An article I wrote about men and depression and how it is overlooked so many times
| Oliver Landreth, July 2003
Men Don't Get Depressed!
Oliver L Landreth
Men don't get depressed. They can be down, sad, intense, absorbed. But they don't get depressed. And if a man is any of these, the usual response is "snap out of it". Men don't get depressed. It is not "cool".
But here are a few sobering statistics that may get all those sceptics to stop and think:
In Japan, work stress related suicide is now the 13th most common cause of death among men;
In the US, recent studies show that 80% of male depression cases are not diagnosed and therefore not treated, in large part because men do not show the typical signs of depression that one would expect. They don't cry, they rarely show sadness, and they almost never verbalize their feelings the way women do;
It is now estimated that 40% of men between 40 and 60 will experience varying degrees of depression, with the suicide rate tripling when compared to younger men;
In the UK, as many as 1 in 100 people will experience manic depression in their lives. 75% of all suicides in the UK are by men! With the rate having increased 50% since 1990;
More than half of respondents of a recent study said that they do not reveal their depression because they are afraid of the stigma and of losing their jobs!
In 1990, there were approximately 25,000 reported male suicides as compared to 6,182 females. Even more staggering: for each older female who commits suicide, 1,325 men also committed suicide!
In Australia, 1 out of every 6 men suffers from depression at some point in his life.
But men don't get depressed. Right?!
A recent article in New York Magazine (June 9, 2003) described the chemical frenzy pervasive in Gotham. It is "cool" to be on anything from Prozac, the original wonder drug that is part of the all too familiar SSRI family, to Clonazepam and Ritalin. The article identified a sad truth: It is OK, even chic, to talk about what prescription drug or drugs you are downing with your Chardonnay, but it is only chic if it is recreational. Ideally, you even broke the law a little by getting your latest blue or yellow pill from a friend, hence bypassing a doctor. God forbid you take something because you actually have a condition. That is definitely not cool.
Our society still looks down on certain behavior patterns and illnesses, no matter how liberal we all claim to be and no matter what the fashion of the moment is. The truth is, men DO get depressed. And I actually believe that the syndrome of moderate to severe depression amongst men is in fact significantly more widespread than anyone would like to admit. This is not based on scientific evidence per se, but on numerous discussions with male friends who, after some prodding, have admitted that they were on Paxil, or Celexa, or Wellbutrin, or a combination of these and a myriad of other chemicals. The statistics at the beginning of this article are merely the tip of the iceberg. If men aren't talking, then we can only assume that there are many more out there in need of help.
The social elite of New York that revels on cocktails of gin and a range of psycho-pharmaceuticals doesn't realize the harm they are doing to themselves and, worse, the negative impact on those of us who actually battle clinical depression every day of every year, hiding behind forced smiles, secretly wishing we were elsewhere or even dead.
I am a 42-year-old male. I have no idea when my depression began. There are times when I think it goes back to the day I was born. At 42, I have had enough time to look back and analyze family and friends as well as myself. My father was, in retrospect, depressed. How much was due to constant nagging by my mother is unclear. My mother, now 80, is most definitely clinically depressed, but she is from a different generation and has successfully mastered the art of denial. Granted, a bottle of wine a day, combined with the belief that all that goes wrong is someone else's fault, certainly helps. My brother has all the symptoms of depression (wild mood swings, severe introspection, feelings of worthlessness, etc. We all know the symptoms by now), but he does not believe in that "psycho-babble" and all those "drug pushing shrinks", so he suffers on, risking marriage and job at every turn.
As for me? I have tried most of the SSRI's, but none really seem to work. So doctors say "try this latest one" or "let's try this with that and a touch of the other" and "let's up the dosage". A few have even said "you got to tough it out". The advice of the latter aside, I have, without fail, gotten to the maximum recommended dosage of every drug that has been prescribed to me. There was some benefit, but negligible when compared to the side effects.
