Big boys don't cry, they suffer in silence: understanding depression in men

Dr. Cosmas Mugambi

Mental health is inseparable from physical health. Mental health conditions account for 12%
of the disease burden and 31% of years lived with disability globally. A 18% increase has been
recorded over the last decade. Today, 350 million people suffer from depression with effects
on work, socialization, school and families. At its worst, depression can lead to suicide,
800,000 people die from suicide annually. Depressed males are four times more likely to
commit suicide than depressed females. The rising rates of suicide, murder and other crimes
globally paint a troubling picture of how the society is today struggling with depression.

Depression is treatable, with talking therapies, cognitive behavioral therapy, behavioral

activation or antidepressant medication or a combination of these, however, less 10% of
patients in low and middle income countries, receive such treatments due to barriers such as
cost of health, shortage of mental health care providers, low awareness, stigma and
inaccurate diagnosis.

In many respects, men fare worse than women in health. One in eight men will
experience depression at some stage of their lives but depression in men is underreported.
Women are twice as likely as men to suffer from depression but men are a numerical
minority group receiving diagnosis and treatment.

The classic presentation of depression is: deep sadness, lethargy, loss of interest in activities,
change in appetite, sleeping pattern changes, anxiety, reduced concentration,
indecisiveness, restlessness, feelings of worthlessness, guilt, or hopelessness and thoughts
of self-harm including suicide.

Men mask or deny these symptoms and they are more likely to experience “stealth”
depression symptoms such as: mood fluctuations – feeling aggressive, hostile or irritable;
reckless behaviours –fights, dangerous driving, drunk driving or gambling; drug abuse;
isolation; and decreased libido. Other commonly overlooked signs of depression in men are:
physical pain such as backache, headaches, insomnia, sexual dysfunction, or digestive
disorders; anger, irritability, sensitivity to criticism, loss of sense of humour, short temper,
violence and controlling tendencies; and other reckless behaviors such as pursuing
dangerous sports, unsafe sex and compulsive gambling.

The causes of depression are complex and diverse including biological (genetic) and
personality factors, adverse life experiences and life stressors. Some of the triggers to
depression in men include: stress at work or home, relationship problems, health problems,
family responsibilities, financial challenges, retirement and loss of independence, death of a
loved one, poor coping skills, aging in isolation, impotence or erectile dysfunction, alcohol or
drug abuse and childhood trauma.

Masculinity plays an important role in depression-the society's confusion over what defines
masculinity creates unnecessary pressure on men. There is a perception that men should be
tough, self-reliant and in control of their emotions, boys hear these and other similar
statements while growing up and internalize them. In their adulthood as men they struggle
to find place in a society which expects them to be “real men' but also be “emotionally
sensitive”. These stereotypical notions along with stigma associated with having mental
illnesses make it difficult for depressed males to be identified or seek help. The 'hidden
curriculum' that teaches that men are stronger than women and shouldn't cry, show
weakness or ask for help is therefore out of place in the modern world.

Early identification of depression in men can ensure that the condition is treated effectively
and they get back to their work, studies, family and hobbies.

Relatives, workmates and friends should help depressed men contact clinicians and ideally
accompany them for such appointments. Other ways to help include: offering support and
encouragement; never ignoring comments about suicide; joint physical and social activities;
reporting any concerns about side effects of depression medication and; support for routine
clinician’s appointments.
For depression men, self-help steps include: seeking professional help; social support;
“wellness toolbox”-eight hours of sleep, keeping stress in check and regaining control,
relaxation techniques and exposure to sun to boost serotonin levels; exercising; healthy
diet with low sugar and low refined carbs, reduced intake of caffeine, alcohol, trans fats, and
foods with high levels of chemical preservatives or hormones, eat more Omega-3 fatty acids
and other foods rich in mood-enhancing nutrients such as bananas and spinach and avoid
deficiencies in B vitamins; pleasurable activities; and challenge negative thinking-remember
thoughts are not facts.

Together, our voices can fight the stigma that real men don’t talk about their troubles. In
doing so, we can usher in a positive conversation to replace the longstanding, detrimental
silence on depression in men.

The writer is an Implementation Scientist