According to the National Institute of Mental Health, the highest rate of suicide is in elderly males, and more than four times as many men than women die of suicide in a given year. Although females generally outnumber males when it comes to depression, the incidence of depression in boys younger than 15 parallels that of girls the same age. According to a NIMH study, treatments including medications and psychotherapy helped significantly reduce depression in 80 percent of older adults with depression.
Significance
Major depression is the leading cause of disability in the United States, and 20.9 million American adults suffer from a mood disorder in a given year. Researchers estimate that at least 6 million men suffer from depression. Men are more likely to report substance use, which often masks depression and makes it more difficult to diagnose and treat. In 2003, the NIMH launched a media campaign about men and depression to help reduce the stigma and raise awareness of this issue. Effective treatments such as medications assume the task of shrinking this emerging epidemic.
Types
Anti-depressants come in three categories: selective serotonin re-uptake inhibitors or SSRIs; tricyclics or TCAs, and mono-amine oxidase inhibitors or MAOIs. Because SSRIs generally have fewer side effects than TCAs, and MAOIs require special dietary considerations, SSRIs take the lead as first-line medical treatment for depression. As sexual side effects might emerge when taking anti-depressants, some physicians choose to prescribe or add bupropion, an anti-depressant in its own class that minimizes or treats sexual dysfunction. No one anti-depressant more effectively treats depression in men, and men must often try a variety of anti-depressant doses, types and combinations to determine the best fit. Mood stabilizers might be prescribed if manic episodes have accompanied major depression. Although not approved for depression, physicians might prescribe stimulants or anti-anxiety medication along with anti-depressants when severe apathy, low energy or anxiety accompany depression.
Misconceptions
Anti-depressants are not habit-forming. Although uncomfortable symptoms might appear when stopping anti-depressants abruptly, no tolerance or addiction to them develops. Unlike rapid symptom relief with medications for pain or headaches, anti-depressants take up to six weeks at therapeutic doses to be fully effective. During this time, side-effects often dominate as the body adjusts, and some deem the medicines intolerable. These side effects are most often transient, and abate as the body adjusts. After a few months on medication, many feel better and stop their anti-depressants. The NIMH suggests continuing anti-depressants for at least four months once depression has lifted.
Considerations
Men often don't know they're depressed. A study conducted by the NIMH concluded that "men described their own symptoms of depression without realizing that they were depressed," denying awareness that physical symptoms, such as headache, digestive disorders and chronic pain, can be associated with depression. Obtaining a full physical and psychiatric evaluation remains crucial to rule out physical and other psychiatric problems that might be causing or compounding depression. An NIMH-funded research study of adolescents with major depression found a combination of medication and psychotherapy the most effective treatment for depression, and the NIMH identifies that as the preferred treatment combination. For optimum results, consider psychotherapy as an adjunct treatment to medications.
Warning
Although common side effects--headache, nausea, insomnia, agitation, dry mouth, constipation, bladder problems, blurred vision, drowsiness and sexual problems--might occur when taking anti-depressants, the FDA mandated a black box warning for children and adolescents taking SSRIs. A review of research revealed a risk of increase in suicidal thoughts or behaviors in this population when on SSRIs. Studies demonstrate, however, substantial benefit for male teens taking medications. To determine the safest and most effective course of treatment for male teens, weigh the benefits and risks with the prescribing physician.