At one point, about a year ago, I was so sick of the side effects that I finally told my doctor that I needed to detox! I wanted to clean out my body so could he please taper me off of everything! He argued but eventually gave way. Two weeks later, I was off of everything. What a great feeling! I was about to move, start a new job, I bought a new car. It was springtime in San Francisco and the world suddenly looked beautiful again. In short, I was making it. No more need to remember to take Paxil at night, together with Klonipin, and whatever the other one was in the morning.
So off I went. New job, new city, new friends, new car, new house...new everything and NO drugs. As always, I was doing everything backwards. Here I was, the Ivy League graduate who had never done any drugs (illegal ones that is) secretly revelling in the fact that he was off drugs. And hey, I was a mature single man, who had travelled the world for all his life, so what was one more move? Wrong.
They say moving and a new job are two of the most stressful things in life. But I had done it so many times, I could do it again - no problem - and I was feeling great. But no doctor, no book, no friend could have prepared me for the crash that followed. When I realized that my new boss was a bipolar manic depressive in need of a serious frontal lobotomy, that I was in the middle of the Bible Belt without a friend in sight, and that my friends were finally worn out with my constant changing and my moods, my depression snuck up on me with a vengeance (Rationalizing my choice to live in the deep South admittedly had not helped). For a few days, I was able to brush it off as just part of the changes I was going through. I was OK though. I was going to make it. After all, most of us men are brought up, consciously or subconsciously, to believe that we have to be tough, not show our emotions, not cry (Can't even remember the last time I did cry!). And then one morning, I just did not want to get out of bed. That had never happened to me. Never. I called in sick and went back to bed for 2 days, without seeing daylight or bothering to eat. I wanted to cry my heart out, but I could not even do that. I was emotionally numb, worn out, anxiety ridden. I ignored phone calls, kept the curtains closed and silently hoped the world would go away...or I, whichever came first.
So once again I went in search of a therapist. I found one. Amazingly enough, he was the first one I contacted and he was/is a great guy. But therapy has its definite limitations. I have tried all types, from traditional Freudian therapy to Cognitive Analysis to California faith healing (You know, the kind that says take a deep breath and get in touch with yourself. They simply forgot to consider the fact that there was no longer a self to get in touch with!). Unfortunately, no therapist has been able to get to the point with me where they are actually helping. They don't tell me anything I don't know. There are only so many ways to interpret childhood and destructive patterns and abuse. Sure, for that hour or so, you feel OK because someone is actually listening and they appear to relate to you and convince you that you are not crazy. But this last therapist recognized that he could not do it alone. Back I went to my GP and then to a full-fledged psychiatrist. I liked my therapist. I liked my GP. I hated my psychiatrist - from the moment I saw him. He was cold, distant, clinical and pretty damned out of touch with any emotions at all if you ask me.
He went through the checklist and proceeded to tell me that I had severe clinical depression coupled with a mild form of Attention Deficit Order (ADD) - What?! No way? I was an honors student! No, no way. But he insisted and so I let myself be talked into the addition of yet another drug: I needed to get on a high dosage of Paxil CR, Klonipin and Aderall! Another damned cocktail! But, whether I liked him or not, all three doctors agreed on one thing: every time one has a severe bout of depression, the subsequent one will be worse. My therapist was actually concerned that I was going to do something drastic. I thought that was ironic, given my excessive level of responsibility and distorted sense of duty to all around me. But he was genuinely concerned. That is when it finally sunk in that I had a real problem and even I was getting scared by some of the thoughts I had.
As I write this, I have moved yet again, this time to the other side of the world. I thought the exotic nature of Asia, a senior position in a promising start-up and a whole list of social introductions would be just what the doctor ordered. I started to self medicate in that I decreased dosage. After all, I was feeling great again. I even had a party for 30 people 2 months after arriving. A whole new me! Oh, and I tried to get a whole night's sleep without a Klonipin. Right!
I have friends, I am working out, I am travelling, but that deep-rooted sense of black emptiness never goes away. It is always there, affecting everything I do. And the scariest part of it all? It is totally unpredictable and my Klonipin is running out, there is no Paxil CR here and the mentality towards mental illness amongst men is even more backward than in the US.
