Big Boys Do Cry

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Depression in men is often missed and rarely treated

By Jennifer Thomas
HealthDay Reporter

You could call Jimmy Brown a man's man. He was a New York City police officer before becoming a fireman.
He was working at the firehouse across the street from the World Trade Center the day of the terrorist attacks.

In the ensuing hours, he found himself running for his life down the stairs of the South Tower and diving through a broken window in a nearby building to avoid being crushed from falling debris when the North Tower collapsed.

Brown got out alive -- but not without a price.

He took up smoking again. He started drinking too much. He couldn't sleep. And he felt paralyzed by a pervasive sense of anxiety and sadness.

Brown, now 36, was diagnosed with depression.

"I started to feel like I had absolutely no purpose in life," he says. "I'd get up in the morning and wonder, 'What the hell are you getting up for?'"

Brown is one of six men who volunteered to be part of a National Institute of Mental Health (NIMH) campaign called "Real Men. Real Depression." The others include a lawyer, a publisher, a college student, a retired Air Force sergeant and a national diving champion.

The campaign, which kicked off Tuesday, aims to raise awareness that depression can, and does, strike men -- and it's OK for men to seek help.

"For generations men have been told that they have to act tough," states U.S. Surgeon General Richard Carmona. "Today, we're saying to men, 'It's OK to talk to someone about what you're thinking, or how you're feeling, or if you're hurting.' We are attacking the stigma that tough guys can't seek help. They can and they should."

But there are barriers, says Dr. Dennis Charney, chief of the mood and anxiety disorders program at NIMH.

The first is that depression is perceived as more of a women's disease. Some studies have shown depression affects twice as many women as men.

While it's probably true more women suffer from depression, Charney says, the gap between men and women is likely not as large as generally believed.

NIMH estimates that about 6 million men in the United States have serious depression, although that number is probably low. "Depression is under-recognized and under-treated," Charney says.

Part of the reason: Men are less likely to talk about their feelings or to seek treatment.

And some men may not recognize their irritability, sleep problems, loss of interest in work or hobbies, and withdrawal as signs of depression. This means they might not even realize they have a condition that can be successfully treated, Charney says.

Men may also try to mask their feelings with alcohol or drugs, or to work excessively long hours.

Older men are especially prone to avoid asking for help, says Dr. Jurgen Unutzer, an associate professor of psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles.

Unutzer and his colleagues surveyed 1,801 adults age 60 and older in 18 primary-care clinics in five states. They found 32 percent of women had received treatment for depression in the three months before the study, compared to only 22 percent of men.

"Women were 50 percent more likely to have had treatment for depression," Unutzer says. "We are missing a tremendous opportunity to help men."

Most of the people Unutzer treats for depression are women. When he treats men, they're often dragged in by their wives.

"It's a very difficult thing for men to talk about it," he says. "They try to minimize it. When I ask them about their symptoms, they tend to say, 'Oh, it's not that bad.'"

But that doesn't mean they're not suffering.

Older men are by far the single highest risk group for suicide, he says. Men 65 and older account for about 10 percent of the U.S. population. But about 33 percent of suicides are among men in this age group.

Brown was able to recognize his symptoms with the help of a peer support group. He sought counseling and within a few months, began to feel like his old self again.

What advice does he have for other men?

"I would tell them that they're not alone," Brown says. "A lot of men suffer with this in the shadows. It's not spoken about. It's pretty much taboo. But there are treatments out there that can help. You can actually have a better life."