Male Depression

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The most common problem associated with male menopause is depression which is closely related to impotence and problems with male sexuality. Approximately 40% of men in their 40s, 50s and 60s will experience some degree of difficulty in attaining and sustaining erections, lethargy, depression, increased irritability, and mood swings that characterize male menopause. The symptoms of depression in men are commonly not recognized for several reasons:

	The symptoms of male depression are different than the classic symptoms we think of as depression
	Men deny they have problems because they are supposed to "be strong"
	Men deny they have a problem with their sexuality and don't understand the relationship with depression
	The symptom cluster of male depression is not well known so family members, physicians, and mental health professionals fail to recognize it.

Male depression is a disease with devastating consequences. To paraphrase from Jed Diamond's book Male Menopause

	80% of all suicides in the US are men
	The male suicide rate at midlife is three times higher; for men over 65, seven times higher
	The history of depression makes the risk of suicide seventy-eight times greater (Sweden)
	20 million American will experience depression sometimes in their lifetime
	60-80% of depressed adults never get professional help
	It can take up to ten years and three health professionals to properly diagnose this disorder
	80-90% of people seeking help get relief from their symptoms

Differences between Male and Female depression:

Men are more likely to act out their inner turmoil while women are more likely to turn their feelings inward. The following chart from Jed Diamond's book, Male Menopause, illustrates these differences.

Female depression	Male depression
Blame themselves	Feel others are to blame
Feel sad, apathetic, and worthless	Feel angry, irritable, and ego inflated
Feel anxious and scared	Feel suspicious and guarded
Avoids conflicts at all costs	Creates conflicts
Always tries to be nice	Overtly or covertly hostile
Withdraws when feeling hurt	Attacks when feeling hurt
Has trouble with self respect	Demands respect from other
Feels they were born to fail	Feels the world set them up to fail
Slowed down and nervous	Restless and agitated
Chronic procrastinator	Compulsive time keeper
Sleeps too much	Sleeps too little
Trouble setting boundaries	Needs control at all costs
Feels guilty for what they do	Feels ashamed for who they are
Uncomfortable receiving praise	Frustrated if not praised enough
Finds it easy to talk about weaknesses and doubts	Terrified to talk about weaknesses and doubts
Strong fear of success	Strong fear of failure
Needs to "blend in" to feel safe	Needs to be "top dog" to feel safe
Uses food, friends, and "love" to self-medicate	Uses alcohol, TV, sports, and sex to self medicate
Believe their problems could be solved only if they could be a better (spouse, co-worker, parent, friend)	Believe their problems could be solved only if their (spouse, co-worker, parent, friend) would treat them better
Constantly wonder, "Am I loveable enough?"	Constantly wonder, "Am I being loved enough?"

What to Do About It?

Often we receive questions at our website from distressed women who wonder what is happening to their husbands or partners or co-workers and how they can help.

It is important to recognize the syndrome because most men will not see it in themselves since their most basic psychological defense is denial.

It is important to realize that most men seek help only when pressured to do so by significant people in their life.

It is important to realize than men can be helped through a variety of approaches including

	exercise
	diet
	getting in touch with their spirituality
	individual and group psychotherapy
	medications
	teaching men to recreate the social supports they have lost or never had
	teaching men to love and accept themselves for whom they are

Medications

There are a number of excellent antidepressant medications now available. No one medication is perfect and it is very important to choose and monitor therapy carefully.

There are the following classes of medications:

Amphetamines and MAO Inhibitors (Parnate and Nardil)-- these are dangerous and should be dispensed only by psychiatrists highly skilled in their use. They are rarely used today.

Tricyclic Antidepressants (TCAs)-- Elavil, imipramine, trazadone, doxepin, nortriptyline etc. These are generic and cheap but have a lot of side effects including sedation, dry mouth, urinary retention.

SSRIs (Prozac, Zoloft, Paxil, Luvox)-- the drugs of choice in the 1990s since they eliminate virtually all the side effects of the TCAs but they are not perfect. Each medication has a slightly different profile of side effects so it may be necessary to try several different preparations to get the optimal response. One of the most common side effects of Prozac and Zoloft is sexual dysfunction. Reported incidence of impotence can be as high as 30%. Obviously these medications would be a very poor choice for a male in mid-life crisis who is obsessing about inadequate sexual performance. Another disadvantage is that these agents are expensive. Caution should be used mixing these agents with weight reduction pills, agents used in smoking cessation (Zyban--buproprion), tryptophan and St. John's Wort marketed in health food stores, and other serotonin-like agents

Other drugs include Wellbutrin (buproprion), Effexor, and Serzone. These effect the brain through other biochemical pathways.

Table 2 Reported vs. Placebo Incidence of Sexual Dysfunction Associated with Various Antidepressants (PDR, 2001)

	abnormal ejaculation	decreased libido	impotence
	reported placebo	reported placebo	reported placebo
Prozac	7% >1%	4% 0%	2% >1%
Zoloft	14 1	6 1	N.A.
Paxil	13 0	3 1	10 0
Celexa	6.1 1	3.8 1	2.8 1
Wellbutrin	N.A.	3.1 .6	3.4 3.1
Effexor	17 1	6 2	6 1
Serazone	>1	1 >1	>1
Luvox	8 1	2 1	2 1

At this time, there is no one best agent for the pharmacological management of the unique issues associated with male depression at midlife.

Drs. Caroline Dott and Andrew Dott are professional lecturers and teachers with a special interest in the interactions between the biological and psychological basis of human behavior at midlife. Among their lecture topics are female and male menopause, the hormonal basis of human behavior, and issues related to depression and anxiety. They are available to travel and give seminars on the topics covered in this website both nationally and internationally.