. “You boost your endorphins and may get a big improvement in mood,” he notes.

Building a holistic treatment plan requires hard work and being willing to make changes to your daily routines, but the payoff can be worth the effort. Ask your mental health provider as early into treatment as possible about the full range of treatment options for depression.

Some cases call for antidepressants and others don’t
If a patient has a predisposition toward depression—perhaps owing to family history or a personal history of trauma—a stressful life event such as a job loss or a troubled marriage might push him over the edge into depression. “If they come in and I find their sleep, their appetite, their ability to do things is affected, then medication might help pull them out of this little vortex of a depressed mood or anxiety,” says Hirsch.

If, on the other hand, someone is not actually depressed but merely bothered by sources of stress, antidepressants are not likely to help. “I regularly tell patients, ‘Listen, a pill is not going to fix your marriage, it’s not going to replenish your bank account, and it’s not going to make your son talk to you,’” says Hirsch. “Those are the kinds of situations where talk therapy is the way to go.”

Antidepressants may also have side effects that warrant their being used sparingly. In addition to headache, nausea and restlessness, the sexual side effects of antidepressants have been well-documented, and Hirsch notes that they can pose real problems for many men in treatment for depression.

“If a major problem for a man is trouble in his relationship, and I'm giving him a pill and now he can't have sex,” Hirsch says, “that's not going to help anything.”

Hirsch, like other psychiatrists, aims to prescribe the minimally effective dose of medication, and he ultimately tries not have patients use medicine if they can avoid it.

Asking for help is hard...
Many men consider themselves problem solvers, so it can be hard for them to admit they have a problem and to seek help for it. “If you ask 10 people on the street, ‘Why do men not go to therapy,’ they’d all say it’s because they don't want to be seen as weak,” says Hirsch.

Even if you do know that something’s wrong, you’re not alone if you find it difficult to express your feelings. In fact, there’s a term for it. "Normative male alexithymia”—coined by the University of Akron psychologist Ronald Levant, EdD—basically means that you lack the words to describe your emotions.

“It’s not as natural for a guy to express himself as it might be for a woman,” says Hirsch. “Men don't have that vocabulary as readily available to talk about what they're feeling.”

If you feel you are at a loss for words, remember that feeling is normal, and take it as a sign to keep reaching outward for help.

…But the stakes are high
Not all men with depression are at risk for suicide, but it is important to recognize that depression—particularly when undiagnosed or untreated—is the most common condition associated with suicide, according to the American Foundation for Suicide Prevention. The Centers for Disease Control and Prevention reports that while females are more likely than males to have suicidal thoughts, males commit suicide at close to four times the rate of females and represent nearly 80 percent of all suicides. What’s more, more suicides are committed by middle-aged adults—and particularly white men—than any other age group.

“I’ve seen older men with otherwise happy lives—loving, supportive wives and families and grandkids—feeling totally incapacitated and useless once their careers are over or their bodies can’t do what they used to,” says Hirsch. “Feeling invalid and harboring stress about it leads to a lot of substance use.” And that can set one on the path toward self-harm.

Pay close attention to warnings signs of suicide, which may include:

  • Extreme mood swings or bouts of rage
  • Feelings of hopelessness or having no reason to live
  • Withdrawing socially or feeling isolated
  • Feeling like you’re a burden to others
  • Talking about wanting to die or to hurt oneself
  • Increasing use of alcohol or drugs

If you or someone you know is showing these or other signs of suicide, don’t wait for an appointment with a psychiatrist or a therapist, get help right away. Call your family doctor or the National Suicide Prevention Lifeline at 1-800-273-8255, or call 911 if you think someone—yourself included—is in immediate danger.

Medically reviewed in September 2018.

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