From time to time, friends, family and women in my practice bring me their concerns about the men in their lives — partners, spouses, relatives or friends. Often they are concerned about mood and behavioral changes, which can signal depression.
What many men and women don't appreciate is that men can display symptoms of depression in different ways than women. In fact, it is often difficult for men to get diagnosed and treated for depression because of their different symptoms and a general reluctance to seek health care compared with women. Rates of depression are commonly reported to be twice as high in women than in men. But it is now becoming better understood that men are probably going undiagnosed because both they and the health care professionals they see do not recognize their symptoms as depression.
How Are Men's Symptoms Different?
People around a depressed man might be the first to notice a change in his behavior. A man who usually does not seem stressed develops a low tolerance for stress, is irritable and easily angered. A man who is otherwise not aggressive becomes more hostile. He may start to abuse alcohol or illicit drugs, or may become a workaholic or exercise excessively. If a man already abuses alcohol, research has shown that he is much more likely to develop depression.
Depressed men may show the usual symptoms of depression, including:
- Feelings of being burnt out and empty
- Constant, unexplained fatigue
- Sleep problems
- Difficulty making ordinary everyday decisions
- Decreased libido
- Depressive thoughts
Men also may exhibit symptoms rarely seen in women, including:
- Lower stress threshold
- Aggressive behavior or difficulty controlling impulses
- Irritability, restlessness, dissatisfaction
- Anxiety, especially in the morning
- Alcohol abuse or illegal drug use
- Excessive exercise or work
- Hyperactive behavior
- Eating too little or too much
- Antisocial behavior
Strategies for Getting Help
I find it hard to get the men in my life to see a doctor for basic health care, so I can imagine how much harder it would be to get them to seek psychiatric help. A first step might be for you to show the man you're concerned about the list of symptoms above. Ask him if he identifies with any of the symptoms. Talk about why you are concerned about his change in behavior and how he must be feeling.
Here are some strategies that have worked for me, as a physician, for my patients and my friends:
- Get him to see his doctor. This is particularly useful if he has something else he wants to be seen for — for example, an allergy or a joint injury. Then, give his health care professional a call and tell him or her what symptoms you are concerned about. His health care professional cannot discuss his care with you, but he or she can use your information to bring up the subject during the visit.
- If he does not have his own doctor, get him to see your health care professional. Often, in such a case, it can be easier for you to make an appointment for him to see your doctor. You can still give your doctor a call regarding your concerns as above. Don't be wary about having him see a woman, either. Many men have come to see me because of prodding from their wives, and even when they seem a little shy at first, they discover that they feel as comfortable or even more comfortable talking about their problems with a woman as with a man.
- Enlist the help of a good friend, a person at work whom he respects, or a member of the clergy. Sometimes, men will consider more carefully the concerned words of someone outside their immediate family. Not only can these people offer support, they might help convince him to seek medical attention as well.
- Seek counseling together. For couples, this can be useful to get a man to start talking about how he feels, and perhaps to see that he might be depressed and how his condition is affecting his partner and family. It also can help the couple to heal a relationship that may be under strain from his depression.
Don't be surprised if a man refuses to seek help the first few times you talk things over. Be persistent, and continue to show your concern and support. Make sure that he feels safe in confiding in you, and that he can continue to talk to you. Let him know that if he ever feels like he might hurt himself or someone else he should tell you or someone else. By offering your support in a calm, nonthreatening way, he will know who can help him find a way to seek help when he is ready.
Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.