Beating back the blues.

• Author: Charney, Dennis
• Position: Medicine & Health - Men and depression

When afflicted with depression, men "may become frustrated, discouraged, angry, irritable, and abusive" or "engage in irresponsible behavior.... It often takes courage to ask for help."

AS I HAVE SEEN MEN who were patients, volunteers in clinical research, and others going about their daily lives, I have learned a great deal about men and depression. In 2002, the National Institute of Mental Health began a national campaign entitled "Real Men Real Depression." This documentary series of books and television public service spots has highlighted some of the ways men first become aware of the symptoms of depression and how it often takes courage to ask for help.

Men consistently rank lower than women in their rates of consultation about anxiety and depression, in their willingness to confide their problems to others, and in acknowledging the need for help. Men sometimes delay seeking assistance until their condition reaches a crisis. Depression can be very dangerous. Although roughly twice as many women as men are diagnosed each year with the condition, men are four times more likely to commit suicide. (Twice as many women as men also are diagnosed with various anxiety difficulties, with the exception of social anxiety disorder, which afflicts both sexes equally.)

Although most people equate women with depression and expect to see sad moods and weeping, men have depression, too. They of ten experience it differently than women and often have dissimilar ways of coping. For instance, men are more likely to acknowledge fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances than sensations of sadness, worthlessness, and excessive guilt.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are afflicted, or they may, become frustrated, discouraged, angary, irritable, and abusive. Some throw themselves compulsively into their work, attempting to hide their condition from themselves, family, and friends; others may engage in irresponsible behavior--crossing a street against the light or driving recklessly.

Men turn to alcohol and drugs more often than women when they are depressed, though in some cases the depression may arise from the substance abuse rather than vice versa. Nevertheless, recreational drugs can mask depression, making it harder to recognize as a separate illness that requires treatment.

Men may fail to seek help when they...