Male Depression

So far weve discussed the history of depression, and explored its

possible causes. Before we conclude this series next week with a
guidebook on managing your melancholy, we of course need to stop to
examine what depression actually looks like. How is it different from runof-the-mill sadness, and how does it manifest itself, especially in men?
Today well tackle those two questions.

Whats the difference between being sad and being

depressed?
Thats the million-dollar question and the source of a lot of debate. Its
also a relatively modern query. As we discussed in our post on the
history of the black dog, depression as a clinical diagnosis only arose
in the early 20th century; before that you were just plain old melancholy
sometimes a little, and sometimes a lot. There wasnt a clear dividing
line, because depression wasnt so much a disorder as a temperament.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has
attempted to establish a set of standardized criteria that distinguishes
normal sadness from clinical depression, but making the diagnosis
remains an inexact science. This isnt a physical tumor you can measure
in centimeters, but a measuring of mood.
According to the DSM-V, for a spell of melancholy to be considered a
Major Depressive Episode, it must persist for at least two weeks, and be
accompanied by at least 5 of these symptoms:

Depressed mood most of the day, nearly every day, as indicated

by either subjective report (e.g., feels sad or empty) or observation
made by others (e.g., appears tearful).

Markedly diminished interest or pleasure in all, or almost all,

activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others).

Significant weight loss when not dieting or weight gain (e.g., a

change of more than 5 percent of body weight in a month), or
decrease or increase in appetite nearly every day.

Insomnia or hypersomnia nearly every day.

Psychomotor agitation or retardation nearly every day (observable

by others, not merely subjective feelings of restlessness or being
slowed down).

Fatigue or loss of energy nearly every day.

Feelings of worthlessness or excessive or inappropriate guilt

(which may be delusional) nearly every day (not merely selfreproach or guilt about being sick).

Diminished ability to think or concentrate, or indecisiveness,

nearly every day (either by subjective account or as observed by
others).

Recurrent thoughts of death (not just fear of dying), recurrent

suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.

Those symptoms can sound rather technical, so heres a list of common

signs put in laymans terms by the Mayo Clinic:

Feelings of sadness, emptiness, or unhappiness

Angry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in normal activities, such as sex

Sleep disturbances, including insomnia or sleeping too much

Tiredness and lack of energy, so that even small tasks take extra
effort

Changes in appetite often reduced appetite and weight loss, but

increased cravings for food and weight gain in some people

Anxiety, agitation, or restlessness for example, excessive

worrying, pacing, hand-wringing, or an inability to sit still

Slowed thinking, speaking, or body movements

Feelings of worthlessness or guilt, fixating on past failures, or

blaming yourself for things that are not your responsibility

Trouble thinking, concentrating, making decisions, and

remembering things

Frequent thoughts of death, suicidal thoughts, suicide attempts, or

suicide

Unexplained physical problems, such as back pain or headaches

Besides Major Depressive Disorder, the other form of depression thats

frequently diagnosed is Persistent Depressive Disorder. Its less severe
from day to day than a bout of MDD, but it lasts longer. PDP manifests in
adults as a low mood that lingers for most of the day, for more days than
not, for at least 2 years. During this 2-year period, depression-free
intervals last no longer than 2 months. Ones low mood must also be
accompanied by at least two of the DSM symptoms listed above.
Other than experiencing a cluster of symptoms, the main crux of either
of these diagnoses is whether ones mood creates clinically significant
distress or impairment. In other words, does your disorder get in the
way of your everyday life? Unfortunately, like the line between general
sadness and depression itself, the standard here is somewhat hazy.
The DSM does not provide objective criteria for what constitutes
clinically significant distress or impairment, so individuals, doctors,
and therapists are left with making subjective calls as to when a low
mood reaches this benchmark. For some people, it might mean their

depression is preventing them from going to work or taking care of their

families; for others, it could mean that their low mood is getting in the
way of achieving unrealistically high expectations for happiness. Some
research suggests that its largely the latter group that is going to their
physician or psychiatrist for anti-depressants, while individuals with
depression so severe they cant even take care of basic life functions are
often not getting treated at all they lack the motivation to even make
an appointment with their doctor.
All of this is to say that figuring out exactly when sadness becomes
depression can be a fuzzy affair. While the DSMs symptoms-based
approach to diagnosis has given depression a more medical, and less
stigmatized slant, critics argue that its also created such a broad net
that it may cause some folks and doctors to view a bout of normal
sadness or low spirits as a disorder.

