EVEN COWBOYS GET THE BLUES

Dear Dr. K.,

I'm worried that my husband is depressed. He works hard, is a good husband, but he never seems happy. When I ask him about it, all he says is "That's the way life is: life stinks, then you die." Is this normal?

J.E., Engelwood

Dear J.,
In general, men tend to be pretty dumb when it comes to dealing with either physical or emotional problems. You almost have to break a guy's arm to get him to go and have a physical. It usually takes some worse threats to get him to go through the dreaded prostate exam or have a colonoscopy when he is older.

In contrast, women have long ago figured it out. "Let's be practical," women think. "If I have a problem, let me find out what it is and do something about it. That's common sense."

I believe society (undoubtedly helped by the testosterone in a man's system) still conveys to a man that he must project the image of strength. Nothing should bother him or get to him. In this way, it seems any man who is depressed is worse off than a woman since he should not be depressed in the first place.

It is estimated that 14 million adults in the U.S. experienced depression in the past year and that 35 million people experience a bad depression at some time in their lives. Of these groups, two-thirds are women, but men are certainly not immune. What further muddies the water is that frequently the men do not know they are depressed or cannot admit to themselves. Although women attempt suicide more, men are more likely to succeed. As they age, the risk of suicide increases in males.

Men often do not present the typical picture of a depressed person. This would be a person who is subdued, withdrawn and avoiding others. A man, in fact, may be attempting to ward off a depression by being more intense, controlling or argumentative. He may be increasingly irritable and quick to pick a fight.
Not infrequently, a man may turn to alcohol and/or other drugs to self-medicate. This serves only to disguise the problem more, especially if the alcohol becomes a problem in itself.
In my experience, it is almost always the woman in the man's life that diagnoses the problem and then insists on his getting treatment. Typically, a guy will show up at my office and say, "I don't know why I'm here, but my wife thinks I'm depressed." More often than not, he is depressed. It is only after he has received some treatment and sees a change that he may realize he was depressed. One fellow, who was a very irritable and faultfinding person at home, returned after treatment with a medication. When I asked how he was feeling, said, "I don't notice anything different, but my wife says that if you stop the medicine expect big trouble from her!" This man, like many others, could not or would not admit that he had a problem.

You might have depression if:

• You are persistently sad or unhappy or 'empty'
• You are tired all of the time whereas in the past you were not
• You have trouble concentrating
• You feel overwhelmed
• You are not yourself (withdrawn when usually social or irritable when usually even-
tempered).
• You think being dead might not be so bad
• You are not sleeping and/or eating well
• You feel guilty, hopeless or helpless
•You have lost your interest in things

With males, add these signs and symptoms:

• He is always negative about life (glass half-empty)
• He is frequently impatient and irritable
• He finds fault with others (lays the guilt on)
• He is overly controlling
• He has an alcohol problem
• He is more and more driven in his life

Especially important is whether there is a family history of depression. Increasingly, studies show that heredity plays a large part in depression. Depression is not a "failing" in how a person copes with life but a chemical imbalance.

There are a variety of treatments for depression. The most successful appears to be a combination of antidepressant medication (remember, it is a chemical imbalance) and what is called 'cognitive therapy' (talking therapy that focuses on the person's bleak view of the world). Depression has never been more treatable than it is now. If you feel you know a man who may be depressed, twist his arm and get him to seek out help.

The National Institute of Mental Health has an excellent web page called "Real Men. Real Depression." This is located at: www.nimh.nih.gov

Dr. K is Stan Kapuchinski, M.D., a board-certified psychiatrist practicing with Psychiatric Associates of Charlotte County located at 3390 Tamiami Trail, Suite 104, Port Charlotte, FL. 33952, Phone 941-764-0444 for an appointment. Please write him there with questions or email him at DrK@Sun-Herald.com.