When depression strikes ...him

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More women suffer from this misunderstood disease--but in men it's more lethal. Here's what you can do to help save his life

Feeling depressed is a normal response to life's curveballs. When things don't go our way, it makes sense to feel down. Hey, that's life.

But the illness known as clinical depression is altogether different. It is a disease, not simply a bad mood, and it can be destructive. Like heart disease, like cancer, like any sickness--if depression is not treated promptly and effectively, it can kill.

"In some studies, up to 30% of patients with depression kill themselves," says psychiatrist Donald F. Klein, MD, in his book Understanding Depression (Oxford University Press, 1993). While clinical depression strikes women more often than men (about one woman in four will experience a depressive disorder at some point, versus about one in seven men), men's suicide rates linked to depression are three to four times higher than women... and rising.

"Men are already less likely than women to seek help for health problems, but with depression, it's even worse," says Frederick Goodwin, MD, psychiatrist and former director of the National Institute of Mental Health. "We call it the `stiff-upper-lip phenomenon.' They often put off getting help, so they end up far more sick by the time they do get some treatment. Their depression ends up being much more severe."

But if they do get treatment, their chances are excellent that their depression will be cured or greatly minimized. In the vast majority of cases, the right medications coupled with psychotherapy can work wonders.

So if you are worried about your spouse or father or brother, don't put off seeking help for him. Because in a case where a man doesn't acknowledge that there's a problem, you may have to roll up your sleeves and get involved. To do that, you'll need to recognize the disease and its symptoms. Then you'll have to seek out the right treatment. Once that's done, he's likely to be on the road to recovery.

DEPRESSION IS NOT A BAD HAIR DAY
If depression is much more than a bad mood, then what is it? And where does it come from? "While perceived failures like job loss or financial problems can trigger depression," says Dr. Klein, "there is a strong underlying biological component to the illness." For years experts debated whether depression was caused by psychological trauma or disorders of a biological origin. Now most experts believethat clinical depression is basically achemical imbalance in the brain, which may or may not be triggered by stressful life events.

What's more, many believe that most biological causes of depression can be traced to low levels of a brain neurotransmitter called serotonin, perhaps the most important mood-governing chemical messenger in the brain. The new antidepressant drugs you've heard so much about--like Prozac, Zoloft and Paxil--are specifically designed to boost serotonin levels. These drugs work by preventing the reabsorption of serotonin into the nerve cells. Since more serotonin hangs around longer, it is believed to initiate a series of physiological events that eventually lifts the depression.

Without that treatment, however, the sufferer is almost always down. "With clinical depression, the mood of a depressed person is rarely in tune with the environment," says Dr. Klein. And while some depressed people can be cheered up momentarily, what marks a clinically depressed person is that even with continued excitement or stimulus, their mood inevitably stays low. (For some reason, certain depressed people improve near the end of the day and are at their worst in the early morning.) But that's not all. There are other symptoms, just as punishing to him and to you, that betray this illness. "If several of these symptoms last over two weeks," says Dr. Klein, "or if family, employment or social life are greatly affected by them, then he clearly needs help."

He's lost his energy. Depressed people often feel as if they are always out of gas. Everything becomes an effort, and they may even complain that their bodies feel heavy or leaden. The goals that were once so easily achieved--whether tending a garden or playing golf--seem unattainable. This may be due to the fact that...

His sleep is disrupted. Don't judge him by how easily he falls asleep. Many depressed people fall asleep easily and suffer from chronic sleepiness, while others may have difficulty sleeping through the night. What they suffer from, instead, is restless sleep and early-morning awakenings. Many men are diagnosed with depression after first visiting a doctor for insomnia! In general, sleep irregularities are an important warning sign.

He's changing shape. Keep an eye on his waistline; it may tell you something. "To a depressed person, food tastes like cardboard," says Dr. Klein. This might cause him to lose weight--or gain weight. "Some depressed people, instead of not eating, may find themselves overeating, mainly on sweets."

He's got aches and pains. While men are very good at hiding depression, often their inner pain expresses itself as bodily pain. Therefore, it's important to pay attention to physical symptoms that can mask depression.