Symptoms of Depression in Men

Making things more difficult in diagnosing depression is that men often
show different symptoms than women. Because women generally report
feeling depressed more often than men, the symptoms and signs the
DSM and other diagnostic outlines have aggregated tend to be femaleoriented. Consequently, many men who may be struggling with
depression arent getting treated for it, and sadly, many of these men
end up committing suicide; while women are more likely to get
depressed, men are more likely to kill themselves, by a margin of more
than 4:1.
While many men experience the symptoms of low mood, lack of interest
in normal activities, problems sleeping, etc. that the DSM lays out, its
also important for them to watch for the often uniquely male signs and
symptoms of depression.
One thing to keep in mind as you think through the symptoms below is
that just because you display one or more of them doesnt necessarily
mean youre depressed. Its important to put the signs in the context of

the other criteria for depression such as the length youve been
manifesting the symptom and whether it causes significant distress or
impairment to your life. Its also important to note that many of the
symptoms below can actually be healthy responses to depression if used
in moderation.
Prudence and wisdom should thus be used when checking yourself
against this criteria; when in doubt, talk to a mental health professional.
Increased use of alcohol and other substances. Theres a common
saying when it comes to gender and melancholy: women get depressed;
men drink. And indeed, a typical response for men going through a
prolonged low mood is to turn to alcohol and other mood-altering
substances to blunt their despondent feelings. If you find yourself using
these sorts of substances more than you usually do, it could be a sign
that youre depressed.
Distraction and escapist behavior. While theres certainly nothing
wrong with taking part in activities that distract you from your low mood
(in fact, well recommend it as a method for managing your depression),
it can become a problem when those distractions are of a type that can
make your depression worse or prevent you from living a thriving life.
Common distractions men resort to when feeling depressed include TV
watching, video game playing, and web surfing. Theres nothing wrong
with these activities in moderation, but if done too much, they may
actually make you feel more depressed or at least no better than
before. In a study in which participants were paged at random times
during the day and asked to report on how they were feeling, people
were found to experience their lowest mood when watching TV or surfing
the web, especially late at night.
Another distraction men commonly turn to when depressed is
pornography. While the good feelings that come with masturbating to
porn can alleviate a low mood in the short-term, this habit can do more
harm than good in the long-term. Repeatedly stimulating your dopamine
production in an artificial way, whether through excessive porn use or

substance abuse, leads to dopamine desensitization. And recent

research has shown that dopamine desensitization can cause
depression. Which makes sense. One symptom of depression is the lack
of motivation to do things that once brought you joy. Dopamine is the
neurotransmitter of motivation, so if your brain becomes deadened to it,
your drive decreases, and you get into a funk.
Workaholism. Related to distractions and escapist behavior is
workaholism. Instead of lying around the house in apathy, some men
respond to their low mood by putting in extra time at the office. Again,
this isnt necessarily a bad response to depression. Focusing on your
work can be a healthy way of harnessing your black dog. It can become
a problem, however, when putting your nose to the grindstone causes
significant distress and impairment to the other facets of your life like
family and community responsibilities.
Irritability and uncontrolled anger. For men, anger and depression
often go hand-in-hand. Melancholy for men might be best described not
as an entirely gray existence, but rather a dark landscape occasionally
punctuated with flashes of red. It may not be acute anger you
experience either, but rather a constant low level of irritability and
peevishness.
Sulking and aloofness. Many depressed men will become socially
aloof, and when they are around people, theyll sulk just silently
sitting there while the low mood and irritable emotions radiate from
them.
Decreased sex drive. Depressed men will often have a depressed
libido. This could be the direct result of blunted dopamine sensitivity, or
be rooted in decreased testosterone levels, which in turn decrease
dopamine production the neurotransmitter that gives you your sex
drive.
Increase in risky behavior. If youre generally not a risk-seeking kind
of guy, but suddenly find yourself doing things like gambling, drinking

while driving, riding your motorcycle recklessly, etc., you may be

depressed. Though you may not be, too. Again, its important to take a
big picture approach when youre reviewing these symptoms.

Conclusion
So are you depressed or just feeling low? As you can see, the line
between the two just isnt very clear.
The good news is that when it comes to light-to-moderate cases of
depression, knowing if youre technically, clinically depressed or not isnt
that important. And thats because the methods youll use to remedy the
situation are pretty much the same whether youre actually depressed or
just going through a gloomy spell. In fact, the best methods for tackling
depression are things you should be doing even during the times when
youre not feeling melancholy.
And, if you have severe depression, well, you wont have much doubt as
to whether youre struggling with the black dog or not. It will be quite
evident. If youre having trouble summoning up the motivation to even
get out of bed, if your whole worlds gone gray and you dont feel
anything at all, and/or youre experiencing suicidal thoughts, youre
almost assuredly clinically depressed. In this case, in addition to taking
up the best practices well lay out at the end of this series, you may
need to talk to a mental health professional. If you wont do that, at least
talk to a friend, loved one, or clergyman; dont keep how youre feeling
to yourself.
Ultimately, while its helpful to give something youre experiencing a
concrete name, depression is so complex, and manifests itself so
individually, that I dont recommend obsessing over clinical checklists in
order to give yourself a label. Only you know for sure whether what
youre experiencing is normal and bearable, or is something that is
getting in the way of the life you want to live. If it is, then you need to
take action. How to take the bull by the horns, and the black dog by the

leash, is what well lay out next week in the final installment of this
series.