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http://www.wsj.com/articles/inmendepressionisdifferent1474305429

BONDS

In Men, Depression is Different

Symptomsand helpare unlike what women experience

Menbecomedepressedmuchlessoftenthanwomendo,accordingtostatistics.Butthatmaybebecausemanymen
resisttalkingabouttheirfeelingsandavoidseekinghelp.ILLUSTRATION:STEPHENSAVAGEFORTHEWALLSTREET
JOURNAL

By

ELIZABETH BERNSTEIN
Sept. 19, 2016 1:17 p.m. ET
I am worried about a friend. Hes stopped responding reliably to texts and calls from his
friends and seems irritable and edgy when we do see him. He complains of insomnia, no
energy and lack of motivation. Ask him how hes doing and he says, Im not myself.
Im drowning.
Hes depressed. I dont know how to help him.
Statistics show that men become depressed much less often than women do. In 2014,
4.8% of men aged 18 or older in the U.S. had at least one major depressive episode in the
past year, compared with 8.2% of women in the same age group, according to the
National Survey on Drug Use and Health conducted by the Substance Abuse and Mental
Health Services Administration.
But experts worry that these figures dont tell the whole story. Men are much less likely
than women to report feeling depressed or to seek treatment for depression.
Psychiatrists and health care professionals define major depressive disorder as five or
more of the following symptoms present for two weeks: depressed mood most of the day,
irritability, decreased interest or pleasure in most activities, significant change in
weight or appetite, change in sleep, change in psychomotor activity such as either
agitation or sluggishness, fatigue or loss of energy, feelings of guilt or worthlessness,
changes in concentration and recurrent thoughts of death.

That sense of defeat is why depressed men typically withdraw and isolate.
Donald Malone, chairman of psychiatry and psychology at the Cleveland Clinic

Women often internalize depressionfocusing on the emotional symptoms, such as

worthlessness or self-blame, experts say. Men externalize it, concentrating on the
physical ones. Men typically dont get weepy or say they feel sad. They feel numb and
complain of insomnia, stress or loss of energy. Often, they become irritable and angry.
Some men arent in touch with their feelings. But the larger problem is that men have
been conditioned not to talk about them. There is that sense that they should be in
control of their emotions and that being depressed can be viewed as a sign of weakness,
says Jeffrey Borenstein, a psychiatrist and president of the Brain and Behavior Research
Foundation in New York. Men are expected to handle problems on their own, he says.
This sense of weakness can make depression worse for men, therapists say. For women,
depression is a signal for getting help, that something needs to be addressed in a
fundamental way, says Nando Pelusi, a clinical psychologist in New York. For men, its
a signal that they are a failure and are submitting to defeat.
That sense of
defeat is why
More from Bonds: On Relationships columnist Elizabeth Bernstein depressed men
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withdraw and
isolate, says
Donald Malone, a
psychiatrist and
chairman of
psychiatry and
psychology at the
Cleveland Clinic.

And this can wreak havoc on a mans relationships, as loved ones, especially spouses, can
feel hurt and rejected. Research shows that marital problems can cause depression in
both men and women. But one classic study, published in 1997 in the journal
Psychological Science, showed that while for women the marital problems often come
first, for men depression comes first and then causes the marital problems. The male
response to depression is to push away, which can lead a partner to feel helpless and
alone, says Wendy Troxel, a psychologist and senior behavioral and social scientist at
the Rand Corp., in Pittsburgh.
How can you help a man who is struggling from depression?
Normalize the situation.
Insist that this isn't his fault and he isn't alone. Look up men and depression on the
internetyou will be amazed at what you see, says Michael Addis, professor of
psychology at Clark University, in Worcester, Mass., and director of the Research Group
on Mens Well-being. Many accomplished men have suffered from depression, including
Abraham Lincoln,Winston Churchill,Buzz Aldrin and Bruce Springsteen.
If youve suffered from depression open up about your struggle. Explain that depression
is treatable and it is important to get help, just as you would with any other illness.
Speak carefully.
Dont be critical. Hes already beating himself up emotionally. And dont express worry
or concern. This suggests you dont think he can handle the situation on his own.
Be sensitive to the way his depression feels profoundly humiliating to him, says
Joshua Coleman, a psychologist and senior fellow at the Council on Contemporary
Families, a nonprofit organization based at the University of Texas at Austin that
distributes research about American families.
Therapists say the word we can be very powerful: We are in this together. We will
find a treatment that works.
Ditch the D word.
Research shows that men can be defensive about the word depression, and that those
who are the most traditionally masculine resist it the most. In a 2013 study in the

journal Psychology of Men & Masculinity, men who said they weren't depressed
admitted to having some symptoms, such as anxiety.
Did he mention he had insomnia? No energy? Encourage him to seek help for the
symptom he is describing. Seeing a primary-care physician is a good start.
Ask about suicide.
Men are about four times as likely as women to die from a suicide attempt, even though
women attempt suicide more often. They use more lethal means.
Dont be shy about asking a man if he has thoughts of hurting himself. Experts also
recommend asking if he has a gun and offering to hang on to it until he feels better. Its
like holding on to a friends car keys when hes drunk, says Rands Dr. Troxel.
Suggest a therapy that focuses on behavior changes.
Many men dont want to talk. And they believe a therapist is going to tell them what they
already believe: You are a loser.
There are several types of psychotherapy that have been shown to successfully treat
depression and that focus on changing ones behavior. These include Cognitive
Behavioral Therapy, which helps a person change his thoughts, and Behavioral
Activation, which helps him become more engaged in his day-to-day life. These may be
more comfortable to many men.
Encourage him to do what he does well.
Activities a man excels at can produce a sense of mastery and satisfaction, says Dr.
Troxel. If they are physical activities, they will produce endorphins. If they are social
activities, they will give him a boost of the feel-good hormone, oxytocin.
Men also typically gain a sense of accomplishment from getting tasks done. But
depression can make even a simple chore feel overwhelming. Dr. Troxel recommends
breaking projects into smaller pieces to make them more achievable and to foster an
immediate sense of accomplishment
Express your limits.
It is important to realize that you dont need to be on the receiving side of a depressed
mans anger or blameor be the only one showing up for the relationship. If you are
reaching your limit, say that clearly. I care about you. I am there for you. But I need you
to get help.
If your husband is depressed and you feel helpless, consider getting therapy for yourself.
Therapy can also help you understand what is happening, and how you can better help.
Dont give up.
Be persistent, even if he is pushing you away. People do get better with treatment, says
Dr. Borenstein.
Write to Elizabeth Bernstein at elizabeth.bernstein@wsj.com or follow her on
Facebook, Twitter and Instagram at EBernsteinWSJ.

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