Depression In Men: Same But Different

Depression is a woman’s disease – at least, that’s what the numbers say. But plenty of signs are pointing towards the possibility that the numbers are skewed – and that depression in men is much more common than we might previously expect.

The statistics speak a clear language: depression is female. Women are twice as likely to be treated for depression as men.

But there’s some contradicting evidence. Three times as many men commit suicide. Experts estimate that up to 70 percent of suicides are due to depression. This shows one thing above all: the enormous need for action in men with depression.

A sad taboo: Male suicides

Public attention was given to the topic of male depression mainly due to tragic suicides of celebrities. The suicides of Robert Enke in 2009, Robin Williams in 2014 and Chester Bennington in 2017 filled fans with dismay and horror.

Obviously, no one was prepared for that – even though Robert Enke had never made a secret of his depression. That a depressive illness should not be underestimated, is now known.

After all, the reverberation of tragic deaths not only has negative effects. An established taboo is wavering – depression is now being talked about, including with, with and among men.

Depression in women and men – the old debate about nature and culture

Is it really true that women suffer so much more from depression than men? Are the statistics telling the truth? If so, how can the differences be explained? Are they biological?

Depression and biology

Fact: When it comes to depression, biology is sometimes on the men’s side. Purely biological, women carry a slightly higher risk. Hormone fluctuations are a key risk factor for depression and depressive moods. For cyclical reasons alone, the risk for women is therefore increased. In addition, there is the so-called postpartum depression, which affects 10 to 20 percent of women after the birth of a child. Causes can be high levels of stress and abrupt hormonal changes during and as a result of the birth of a child. However, these specifically female cases are by no means capable of explaining the supposedly twice as high risk to women.

Depression and socialization

So perhaps culture also plays a role. Does socialization mean that women are more likely to suffer from depression than men? From childhood, boys and girls learn and internalize different patterns of behavior, even when they are changing and differences are less pronounced than they used to be. Showing vulnerability is still a trait that is more conceded to girls than boys. On the other hand, boys often have to prove their “strength” as children.

As a consequence, the socially accepted behavior of men is different from that of women. Stereotypes of man and woman are defined. The image of the “strong man” is still present in society and not only firmly anchored in the minds of men. Belonging to this male stereotype is to be stress-resistant and resilient, to maintain control and independence, to cope with dangers and to avoid the associated fears and suffering. Accordingly, classic depressive features such as depression, lightheartedness, pondering and self-doubt are often considered “unmanly”. On the other hand, a certain amount of elbow mentality and competitive thinking is socially accepted and is often interpreted positively as an enforcement force.

The Stereotype of Masculinity

A number of researchers doubt the clear sex differences in the statistics on depression. The so-called “artifact theory” states that the differences in depression are artificial in both men and women. The statistics are distorted and do not correspond to reality. Finally, gender role attribution makes it difficult for the man to admit depression.

Affected men sometimes do not perceive depressive symptoms as such, they try to ignore or overplay. In addition, seeking help is different: women seek help faster and in earlier stages of depression, while many men only go to the doctor when the symptoms are already unbearable. This is also supported by the fact that the harder the depressive episode, the closer the numbers of men and women are. At the family doctor, which is the first port of call for many patients, men often first describe physical conditions such as tiredness, sleep disorders, difficulty concentrating, pain or sexual problems.

Bravely sticks the “one-man-knows-no-pain” mentality. Depression often means for men to admit weakness. This different request for help may indicate that the disease is underdiagnosed in depression in men.

Male Depression is Misunderstood

But the stereotypes do not only come from inside: not only affected men themselves have difficulty recognizing depression symptoms. Even doctors and psychotherapists often recognize depression in men too late.

Since a depressive episode often involves physical complaints such as back or headaches, doctors often resort to diagnoses that relate to the body. Depression is often hidden behind addiction: More men than women resort to alcohol or drugs to hide their emotional vulnerability. Symptoms of depression are drowned out by it.

In Australia there is even a campaign that encourages men to cry when they are sad – with the aim of preventing greater suffering.

Male Depression as a Separate Condition

In recent years there has been increasing discussion in science about whether prototype male depression differs from “female symptomatology”. There have been calls to take a different approach to male depression. The term “male depression” came into being when Wolfgang Rutz, the psychiatrist and former European Regional Director of the World Health Organization, launched a prevention program on the Swedish island of Gotland in the early 1990s to reduce the suicide rate of those affected by depression. While the program was able to reduce women’s rates by 90 percent, the number of male suicides remained unchanged.