"They'll go to a doctor complaining of chest pains, or vague aches and pains--which may seem very real, but are often the result of being depressed," says Dr. Goodwin. Men don't like to go to doctors to begin with, and some find it even harder to make an appointment for something as intangible as their mental health.

All of his glasses are half empty instead of half full. An underlying symptom of depression is increased expression of pessimism. It's important to pay attention to how he interprets things that happen to him. "If he starts interpreting life situations more on the negative than positive side, even when both are plausible, then you're probably looking at depression," says Dr. Goodwin.

He's drinking more. Men suffering from depression may use alcohol as an anesthetic and a temporary distraction. Others use it as a tranquilizer to battle the insomnia. It doesn't work: Booze only makes matters worse. "The more a man drinks, the more disruptive his sleeping patterns become," says Dr. Goodwin. He's not making love anymore.

He's not making love anymore. No longer taking interest in normal pleasures like sex is a common symptom of depression, although many women mistake this sign for something else. Says Dr. Goodwin, "A woman may think her husband's having an affair." Something's broken, but it's not his marriage vows.

He can't make up his mind. When you're depressed, simply choosing between a quart of milk or a half gallon can be a monumental struggle. "Depressed patients will find that their concentration is so poor they have difficulty making even the most trivial decisions," says Dr. Klein. They may end up doing nothing all day--and may not even get out of bed.

He's not the only one with these symptoms. Studies show that people with clinical depression in their family history are far more likely to experience depression themselves than folks who don't have the disease in their background.

HELPING HIM GET HELP
The fact that depression has a biological basis can be, in a way, something of a relief for you both. "If men understand that the disease is not a sign of mental weakness but a real illness, then they will be more likely to seek help," says Dr. Goodwin. His flat outlook can be fixed. Treating it is as sensible and necessary as fixing a flat tire.

But it's not as easy, and you're likely to face quite a challenge. Approach him directly, and chances are he'll dismiss your concerns--even get defensive. "It's hard for men to admit they have problems, even to their wives," says Steve Manley, PhD, a psychologist at the Male Health Center, Dallas. Try to approach him calmly, without making him uncomfortable or upset. More important, you'll have to be persistent about pursuing treatment. A few suggestions:

Don't ask, 'Are you depressed?' That's a yes or no question, says Dr. Manley, which is too easily answered with the shake of a head. "It's better to say something like 'You don't seem to be happy lately. What's going on?' " This open-ended question is harder to dismiss, and you may get a step closer to how he's really feeling. Other ones might be: "You aren't sleeping at night--what are you thinking about when you lie awake?" "I wish you'd come to bed instead of staying up and watching television--tell me what's going on with you."

Don't press him to look for reasons for his depression. You may inadvertently give too much weight to plausible-sounding causes for his unhappiness. "Depressive illness itself can make people less capable of dealing with life's problems and may actually lead to more life stress," says Dr. Klein. Don't get into chicken-and-egg questions. Focus on the treatment.

Don't be Miss Sunshine. Instinctively, we want to cheer someone up when they're down. So maybe you'll run off a laundry list of all the things in his life he should be joyful about: a loving family, great kids, a nice house. Bad move. That It's-A-Wonderful-Life stuff can backfire. "It can make a depressed person feel even more guil-ty, out of touch, alienated, alone and inadequate because he's depressed," says Dr. Goodwin. "It's as if you're blaming him for his unhappiness."

Go together. If he's uncomfortable with seeing a doctor or psychiatrist, offer to go with him. It shows him the level of concern you feel, and that in itself can be a motivating factor. It also turns the visit into a team effort.

Put the pressure on. If he's resistant, then get tough. Make the doctor's appointment and let him know well in advance. On the day of the visit, if he refuses to go, get in the car and honk the horn until he comes out. Or call a brother or a son to do some convincing. This may sound forceful, but with depression, forcefulness has its merits. "Part of being depressed is a feeling not just of hopelessness, but also of helplessness," says Dr. Goodwin. "So when the depressed person refuses to seek help, it's really not an outright total refusal. He may reject help, but he won't fight it if you do it for him, because he's so passive."

Stick with him. "The best treatment re-quires that the spouse be an active participant," says Dr. Klein. This means monitoring his symptoms, helping the physician assess response to treatment and speaking up if the treatment isn't going well. "Sometimes the first medication used may not be effective, but another one will be," says Dr. Klein. It's up to you to provide an objective view of your partner's progress.

