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What is Cognitive therapy

Depression is an illness that affects both men and women. But people working in mental health services see far fewer men with depression than women with depression. It seems likely that men suffer from depression just as often as women, but that they are less likely to ask for help. This leaflet gives some basic facts about depression in general - and how it affects men in particular.

Depression causes a huge amount of suffering. It is a major reason for people taking time off sick from their work. Many people who kill themselves have been depressed - it is a potentially fatal disorder. However, it is easily treatable and best treated as early as possible. Men need to know what it is and how to get effective help.

Everybody has times in their lives when they feel down or depressed. This is usually for a good reason and does not last for a long time or take over your life. However, if these feelings go on for a long time, or become very severe, you may find yourself stuck, utterly unable to get out of the depression. This is what doctors call a depressive illness. Some people suffer from manic depression (also called Bipolar Affective Disorder). They have periods of bad depression, but also times of great elation and overactivity. These can be just as harmful as the periods of depression.

If you are depressed, you will probably have several of these signs and symptoms:

Psychological Symptoms:

  • Unhappy, miserable or depressed. These feelings just won’t go away. These feelings will often be worse at a particular time of day, often first thing in the morning.
  • Unable to enjoy anything
  • Unable to concentrate properly
  • Guilty about things that have nothing to do with you

Physical Symptoms:

  • Unable to get to sleep, waking early and during the night
  • Uninterested in sex
  • Unable to eat
  • Losing weight

Other people may notice that:

  • You are performing less well at work
  • You seem unusually quiet, unable to talk about things
  • You’re worrying about things more than usual
  • You’re more irritable than usual
  • You’re complaining more about vague physical problems

The way that men think about themselves can be quite unhelpful. Compared with women, they tend to be far more concerned with being competitive, powerful and successful. Most men don’t like to admit that they feel fragile or vulnerable, and so are less likely to talk about their feelings with their friends, loved ones or their doctors. This may be the reason that they often don’t ask for help when they become depressed. Men tend to feel that they should rely only on themselves and that it is somehow weak to have to depend on someone else, even for a short time.

This traditional view of how men should be - always tough and self-reliant - is also held by some women. Some men find that owning up to their depression actually results in their partner rejecting them because of this. Even professionals sometimes share this view, and may not diagnose depression in men when they should.

Instead of talking about how they feel, men may try to make themselves feel better by using alcohol or drugs. This will usually make things worse in the long run. Their work will suffer and alcohol often leads to irresponsible, unpleasant or dangerous behaviour. Men also tend to give their work a higher priority than their home life, which produces conflicts with their wives or partners. All of these things have been shown to make depression more likely.

For married men, research has shown that trouble in a marriage is the most common single problem connected with depression. Men can’t cope with disagreements as well as women. Arguments actually make men feel very physically uncomfortable. So, they try to avoid arguments or difficult discussions. This often leads to the situation where a man’s partner will want to talk about a problem, but he will not and will do his best to avoid talking about it. The partner feels that they are being ignored and tries to talk about it more, which makes him feel he is being nagged. So, he withdraws even more, which makes his partner feel even more that they are being ignored . . . and so on. This vicious circle can quite easily destroy a relationship.

Men have traditionally seen themselves as being the leaders in their family lives. However, the process of separation and divorce is most often started by women. Of all men, those who are divorced are most likely to kill themselves, probably because depression is more common and more severe in this group. This may be because, as well as losing their main relationship, they often lose touch with their children, may have to move to live in a different place, and often find themselves hard-up for money. These are stressful events in themselves, quite apart from the stress of the break-up, and are likely to bring on depression.

Depressed men feel less good about their bodies and less sexy than when they’re not depressed. Many just go off sex completely. Several recent studies suggest that, in spite of this, men who are depressed have intercourse just as often, but they don’t feel as satisfied as usual. A few depressed men actually report increased sexual drive and intercourse, possibly as a way of trying to make themselves feel better. Another problem may be that some anti-depressant drugs will also reduce sex-drive in a small number of men who take them.

HOWEVER, the good news is that, as the depression improves, so will your sexual desire, performance and satisfaction.

It’s worth remembering that it can happen the other way round. Impotence (difficulty in getting or keeping an erection) can bring about depression. Again, this is a problem for which it is usually possible to find effective help.

We have known for many years that some mothers feel severely depressed after having a child. It is only recently that we have realised that more than 1 in 10 fathers also suffer psychological problems during this time. This shouldn’t really be surprising. We know that major events in people’s lives, even good ones like moving house, can bring about a period of depression. And this particular event changes your life more than any other. Suddenly, you have to spend much more of your time looking after your partner, and the children.

On an intimate level, new mothers tend to be less interested in sex for a number of months. Simple tiredness is the main problem, although you may take it personally and feel that you are being rejected. You may have to adjust, perhaps for the first time, to taking second place in your partner’s affections. You will also probably find that you have to spend less time at work. Paternity leave is still quite unusual in the UK.

