Irene S. Levine, PhD
Freelance Writer



Weighed Down
When a man is depressed, taking the first step to get help may seem almost impossible

September 2, 2003

Steve Imparl, 39, a successful lawyer and businessman in Chicago, views the discussion boards at his Web site, www.male, several times a day. Sometimes he posts a comment.

The site, which Imparl created last year, gets as many as 150 hits per day, mostly from men, he said. But men aren't the only ones flocking there. Girlfriends, spouses and concerned friends visit the site because they're often the first to notice when men get depressed, he said. The "guy-friendly" site is designed to provide support and encourage open discussion about mood disorders.

Although depression is twice as common in women as it is in men, an estimated 6 million men suffer from depressive disorders each year, according to the National Institute of Mental Health - but men are far less likely than women to acknowledge the symptoms of depression or to ask for help on their own.

A landmark study on depression, recently reported in the Journal of the American Medical Association by Ronald Kessler and colleagues at the Harvard Medical School, found that the lifetime prevalence of major depression among all adults in the United States is about 16 percent.

Imparl said he was in his late 20s when things started to unravel. He was able to maintain his job as an information-technology manager but couldn't sleep well. He recalled being edgy and irritable, blowing up at the slightest provocation.

His relationship with a girlfriend began to deteriorate - it was one more responsibility that felt overwhelming at the time, he said. The woman thought he was self-absorbed. He was.

Before long, the relationship ended.

Like most men, Imparl said he was reluctant to seek medical treatment. "I had a lot of misconceptions about the medications that are used in psychiatric treatment. I thought I would lose my personality or lose my creativity. Ironically, I had lost them both already."

At the time, he was working an average of 50 hours a week and attending law school in the evenings. "Strangely enough, with all this suffering, I was still functioning at a high level," Imparl said. "Keeping busy at work became a way of self-medicating. "As things slowed down at work, I became more aware of the symptoms."

When he found himself thinking about suicide and even planning the mechanics of how to kill himself, he said, he turned to the employee-assistance program at his firm and took a difficult step: He admitted he needed help.

From the stories he reads on his site, Imparl said, he believes that, although depression typically is characterized by sadness in women, irritability is the more dominant emotion in men.

Men initially have symptoms that are different from the "classical textbook symptoms" of depression, said Dr. John Zajecka, director of treatment research at Rush-Presbyterian-St. Luke's Medical Center in Chicago. He sees men with depression in private practice and conducts clinical trials to develop improved treatments for mood disorders.

"They come in with physical complaints like back pain, headaches and general musculoskeletal problems," Zajecka said. "They are workaholics or have other addictions, such as gambling or alcohol abuse. Some have problems that are masked by relationship issues. The depression emerges when they get divorced or lose their job.

"When you start probing, you find out about the lack of sleep or loss of appetite," Zajecka said. "Then they tell you about their lack of energy, lack of interest in things they once enjoyed and the sexual apathy. But men don't come in complaining about these things up front."

Dan Mendelson, 41, who was diagnosed with depression in his early 30s, agrees. "We're not accustomed to talking about our feelings," said Mendelson, who works for a nonprofit organization in Chicago.

Clinical depression is a serious medical condition that interferes with a person's ability to function and dramatically alters an individual's body, mood and thoughts. It isn't a passing blue mood or something that someone can "snap out of" without help; it can linger for weeks, months or years, leading to feelings of emptiness and despair, broken relationships and disrupted careers.

"Men think that they can overcome their symptoms through willpower," said Lydia Lewis, president of the Depression and Bipolar Support Alliance. "But they can't - any more than a man with asthma or hypertension can overcome his symptoms through willpower." The alliance, based in Chicago, is the nation's largest patient-directed advocacy organization, representing the voices of the more than 23 million Americans who live with depression.

"More than 60 percent of those who are treated have marked improvement," said Dr. Barnett Meyers, professor of psychiatry at Weill College of Cornell University in White Plains. "When people were treated 20 years ago, the worst part of antidepressant drugs was their side effects," Meyers said. "Now most patients have minimal or no side effects."

But the sexual side effects of antidepressants are one of the most common reasons people prematurely stop treatment, Zajecka said. Researchers at Rush-Presbyterian are studying the problem.

Shame, embarrassment and stigma prevent many men from seeking help. The feelings of hopelessness that are part of the disorder can compound the problem. "Many patients may feel the stigma of seeking treatment is greater than the stigma of living with the disorder," write Drs. Thomas Insel and Dennis Charney of the National Institute of Mental Health in a commentary in the medical association journal.

"Don't be afraid to ask for help," Mendelson said. "I knew something was going on, but I didn't want to deal with it. I closed myself off from others, focusing on work and school. If I knew I had cancer, I wouldn't sit at home and think about what to do. If you aren't feeling right, see your doctor."

Untreated depression can have life-threatening consequences, Lewis warned. "There is a significantly higher risk for alcohol and substance abuse in men with depression. And each year, four times as many men commit suicide as women."

But Zajecka said he is noticing an increase in younger males, in their 20s and 30s, seeking treatment compared with what he saw a decade ago. "Men are much more willing and able to come forward and not worry so much about being ostracized."

Where to Turn

For more information about depression:

National Institute of Mental Health, www.nimh.nih .gov or menanddepression; 866-227-6464 (toll-free).

Depression and Bipolar Support Alliance, www.dbsalli or call 800-826-3632.

- Chicago Tribune


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