And now the job - that dream job - has gone south in a hurry. While this is in large part due to a boss who is generally hated by the local population, it is also in large part my fault because I have spent my life trying to live up to expectations others have of me, never having found the courage to stop and analyze what I want! So, let's add in to the mix a healthy dose of mid-life crisis. You know, that point when we realize that we have no idea why we have gone down the path we are on, the credit card bills are piling high, the job seems pointless, and suddenly a tent overlooking the ocean looks kind of appealing? Result: a new spiral downwards, and back come the drugs, because it's that or the abyss. And, let's face it, how many people want to hear you speak about how everything in life sucks?!
I have moved from a country in which SSRIs and their relatives are recreational to one in which they are borderline controlled substances that may well put you on the government watch list if you are taking them. Either extreme is absurd and harmful to those of us - men and women - who truly suffer from severe depression.
The prescription drugs that are the rage of New York and The Hamptons' social circuits are not recreational drugs for most of us who have no choice but to use them. They often mean the difference between living a somewhat normal life and sinking into a bottomless black well. Some years ago, that well had a bottom and light was never out of reach. With the passing of time, every time that well becomes visible, I never know how deep I may sink into it. One day, if it sucks me in too deep, I may not come out of it. And every man, woman and child that has symptoms of depression deals with this. But men are undeniably asked to sweep these feelings of gloom under the carpet. As a result, the pressure to conform and to succeed is at times unbearable and highly destructive. We risk getting into a negative cycle that has potentially catastrophic results. Most GPs don't even know how to analyze male depression.
Men's role in society is changing (A subject of its own merit). Women now populate a significant portion of the work force and have become more successful. But men's egos are tied to a great extent to their professional situations. Ask them what they do or who they are and they will answer "I am a lawyer" or "I am a consultant". The way we have been brought up has left us unequipped to deal with the rapid changes in our society's structure, without real recourse. Most of us do not live in New York or Los Angeles or London. Most of us live in cities and countries in which male depression is simply not acceptable, in which men cannot express themselves freely, cry, or escape from the daily pressures. It is a sign of weakness.
My hope? That male depression will be recognized as a true problem around the world and that men who suffer from it will have the courage to speak up, seek help and, most of all, learn to live a happier life by doing what they want, not what they think others expect. And if drugs help, then so be it.
The drugs of the moment are in fact addictive and have a range of unpleasant side effects. They also make you emotionally numb. You don't feel the lows, but you don't feel the highs. But I live with them because I have no choice. It is now clear that without them the results are potentially life-threatening. Those who do have a choice and still take them are downright immature, irresponsible and stupid. Just when some progress was being made in recognizing that men can suffer from depression and may in fact suffer worse consequences than women because we cannot talk about it, comes along a group of smart-ass socialites who make talking about it and recognizing the illness even more taboo because it is not "cool". I hope none of those enjoying their cocktails by the pool ever really need what they are taking now. I would not wish that on anyone.
Singapore, June 15, 2003.
"Male Depression", Health and Age, A Novartis Foundation, July 3, 2003
"Gender Stress", Lifepositive.com, Inc., www.lifepositive.com
"Depression in Men and Women: What's the Difference", National Institute of Mental Health, March 24, 2001, www.nimh.nih.gov/research/differencesummary.cfm
Real. Terrence (1997), I don't want to talk about it: Overcoming the secret legacy of male depression (Simon and Schuster, New York, New York)
Britt, Bruce, "Depression: The new male problem", www.bet.com
Depression: Facts and Statistics, Depression Alliance, www.epolitix.com/data/companies/
Youth Suicide facts, 211 Information and Crisis Services, http://211palmbeach.org
Ross, Robert, "Men and Suicide...Why?", for National Coalition of Free Men, www.ncfm.org/ross.htm
Suicide Statistics, National Center for Injury Prevention and Control, USA
Better Health Channel, www.betterhealth.vic.gov.au
Page 6 of 6
Oliver L Landreth
June 15, 2003