New fathers are more likely to become depressed if their partner is depressed, if they aren’t getting on with their partner, or if they are unemployed. This isn’t important just from the father’s point of view. It will affect the mother and may have an important impact on how the baby grows and develops in the first few months.

Leaving work, for any reason, can be stressful. Recent work has shown that up to 1 in 7 men who become unemployed will develop a depressive illness in the next 6 months. This is much more than would be expected in employed men. In fact, after relationship difficulties, unemployment is the most likely thing to push a man into a bad depression. This isn’t surprising, as work is often the main thing that gives a man his sense of worth and self-esteem. You may lose symbols of your success, such as the company car. You may have to adjust to looking after the home and children, while your wife or partner becomes the bread-winner. From a position of being in control, you may face a future over which you have little control, especially if it takes a long time to find another job.

It is more likely to happen if you are shy, if you don’t have a close relationship or if you don’t manage to find another job. Of course, if you get depressed, you may well find it harder to get another job, which may make your depression worse.

Retiring from paid employment can be difficult for many men, especially if their partner continues to work. It may take some time to get used to losing the structure of your day and contact with workmates.

On the whole, gay men do not suffer from depression any more than straight men. However, it seems that gay teenagers and young adults are more likely to become depressed, possibly due to the stresses associated with coming out.

Men are around 3 times more likely to kill themselves than women. Suicide is commonest amongst men who are separated, widowed or divorced and is more likely if someone is a heavy drinker. Over the last few years men have become more likely to kill themselves, particularly those aged between 16 and 24 years and those between 39 and 54 years. We don’t yet know why this should be so, but it is very worrying.

We do know that 2 out of 3 people who kill themselves have seen their GP in the previous 4 weeks and nearly 1 in every 2 will have done so in the week before they kill themselves. We also know that about 2 out of 3 people who kill themselves will have talked about it to friends or family.

Asking if someone is feeling this way will not put the idea into his head or make it more likely that he will kill himself. So, although some men may not be very good at talking about how they are feeling, it is important to ask if you have any suspicion - and to take such ideas seriously. For a man who feels suicidal, there is nothing more demoralising than to feel that others do not take him seriously. He will often have taken some time to pluck up the courage to tell anybody about it. If you do find yourself feeling so bad that you have thought about suicide, it can be a great relief to tell someone.

Some studies have shown that men who commit violent crimes are more likely to get depressed than men who don’t. However, we don’t know if the depression makes their violence more likely, or if it’s just the way they lead their lives.

Many men find it difficult to ask for help when they are depressed - it can feel unmanly and weak. It may be easier for men to ask for help if those who give that help take into account men’s special needs.

Men who are depressed are more likely to talk about the physical symptoms of their depression rather than the emotional and psychological ones. This may be one reason why doctors sometimes don’t diagnose it. If you are feeling wretched, don’t hold back - tell your GP.

It can help to be reminded that depression is a result of chemical changes in the brain. It is nothing to do with being weak or unmanly, and it can easily be helped. Antidepressant tablets are often an important part of getting better - and it’s important to remember that this sort of medication is not addictive.

If a depressed man is married, or in a steady relationship, his partner should be involved so that she can understand what is happening. This will make it less likely for the depression to cause permanent problems in their relationship.

Some men don’t feel comfortable talking about themselves and so may be reluctant to consider psychotherapy. However, it is a very powerful way of relieving depression and works well for many men.

Don’t bottle things up - If you've had a major upset in your life, try to tell someone how you feel about it.

Keep Active - Get out of doors and get some exercise, even if it’s only a walk. This will help to keep you physically fit and you will sleep better. It can also help you not to dwell unhelpfully on painful thoughts and feelings.

Eat properly - you may not feel very hungry, but you should eat a balanced diet, with lots of fruit and vegetables. It’s easy to lose weight and run low on vitamins when you are depressed.

Avoid alcohol and drugs - Alcohol may make you feel better for a couple of hours, but it will make you more depressed in the long run. The same goes for street drugs, particularly amphetamines and ecstasy.

Don’t get upset if you can’t sleep - Do something restful that you enjoy, like listening to the radio or watching television.

Use relaxation techniques - If you feel tense all the time there are many ways of helping yourself to relax. These include exercises, audio-tapes, yoga, massage, aromatherapy etc.

Do something you enjoy - Set some time aside regularly each week to do something you really enjoy - exercise, reading, a hobby.

Check out your lifestyle - A lot of people who have depression are perfectionists and tend to drive themselves too hard. You may need to set yourself more realistic targets and reduce your workload.

Take a break - This may be easier said than done, but it can be really helpful to get away and out of your normal routine for a few days. Even a few hours can be helpful.

Read about depression - There are now many books about depression. They can help you to cope, but can also help friends and relatives to understand what you are going through.

