Do Men and Women Express Depression Differently?

Men's Health has an article in its latest issue, entitled "Exercising Your Demons," about men and depression (thanks to the reader who sent the article to me). The caption reads: "Some people might call you highly competitive. Some might call you superfit. But a growing number of doctors would label you something else: Depressed." A 33-year-old male, Raymond Britt, who runs competitively is used as an example of a depressed man who takes up grueling sports to ward off anger, hurt and unhappiness.

The article speculates that men suffer from depression as readily as women but the symptoms in men show up as pushing themselves too hard at sports, working too hard, drinking and anger:

The numbers seem to show that men and women suffer from various mental illnesses at about the same rate, with some notable variations and exceptions. One of the differences, long accepted as gospel by the psychiatric professions, is that twice as many women as men suffer from depression. Kessler says his numbers show that a woman is twice as likely as a man to have a single episode of major clinical depression in her life. After the first episode, however, men and women don't differ in the number of episodes they'll have during a lifetime, or in whether they'll have another episode. Only the first step differs, he says. Then the statistics flatten out to equal.

But if repeat episodes of depression are equal for men and women, doesn't it stand to reason that they may be having first bouts at the same rate? Maybe the discrepancy lies not in the number of men and women who are depressed, but rather, in how depression is expressed.

According to an increasing number of experts, the diagnostic tallies don't take into account the real experience of a lot of men like Britt. They also ignore the fact that women are much more likely to report depression and seek help. Men are more likely to try to fight through their depression, using strategies ranging from hard work to extreme exercise to drinking to violence. Nearly four times more men than women kill themselves.

In my clinical experience with men and boys, it certainly seems that those around them are often clueless about their depression. I had one teen who was irritable and angry at school and often overreacted with other kids in class. When I met with the school staff to discuss some test results showing a significantly high level of depression, they were shocked. One female teacher said, "I never knew he was depressed -- when I am sad, I go home, cry and eat chocolate chip cookies, I don't get angry."

"Well, maybe not," I said, "but then, you are not an adolescent boy who is being bullied at school." Once the staff understood the dynamics of this young man's depression, they started to change the way they dealt with him and worked on reducing the depression, with the result that his anger subsided some. Yet the depression would have gone untreated if the staff had continued to think depression was only expressed by crying, eating too many cookies, and withdrawal.

In an article entitled Are Men Getting Shorted on Health? the author likens depression in men to heart disease in women: "Some experts think that depression contributes to these reckless and self-destructive behaviors, but that just as heart disease was initially defined by men's experiences and therefore ignored or missed in women, depression may have been framed by women's experiences and therefore may be missed and go untreated in men."

It is often said that anger is depression turned outward and this is often true (of course anger can be other things, such as a response to a sense of injustice or unfairness). Dealing with men's depression means that one cannot be afraid of anger or the underlying emotions that go with it. But the key is to know the difference between typical masculine behavior and true depression and to not pathologize the former, while being sure to properly treat the latter.