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Depression Is Not Gender Biased
Depression has always been a woman;s disease. But the fact is that men also suffer from this disease, however they are often misdiagnosed.
You might call it melancholy on steroids -a muscular mixture of fast driving, heavy drinking, hard-charging cussedness. For perhaps 3 million American men yearly, that's the plotline for depression. For almost 24,000 men yearly, the final scene is suicide. Often, there is no cry for help, no abyss of sadness.

Research suggests a man is four times more likely than a woman to commit suicide. Yet, he is only half as likely to be diagnosed with depression. Depression in men often does not look like the mixture of sadness, guilt and withdrawal that dominates the popular perception of the disease. As a result, a man's depression is, often missed by loved ones, by physicians, by the sufferer.

But today the diagnosis of depression is in the midst of a long-overdue makeover, as medical and mental health professionals have come to recognise that in at least half of depressed men, the recognizable litany of symptoms don't really fit.

Some depressed men may be plagued by impotence and loss of sexual interest, but others may become wildly promiscuous.

Many complain of depression's physical symptoms, sleep troubles, fatigue, headaches or stomach distress, without ever discerning their psychological source. Compared to women suffering depression, depressed men are more likely to behave recklessly, drink heavily or take drugs, drive fast or seek out confrontation.

Instead of acting like they are filled with self-doubt, depressed men may bully and bluster and accuse those around them. For many men, anger-a masculine emotion that one 'manages' rather than succumbs to-is a mask for deep mental anguish.

"That's their way of weeping," says psychologist William Pollack, director of the Centers for Men and Young Men at McLean Hospital in suburban Boston and an expert on depression in men.

Dr Thomas Insel, director of the National Institute of Mental Health, likens the shift now taking place among psychologists and psychiatrists to one that is taking hold in other areas of medicine. In the diagnosis of, say, heart disease, physicians have come to recognise that men and women can have the same illness, but their symptoms often look very different.

For almost two decades as an aerospace machinist in San Diego, a coffee-fuelled Steve Klepper worked so much overtime that he was able to buy a family home by himself. At work, he says, he was short-tempered and had little patience for his co-workers' blather about friends and family.

At home, he would drink himself numb virtually every night. By his own admission, he "acted very much like a jerk" to women and friends, and suffered constant stomach problems and skin rashes. He thought frequently of suicide.

Today, Klepper manages his condition with medication, and leads a San Diego support group for those suffering depression and bipolar disorder.

He finds it hard to fathom why no one ever called his evident depression what it was. But he knows why it's a hard diagnosis for a man to admit to himself.

"It's embarrassing to be sad," he says. "And the difference between being sad and lazy is hard to distinguish."

Neither tears nor indolence, it seems, are manly virtues.

"Depression equals vulnerability and shame and lack of functioning. That takes away the man's masculinity -and for men, that takes away the sense of self," says Pollack, author of Real Boys: Rescuing Our Sons from the Myths of Boyhood. Pollack and a small but growing number of depression experts are pushing for a new category of depression -Pollack calls it 'male-based depression.'

However, even physicians and mental health professionals who have come to recognise depression's unexpected manifestations in men are careful to avoid what psychologist Pollack calls 'the D-word' when they first suspect it. Dr Kevin Brown, a Los Angeles family physician, says that with men in general-and his predominantly black and Hispanic patients in particular --he reaches for other words to open a conversation about depression.

"I tend to use the words 'under stress' more often than not, and people can definitely relate to that," Brown says.

A referral to a mental health counsellor or a psychological support group "is definitely almost a no-no," he says, because "there's usually more machismo or bravado about men's ability to handle whatever emotional problems they might have."

Brown says that in men who do not appear to have reached a state of crisis, he may first prescribe an anti-depressant. Only after a few follow-up visits, when he has gained a patient's trust, would he suggest counselling.

Brown, who is black, suspects that among males in the population he serves, depression is quite common and largely unrecognised. Most of it, he suspects, plays itself out on the streets, in gangs and behind the tinted windows of cars.
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Posted on : 18/11/2005
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