Remember, in the long run, this might be helpful - It’s unpleasant to have it, but depression can be a useful experience, and some people emerge stronger and coping better than before. You may see situations and relationships more clearly and may now have the strength and wisdom to make important decisions and changes that you were avoiding before.

The best place to start is your general practitioner. He or she will be able to assess you and to discuss the options for treatment with you. It is true that many men are concerned that the information held by their family doctors may need to be given in medical reports, and so may damage their chances in work. In spite of this, your GP is the best person to approach. Depression may be due to physical illness, so it is important that you have a proper physical check-up. If you are already receiving treatment for some physical disorder, your GP will need to know because of the possible interactions between drugs. Any worries about confidentiality should be discussed with your GP.

If you really feel that you can’t talk about it with anyone you know, the Samaritans offer a 24 hour telephone service which can give you the opportunity to discuss things anonymously.

Depression can be as much of an illness as pneumonia or breaking your leg. We really shouldn’t feel embarrassed or ashamed about it. The most important thing to remember is to ask for the help you need, when you need it. If you need more information, or to talk to somebody confidentially, the following lists of publications and other organisations may be helpful.

Remember - depression is easily treatable and you are entitled to the help you need.

Pitt B. and Calman M. Down with Gloom! or How to Defeat Depression (1996) Gaskell (£5.00 including p&p)

Stillwell V. Living with a Stranger (1997) Gaskell (£5.00 including p&p)

Coping with Depression
Talking Life, PO Box 1, Wirral L47 7DD
Two cassette audio-pack with advice about depression, cognitive therapy techniques and relaxation. £8.50 for shorter version and £13.99 for two cassette version (p&p) included. (Cheques payable to ‘Talking Life’). Tel: 0151 632 0662.

Coping with Bereavement
Talking Life, PO Box 1, Wirral L47 7DD
Audio-pack giving support, comfort and practical help for people who have been bereaved. £13.99 (p&p) included. (Cheques payable to ‘Talking Life'). Tel: 0151-632 0662.

Fellowship of Depressives Anonymous: 36 Chestnut Avenue, Beverley, Humberside, East Yorkshire HU17 9QA. Tel: 01482 860 619
Support and encouragement for sufferers of depression.

Depression Alliance: 35 Westminister Bridge Road, London SE1 7JB. Tel: 020 7633 0557 Fax: 020 7633 0559
Information, help and advice for those suffering from depression and for their carers.

The Samaritans: 10 The Grove, Slough SL1 1QP  Tel: 08457 909090 in the UK or 1850 609090 in Eire (the number of your local branch can be found in the telephone directory)
The Samaritans is a registered charity based in the UK and Republic of Ireland that provides confidential emotional support to any person who is suicidal or despairing and that increases public awareness of issues around suicide and depression.

AWARE - Helping to Defeat Depression: 147 Phibsboro Road, Dublin 7, Ireland
Tel: (01) 830 8449 Fax: (01) 830 6840 Email:
Assists and supports those suffering from depression and their carers in Ireland

Saneline: 1st Floor Cityside House, 40 Adler Street, London E1 1EE
Direct line: 020 7247 6647 Mobile: 07718 735 121 Fax: 020 7375 2162 SANELINE: 0845 767 8000
SANELINE is the national out-of-hours telephone helpline for anyone affected by mental illness. It offers emotional and crisis support to people coping with mental illness, their families and friends, and information to professionals and organisations working in the mental health field. SANELINE is open from 12 noon to 2am every day of the year.

Mind: Granta House, 15-19 Broadway, London E15 4BQ
Tel: 020 8519 2122 Fax: 020 8522 1725 Email:
Mindinfoline: 8522 1728 (London) 08457 660163 (outside London area codes)

Mind Cymru: 3rd Floor, Quebec House, Castlebridge, Cowbridge Road East, Cardiff CF11 9AB Tel: 02920 395123.

Rural Minds: based at the Arthur Rank Centre, c/o National Agricultural Centre, Stoneleigh Park, Warwickshire, CV8 7LZ
Tel: 02476 414366 Fax: 02476 414369 Email:
Publishes a wide range of literature on all aspects of mental health.

The Manic Depression Fellowship: Castle Works, St. George's Road, London SE1 6ES. Tel: 020 7793 2600 Fax: 020 7793 2639 Email:
Provides support, advice and information for people with manic depression, their friends and carers.

The Pre-Retirement Association
9 Chesham Road, Guildford, Surrey GU1 3LS Tel: 01483 301170 Fax: 01483 300981
Runs courses and produces literature on the subject of retirement for employees and employers. Produces a newsletter dedicated to mid-life and retirement planning.

CALM Campaign against Living Miserably: Tel: 0800 58 58 58 Lines open 5pm - 3am
The campaign against living miserably is about fighting depression amongst young men.