Then Rutz and his team formulated the concept of “men’s depression” and developed the “Gotland Scale of Male Depression”, a screening tool to better identify depression in men. In a second part of the study social withdrawal, low impulse control, antisocial behavior and aggressiveness were considered as risk factors for suicide in addition to the classic criteria of depression. In this second part, the depressive men were recorded and as a result the number of male suicides was reduced.

Male Depression Is Not Always Specific

The experts are not unanimous whether a distinction in gender-related forms makes sense. Anyone who represents the concept of men’s depression assumes that depression can be expressed differently in men than in women. Of course, this does not apply to all men, and at the same time there are women whose depressive symptoms are more on the “masculine” side of the spectrum.

It is also central in this context that the phenomenon of masculine depression is not a counter-concept to the usual depression. Rather, it is meant to sensitize, in addition to the conventional symptoms, to other features that can hide depression.

Male Depression and Hidden Symptoms

Common depressive symptoms such as inner emptiness, depressed mood and suicidal thoughts remain central to depression – with the added implication that many men find easier access to other conditions that are less likely to jeopardize their social role. The differences are based on a prototypical role model and not on biological differences and are therefore changeable and by no means universal.

According to proponents of “male depression”, the depressive mood in men is more often associated with increased irritability than in women. While most women tend to listen to themselves in sadness, many men are more likely to “externalize,” according to the men’s depression. Concerned it is harder than before to control impulses, the stress limit is reached faster.

Men Respond to Stress Differently

Increasingly aggressive defense reactions can be an indication that one is about to slip into a depressive episode. Evolutionary psychology is also referred to as the “fight or flight” pattern, with which, in particular, men react to stress: one fights or escapes from the situation. Evolutionary and socialization-related, women are more likely to react with a pattern that is called “tend and befriend”: guard and appease. It makes sense: with offspring in the arm, it does not fight or flee as fast as without. Of course, one can not generalize this, especially as role models break up and men and women need both ways of reacting in order to be successful.

It comes to typical defense mechanisms such as social withdrawal, which is denied at the same time. Depressed men often feel the need to be left alone. Grief and dejection do not carry them out, they rather try to hide their suffering in order not to admit helplessness. Characteristic of the “male depression” is an increased vulnerability. Criticism is taken more quickly than usual because it makes you feel threatened faster. At the same time, people with men’s depression are more likely to be very strict with themselves. Even because of trivialities they reproach themselves, are afraid to fail. The masculine depression also features strong inner restlessness. The concentration decreases, you get sleep problems.

Many men increasingly resort to alcohol, cigarettes, but also to excessive work, excessive sport or television consumption. The self-injurious behavior can lead to suicide in extreme cases – in depressed men more often than in depressed women.

Suicides in Men

Although the rate of suicide attempts is higher among women, men choose the violent forms, so that there are twice as many suicides of depressive men as women.

Sociological research has dealt with deviating risk factors in addition to the clinical picture. According to Anne-Maria Möller-Leimkühler, a professor of medical sociology, men are “particularly vulnerable to stressors that threaten their social status”. While women encounter risk factors at different levels, the professional role of men is the overriding source of stress. However, unlike a generation or two ago, there are more and more women who mainly define themselves through their job rather than family or friendly relationships.

This change in the role model of women shows one thing above all: Of course, the different risk factors are not carved in stone, but go back to the socialization and resulting different role models. The more the social roles of men and women converge, the more the risk factors will resemble each other. If the socioeconomic status of a family is traced back to the woman as much as to the man and it is socially accepted to be a homemaker as well as a housewife, a separate consideration of depression in both men and women will most likely become superfluous. As a consequence, this means that the phenomenon of “male depression” is a transient construct and that such a distinction may not be necessary at some point.

Depression in Men – Undoing the Taboo

Of course, the specific “men’s depression” does not mean that the usual symptoms of depression do not apply to men. There is no doubt that the usual symptoms of depression are for both men and women. But in men, the leading symptoms often appear masked. Precisely because the assumption is obvious that men are underdiagnosed and underrepresented in the statistics, there are calls in professional circles to extend the symptom catalog of depression to men typical complaints. The goal is to better recognize depression in men.

The gender paradox in the rates of depression and suicide makes it clear: not the depression, but the statistics are female. At the same time, depression requires more attention in men. Tiredness, irritability, workaholism, excessive alcohol, back and headache – just because depression in men is often first on the basis of physical symptoms, doctors should ring in such descriptions the alarm bells. The topic of depression in men must be extracted from the taboo in order to detect illnesses earlier and, in the final analysis, to prevent suicides. An overly rigid masculinity ideal can only be a hindrance.

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