MANY HAPPY ENDINGS
Once a diagnosis is made, treatment for depression is effective in up to 90% of all cases. Advances in medications have made it possible to alleviate the anguish in the majority of patients within a period of months. But you have to get the right treatment. Because therapy for various mental illnesses are offered not only by psychiatrists but also by psychologists, social workers and counselors, it can become a confusing task trying to figure out where to go. To make it easier, here's a plan:

See your primary doctor first. Your primary physician knows your medical history, and he or she may even treat depression. In fact, 70% of all antidepressant drug prescriptions are written by primary-care physicians, not psychiatrists, says Dr. Goodwin. But he or she isn't foolproof. "Studies show that the family doctor misses depression in half the patients who actually have it," says psychiatrist Peter Kramer, MD, author of Listening to Prozac, (Viking, 1993). That's why your partner should see a specialist, too.

Ask your doctor for a referral to a psychiatrist and discuss treatment options. Psychiatrists are MDs who can prescribe antidepressants, the treatment that offers the fastest and most effective relief from symptoms. Psychotherapy, a type of talking and skill-building therapy, may be a good addition to the drug therapy. (Nonphysician therapists, such as psychologists and social workers, cannot prescribe medication independently, but may offer psychotherapy.) Combining the two treatments may be the best intervention, because once medication has stopped, you can still rely on the skills you learned in psychotherapy to prevent a recurrence.

A psychiatrist may have to try several antidepressants before finding one that works for a particular person. Plus, it's important to have a psychiatrist perform a psychiatric and medical evaluation before treatment. A complete evaluation, often in collaboration with another specialist, should involve a physical exam (including neurological and lab tests), a medical and psychiatric history and a mental-status exam. This is necessary to rule out any physical disorders that may cause depression-like symptoms (such as thyroid disease, anemia or viral infection). Medications taken for certain illnesses can also cause depression as a side effect.

Investigate. If your doctor isn't familiar with psychiatrists in your area, you can find a specialist on your own. You can do this by contacting a state or district branch of the American Psychi-atric Association. The branch can give you names of several psychiatrists practicing in your region. Also, you can contact a nearby university medical school that has a research or treatment clinic for depression. "Such clinics evaluate new drugs and the expertise is usually high," says Dr. Klein.

Finally, don't fear that these medications will somehow alter your husband's personality or turn him into a different person. "All these drugs do is make a depressed person lose his depressed feelings," says Dr. Klein. Nor is he necessarily going to take these drugs for the rest of his life. However, for people with recurrent illness, continued medication is often necessary. But, in the majority of cases, there is marked improvement after two months, and treatment may end in six months to a year.

FOR MORE HELP...
Depression Awareness, Recognition and Treatment (D/ART), a profession-al and public-education program sponsored by the National Institute of Mental Health. For a free brochure call 1-800-421-4211.
National Depressive and Manic Depressive Association; 1-800-826-3632. They provide free information packets on depressive disorders.
National Foundation for Depressive Illness; P.O. Box 2257, NY, NY 10116. For referrals to support groups and physicians located in your area, send a self-addressed business envelope, $1.01 postage affixed, with a $5 optional donation. For a recorded message on symptoms, call 1-800-248-4344.

PHOTO (COLOR): Illustration of a man walking through sunglasses.

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By Greg Gutfeld with Linda Rao and Therese Walsh

DEPRESSION OR MANIC DEPRESSION?
A less common form of clinical depression is called manic depressive illness. It's marked by wide mood swings. There may be periods of frenzied activity followed by periods of "down" days. During his "up" days, a manic depressive may act in a manner that is entirely opposite of what you would expect from a depressed person. "He may feel very creative, have lots of energy and get very little sleep," says Dr. Frederick Goodwin. Any sudden change in his behavior that strikes you as out of character shouldn't be dismissed. Symptoms include high-energy risk taking, expressing unrealistic beliefs in his own abilities, showing aggressive responses to frustration, or engaging in more social or sexual activity. If he suffers from several of these for over two weeks, discuss your concerns with him in a supportive way and consult his primary-care physician.

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