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A distinct depression
How to break the code of silence
and get
men to open up
BY George Barr, MD
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Depression is a very common diagnosis in family
practice. While both men and women can develop the typical symptoms
associated with this disorder, men will likely experience it differently
and cope with it in their own way. The real issue, however, is that
men are less likely than women to seek help for symptoms related
to depression. Often, their spouses have tried in vain to tell them
there's a problem and that they need to get help.
Treating men with depression can become particularly
complicated as, quite frequently, many refuse to accept the diagnosis
and begin therapeutic measures. The following outlines useful strategies
to assist the family physician in how to get male patients to open
up about their feelings and encourage therapeutic compliance in
the stubborn patient.
Do
symptoms present differently in men?
Men don't necessarily demonstrate the same signs and symptoms
of depression as women do. In men, the symptoms are frequently physical
in nature — not emotional. Men don't typically feel sad when
they're depressed as many women do. Sometimes, these signs may be
misleading. In men, depression can manifest itself as headaches,
digestive disorders, chronic pain, fatigue, irritability, anger,
loss of interest in work or hobbies, and sexual dysfunction. Moreover,
because many men don't characteristically acknowledge their feelings,
this patient population is more apt to turn to alcohol or substance
abuse.
Because these symptoms aren't as "typical"
as those seen in women, it's crucial that they're not overlooked,
and that appropriate treatment is initiated. According the U.S.
Centers for Disease Control, men are four times more likely to commit
suicide.
Is
depression a different illness in men?
While the presenting complaints may be very different in
men, often, once a good symptomatic history is obtained, it will
confirm the presence of more traditionally recognized symptoms of
depression. Arguably, it is the same illness and once diagnosed,
men respond every bit as well to medication and counselling, suggesting
that it is, in fact, the same illness.
Andropause is worth considering in a man who's
over age 40; though, it's rare to find confirmatory low levels of
testosterone, either standard or bioavailable. If the predominant
symptoms hint at depression and not at weakness and loss of muscle
mass, then treat the depression first. It will likely have to be
treated anyway, even if testosterone levels are restored.
So,
how do we get men to open up?
When talking to men about the possibility of depression,
it's important to focus on the physical symptoms initially. Questions
about fatigue and sleep patterns are a good starting point. Keep
in mind that anxious patients may say they have a lot of energy,
though you can qualify this response by asking them if it's a "good
energy" (i.e. "I can get a lot of work done") vs a "driven energy"
(i.e. "I have to do this and that"). They may deny sleeping abnormally,
but ask if they feel rested when first getting up (at least after
the first few minutes).
In differentiating fatigue due to physical
causes, ask patients whether they are too tired to get off the couch,
or whether they wear themselves out halfway through an activity
and need to sit down. Depressed patients feel tired after
activity, but not during exercise and almost always talk
about being too tired to get off the couch to start any activity.
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