Stories and expert health tips from Sunnybrook

Author - Dr. Ari Zaretsky

When it comes to Movember and men's health, the focus has typically been on prostate and testicular cancer. However, there is another common male medical condition that has been relatively overlooked: depression. Clinical depression is a costly and debilitating condition that affects approximately five per cent of the Canadian population in any given year, and 10 per cent of Canadians over the course of a lifetime. Although it has been commonly believed — based on community and epidemiological studies — that women are diagnosed with depression twice as often as men, this impression is more recently being brought into question. In a 2013 article published in JAMA Psychiatry, authors explored whether sex disparities in depression rates are related to the phenomenon of men masking their depression with anger, hostility, risk taking and substance use because they believe it’s socially unacceptable to acknowledge depression publicly. What the authors determined was surprising. When the above symptoms are considered in addition to the conventional depressive symptoms (such as sadness, loss of pleasure, self-criticism, diminished appetite) the rates of depression were no different between men and women. Even if we put the study aside, it’s clear that depression is not exclusive to women. In fact, approximately one million Canadian men suffered from major depression in 2016 alone. What are the consequences of untreated depression in men? Beyond decreased quality and function of life, and potential social consequences resulting from increased anger, aggression, risk taking and substance use, untreated depression can lead to suicide. In Canada, suicide is the leading cause of death for all men between ages 10 and 49. This is the third highest suicide rate in the industrialized world. What role does stigma play in male depression? Stigma and cultural expectations can lead men to mask the true symptoms of depression, impeding diagnosis and treatment. Generally, men tend to be socialized to control their emotions and base their self-esteem on mastery, financial and occupational success, and strength. In the face of loss, failure, or other life setbacks, some men may express aggression and anger since these emotions are more socially “acceptable.” These cultural expectations can also mask some of the common symptoms of depression. Men are more likely to deal with their depressive symptoms by drinking alcohol, using drugs or pursuing other risky behaviour. Many men also avoid talking about depressed feelings with their friends or family. Is depression common in elderly men? Depression is not a normal part of aging. However, specific medical conditions such as heart disease, stroke and cancer can contribute to depression, either directly (through the disease itself) or indirectly (e.g. through the medications and other treatments involved). In addition, there are important psychosocial factors that need to be considered in older-aged men. Retirement is difficult for many men because they lose meaningful work (an important source of self-esteem), they lose a routine, and they lose a way to organize their lives. In addition, loss of a spouse/partner can be particularly devastating for men, as a spouse may have played a central role in organizing social networks and connections. As those networks/connections begin to deteriorate, it can result in even further isolation. How is depression treated in men? The general consensus is that 80 per cent of people with depression — both men and women — can be treated equally effectively with antidepressant medication, specific active forms of psychotherapy (such as cognitive behavioural therapy or interpersonal psychotherapy) or a combination of both modalities of treatments together. How can you get help? If you are feeling depressed, talk to your family doctor. S/he can help you get the help you need. Other resources: • Toronto Distress Centre - (416) 408-4357 • Distress & Crisis Ontario – A list of distress centres across the province • Gerstein Centre - 416-929-5200

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