The pressures of masculinity - understanding depression in men
Suicide currently stands as the biggest single killer of men under the age of 45 in the UK. The recently published Samaritan’s Suicide Statistics 2017 show that the rates of completed suicide have gradually increased since 2014 and male suicide rates continue to be three times as high as female suicide rates in the UK. This means that in 2014, out of the 6,109 suicides that took place in the UK, 76% were male.
The differences between men and women
The lessons that we teach our children matter, and can be helpful and harmful in equal measure. The 'hidden curriculum' that teaches boys and girls that men are stronger than women, that men shouldn't cry or show weakness and that asking for help is an inconvenience, is out of place in the modern world. There is always an argument for a stoic search for meaning in adversity and that we can grow emotionally through difficult times. However, if you have become clinically depressed, it is OK to ask for help. One could argue that it is brave to acknowledge your own vulnerability and ask for help when you need it, and it is this, that men struggle with more than women.
It is a tragic situation that some men would rather consider suicide than take off their false mask of masculine 'bravery'. On the whole, men find it more difficult than women to open up to others about feeling vulnerable, and they fear that this will be seen as a sign of weakness. The modern man continues to struggle to find his place in a society which expects him to 'be a real man' at the same time as being emotionally sensitive. Society's confusion over what defines masculinity is creating an unnecessary pressure for men.
Men and women are also known to use very different methods when attempting to take their own lives. Men tend to use more violent means and therefore tend to be more successful as a result.
The important issue is for men to take their stress and low feelings seriously and know that they are not alone… men too often feel isolated and side-lined when it comes to emotional support...
Identifying those at risk
The act of taking one's own life is a permanent solution for a temporary problem, which could be prevented if individuals are given the right support at the right time. If the signs and symptoms of depression can be identified upon a visit to your GP surgery, men at risk can be offered professional help and effective interventions. Signs and symptoms include:
- Poor sleep or feeling tired all the time
- Anxiety or low mood
- A change in appetite/weight loss or gain
- Struggling to concentrate
- Lack of libido
Some men with depression may also attend a GP surgery complaining of non-specific pains, headaches and gastro-intestinal symptoms.
To deal with the pressures of modern life, coping mechanisms tend to differ between men and women. Unhelpful ways of dealing with depression that men are likely to present with, include:
- Risk taking behaviour such as gambling, drinking in excess or substance misuse
- Becoming violent or demonstrating anger issues
- Seeking and carrying out extra-marital relationships
Statistically, women tend to spread out their emotional ties and capital beyond their primary relationship (e.g. a spouse), whereas men have more superficial relationships beyond their primary relationship. Divorce or break-ups can cause extreme emotional pressures on an individual, which can be even more pronounced in men due to their reduced network of emotional support.
Supporting men with depression
Early identification of when a man might be suffering with a mental health disorder can ensure that the condition is treated more effectively. The most effective interventions to reduce suicide are all linked to good quality, ongoing care. This means that we need to refer men at risk quickly and they need to be seen by a professional in a timely fashion, to ensure that treatment is not delayed.
Men need to be made aware of how to access help before their suicidal thoughts or plans become active. This is why it is so important to get men to open up and seek help at the earliest possible chance. As a GP, if you can instill a sense of therapeutic hope for your patient, they may be more likely to accept the help that they need.
One option is to book longer appointments with these patients so they feel that they are being listened to by their doctor. Screening for low mood can take place immediately, with simple questions including:
- Have you been feeling low over the last couple of weeks?
- Have you lost interest in activities that you used to enjoy?
- Have you been sleeping well?
The most effective treatment for moderate to severe depression includes:
- Cognitive behavioural therapy (CBT)
- A combination of talking therapies and antidepressants
- Interpersonal therapy (IPT)
The most commonly prescribed therapy is CBT. This focuses on teaching the patient ways of challenging their negative thoughts. There are several other therapies that might be helpful, which also have a good evidence base. The type of therapy that the patient is offered is usually dependent on what therapy is available and the skills of the therapist. There are therapies that are just as effective as medication in treating depression.
Despite the negative media coverage, antidepressants are effective, safe, not addictive, and can prevent the patient from having a relapse during their recovery from clinical depression. However, antidepressants can take a few weeks to start working and the majority of side-effects are usually experienced in the first few weeks. Selective serotonin reuptake inhibitors (SSRIs) remain the most popular class of antidepressant, due to their relative effectiveness and safety. It is important to advise on the side-effects when monitoring your patient in follow-ups, as they might not be forthcoming with certain complaints which can impact compliance.
Priory offers tailored treatment programmes for individuals suffering with depression, which are based on their medical history and personal experiences. There are a number of specialist consultant psychiatrists who will oversee the treatment, which may include a combination of both medication and psychological therapies. There is the option for receiving treatment on an inpatient basis if the severity, risk or personal choice is to do so.
Our outpatient wellbeing centres support a range of mental health difficulties including depression. For more information, please view our GP section of the Priory website, including information on our outpatient therapy packages.