Men and Depression: Treatment

Men often avoid addressing their feelings. In many cases, friends and family members are the first to recognize that their loved one is depressed. It is important that friends and family support their loved one and encourage them to visit a doctor or mental health professional for an evaluation. A health professional can do an exam or lab tests to rule out other conditions that may have symptoms that are like those of depression. They also can tell if certain medications are affecting the depression.

The doctor needs to get a complete history of symptoms, such as when they started, how long they have lasted, how bad they are, whether they have occurred before, and if so, how they were treated. It is important that the man seeking help be open and honest about any efforts at "self-medication" with alcohol, nonprescribed drugs, gambling, or high-risk activities. A complete history should include information about a family history of depression or other mental disorders.

After a diagnosis, depression is usually treated with medications or psychotherapy, or a combination of the two. The increasingly popular collaborative care approach combines physical and behavioral health care. Collaborative care involves a team of health care providers and managers, including a primary care doctor and specialists.

Medication

Medications called antidepressants can work well to treat depression, but they can take several weeks to be effective. Often with medication, symptoms such as sleep, appetite, and concentration problems improve before a person's mood lifts, so it is important to give medication a chance before deciding whether it is effective or not.

Antidepressants can have side effects including

• Headache
• Nausea or feeling sick to your stomach
• Difficulty sleeping and nervousness
• Agitation or restlessness
• Sexual problems

Most side effects lessen over time, but it is important to talk with your doctor about any side effects that you may have. Starting antidepressant medication at a low dose and gradually increasing to a full therapeutic dose may help minimize adverse effects.

It's important to know that although antidepressants can be safe and effective for many people, they may present serious risks to some, especially children, teenagers, and young adults. A "black box" warning—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications to warn people that antidepressants may cause some young people to have suicidal thoughts or may increase the risk for suicide attempts. This is especially true for those who become agitated when they first start taking the medication and before it begins to work. Anyone taking antidepressants should be monitored closely, especially when they first start taking them.

For most people, though, the risks of untreated depression far outweigh those of taking antidepressant medications under a doctor's supervision. Careful monitoring by a health professional will also minimize any potential risks.

For reasons that are not well understood, many people respond better to some antidepressants than to others. If a man does not respond to one medication, their doctor may suggest trying another. Sometimes, a medication may be only partially effective. In that case, another medication might be added to help make the antidepressant more effective.

If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Some people who relapse back into depression after stopping an antidepressant benefit from staying on medication for additional months or years.

Psychotherapy

Several types of psychotherapy or "talk therapy" can help treat depression. Some therapies are just as effective as medications for certain types of depression. Therapy helps by teaching new ways of thinking and behaving and changing habits that may be contributing to the depression. Therapy can also help men understand and work through difficult situations or relationships that may be causing their depression or making it worse.

Cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy are examples of evidence-based talk therapy treatments for depression.

Treatment for depression should be personalized. Some men might try therapy first and add antidepressant medication later if it is needed. Others might start treatment with both medication and psychotherapy.

Brain Stimulation Therapies

Brain stimulation treatments can be considered when other approaches are unsuccessful or unwanted. One of the oldest treatments in psychiatry, electroconvulsive therapy (ECT), is still used today. Generally, ECT is used in cases of severe depression that do not respond to multiple courses of antidepressants, or where there is a great need for rapid relief. For example, ECT might be considered if someone has strong suicidal thoughts or plans, or has stopped eating and drinking adequately. Advances in ECT make it safe and effective for most individuals; however, concern over possible memory loss and continuing stigma have limited its availability and acceptability in some places. ECT is generally considered the "gold standard" treatment of severe depression.

Another type of brain stimulation using a magnetic stimulus is known as transcranial magnetic stimulation (TMS). TMS is an approved depression treatment and has been used for nearly a decade. This is a less powerful treatment than ECT, but a series of near-daily TMS sessions over several weeks is helpful for at least half the people who complete a full series.

"I lost interest in the kids and doing things that we used to do…they'd ask their mother, 'Why is Daddy not getting up and not wanting to do anything with us? Did we do something wrong?' They didn't do anything to me. I just didn't want to do anything."—Rene, Police Officer