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"Are You Being Chased by the "Black Dog"? Understanding, Diagnosing and Treating Male Depression

06/01/2007 - In a recent report from the Mayo Clinic, it was estimated that 6 million men are affected by depression each year. The report also indicated that Winston Churchill was depressed and referred to his own depression as the "black dog". The numbers of men that suffer from depression may be much higher due to the fact that men do not as readily seek help for depression for a variety of reasons. Men may consider "hopelessness" or "sadness" as being weak or unmanly characteristics. Since their emotional difficulties may go undiagnosed and untreated, depressed men often manifest physical symptoms such as headaches, chronic pain, muscle tension, and digestive problems; which cause the focus to be placed on these physiological symptoms and the depression is overlooked. Even in cases where the depression is diagnosed, many men consider mental health treatment as potentially damaging to their reputation, career, and respect by family and friends.

While some males share the common signs of depression with their female counterparts (sleep disturbance, feelings of sadness, guilt and worthlessness), there are some other symptoms that are more common specifically to men who are depressed:

·Anger and frustration

·Violent behavior

·Unintentional weight loss

·Risk-taking (e.g., reckless driving, extramarital sex)

·Inability to think clearly and concentrate

·Isolation from family and friends


·Abuse of alcohol and other substances

·Suicidal thoughts

·Loss of interest in work, hobbies, and other pleasurable activities

This report also indicates that while women are twice as likely to experience depression, men are four times as likely to commit suicide as a result of depression. An interesting sidelight is that women attempt suicide more often than men, but men more have a higher rate of completing suicide attempts.

Dr. Michael Lyles in his article "Men and Depression" identifies characteristics that are more common in men than in women who are depressed. Men tend to have more irritability, anger and insomnia. Men are more likely to deny their depression and act it out with aggressive behavior or alcohol abuse. In addition, Dr. Lyles identifies the risk factors that are associated with male depression: family history of depression, drug and alcohol abuse, presence of chronic illness, decreased sexual potency, work stress, and marital problems. There is new research focusing on the role of male hormones in depression. Dr. Lyles reports that men may go through "andropause" (similar to menopause in women) where they experience testosterone declines that result in a depressed mood, low self-confidence, fearfulness, irritability, low libido and impaired sexual functioning. This type of hormonal-based depression does not typically respond to treatment with standard antidepressants.

In next month's article, we will continue to examine the causes, symptoms and treatment modalities related to male depression.

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