It's More Than the Blues: Why Men Finally Have to Face Their Depression

A close friend of mine told me about her first marriage to Paul, 55. Although he can now say that he suffered from depression some 15 years ago when they were married, back then he had no words or theories to understand his feelings.

Alicia, my friend, remembers how Paul would never sleep with her, despite the fact that they'd just married. He gained weight. He was irritable -- downright nasty sometimes. And despite a strong work ethic that ensured he never called in sick, today when Paul looks back on those days, what he remembers is that all he wanted to do was lay in bed and sleep. "I just had no energy," he recalls. At the time, Paul was in a dead-end job, working with a man he had no respect for, and his father, who has since died, had just entered a nursing home.

Having to put his father in a home, Paul believes, was likely the trigger. "It went against everything I was raised to believe," he says, citing his Italian heritage and sense of responsibility toward family. "Where I came from [in Italy], you just didn't send your parents away just because they were old. But the truth was that my father was too ill for my wife and I to take care of him. And even though I knew that, I also felt really guilty. I was angry with myself, I guess, for not being able to do for my father what I'd been raised to do."

Between working for a man whose machinations went against Paul's sense of integrity, and having to make a decision about his father, whose placement in a nursing home ended much of how Paul saw himself as a family man, Paul lost a huge portion of his identity. And that loss became depression.

Fifteen years ago, however, Paul had none of these insights, and before he would come to them and eventually get better, the depression destroyed his marriage. He's grateful that he and Alicia maintained a close friendship, but every now and then, he says, he lets himself wonder what might have been, had his depression not gone untreated all those years ago.

Paul's inability to recognize his depression is not uncommon. Depression, so often seen as a woman's disease, shows up differently in men than it does women. Whereas women, for example, may be able to express their hurt, men more often lash out, appearing more angry than they do sad.

But the numbers tell quite another story. Although 80 percent of Americans diagnosed as depressed are women, fully 80 percent of those who commit suicide are men. And as men grow older and are impacted by the variables of aging -- from experiencing hormonal changes (and the flagging libido that often results) to being pushed out of a job that often defined who they were in the world -- their risk for depression that leads to suicide skyrockets. By mid-life, male suicide rate are three times higher than with younger guys. By the time a man reaches 65, that rate increases seven-fold.

This week is National Men's Health Week. And while we hear a lot these days about men and their physical health -- everything from prostate cancer to obesity, heart disease and diabetes -- we hear almost nothing about men and depression. Yet the correlation between physical challenges and mental health challenges cannot be ignored. People who are depressed risk heart disease at twice the rate of the population. A Montreal Heart Institute study a few years ago looked at the lives and recoveries of 222 heart patients. Those patients who'd had heart attacks and were also depressed were four times as likely to die within six months as those who had heart attacks but no depression.

Similarly, a Johns Hopkins study involving 1,551 people concluded that those who suffered from depression were also four times more likely to have a heart attack within 14 years. The Medical Journal of Australia has gone as far as to say that depression is a reliable indicator of risk when it comes to heart attack.

With these kinds of statistics, we have no choice but to finally pay attention to depression and how it can destroy lives.

When a man we care for is suddenly more irritable and aggressive, if he's agitated and can't sleep, if he's drinking more heavily or using drugs, the answer may not be that he's turned into some kind of Mr. Hyde character. It may mean that he's depressed. This is especially true if he's recently divorced or recently unemployed -- two of the biggest indicators of male depression. But given that we live in a culture that discourages male expression of emotion, we as friends, family and colleagues, have to learn to hear the message behind the words. Men likely won't say that they feel bad. What they will more likely discuss are the attendant symptoms of depression, like feeling tired.

Moreover, because depression often affects sexual desire and performance, men may be reluctant to discuss the issue because they see it as a reflection of their "manhood" when the truth is that it's a reflection of a medical problem.

Right now in America, some 20 million people experience depression. Somewhere between 60 and 80 percent navigate this hell undiagnosed and untreated. But as we would not just keep "pushing on" if what we were talking about was a broken leg, neither should we do it if what's been hurt is not in our bones but in our minds. And here's the good news: 80 to 90 percent of the people who find the courage to seek relief actually do get relief, often through a combination of talk and drug therapy.

This leaves men with a challenge to transcend traditional -- and often unhealthy -- notions of masculinity and realize that while so-called "real men" might not eat quiche, they must take care of themselves so they can be here, living the lives they deserve and the lives we want to live right alongside them.

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