It’s not a sign of weakness, and it isn’t a ‘feminine’ problem. If you’re one of the millions of guys who struggles in secret, take heart. This is a battle you can win …but don’t go it alone.

“His mind is somewhere else. He’s not even interested in sex!” Jenny wondered: “Where is the man I married. He is just so unavailable that I can’t reach him. When I try to talk to him, he gets reactive and yells at me.” Bill and Jenny had come for marriage counseling, and she was describing her concern about and frustration with Bill’s recent behavior. He had become increasingly picky and verbally abusive. He wasn’t sleeping well; he was eating less; and he was avoiding intimacy.

Bill responded angrily with: “She just wants more than I can give, and I’m maxed out. …I just want to run away and hide.” Even though Bill couldn’t recognize it, he was depressed and it was dramatically affecting his life and marriage.

Millions of men struggle with some form of depression. According to The American Journal of Psychiatry, in a given year, about 8 percent of American men over the age of 30 exhibit major depressive disorder and millions more experience chronic low-grade depression. Sixty to 80 percent of depressed adults never receive professional help, according to organizations such as the National Institute of Mental Health. Men are at the top of this list.

One of the problems with treatment is that depression is often not properly diagnosed. Yet, 80 to 90 percent of men seeking treatment can get relief from their symptoms, organizations such as the American Psychological Association say. We are convinced that the majority of men are depressed at some point in their lives, and, yet, most of them either don’t realize it or won’t admit it.

Male depression comes in two types: covert and overt. In overt depression, men feel fatigue, are sad, and experience changes in sleeping and eating habits. In other words, their depression is apparent.

In covert depression, the symptoms are masked by self-medication, isolation and lashing out. A man self-medicating a covert depression may be drinking, using drugs, womanizing or living the life of a couch potato. Isolation can be keeping to himself, even if he has a family. Lashing out can mean becoming violent and abusing a spouse or child.

Some types of depression run in families. However, they can also occur in people who don’t have a family history of depression. Common symptoms of depression include a mood of sadness, despair or emptiness. An inability to experience pleasure (called anhedonia) often accompanies a lowering of one’s self-esteem. Apathy, low motivation and social withdrawal with an excessive emotional sensitivity can occur, as well as negative, pessimistic thinking and increased irritability.

True depression as a disorder or disease state should not be equated with brief mood fluctuations or the feelings of sadness, disappointment or frustration that can arise from daily stressors. Clinical depression can last weeks to months, and many of you readers have suffered for years.

The American Psychiatric Association uses the following criteria to diagnose depression. To be clinically depressed, a person must have at least five of the symptoms listed (including the first two) for the same two-week period. The symptoms can’t be the normal reaction to the death of a loved one:

Depressed mood most of the day, nearly every day

Marked diminished interest of pleasure in all, or almost all, activities most of the day, nearly every day

Significant weight loss when not dieting (more than 5 percent of body weight in a month) or decrease/increase in appetite nearly every day

An abnormal speeding up or slowing down of physical activities or mental processes, nearly every day, as observed by others

Fatigue or less energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick)

Diminished ability to think or concentrate nearly every day

Recurrent thoughts of death (not just fear of dying) or suicide with or without a specific plan, or a suicide attempt.

Self-harm is the most significant potential result of a serious depression. According to the National Vital Statistics Report, there are an estimated 765,000 annual suicide attempts in the United States. Women may attempt suicide more often, but according to Unmasking Male Depression by Archibald D. Hart, 80 percent of all “successful” suicides in the United States are men, with those over 65 years old the highest risk group. The male suicide rate at midlife is three times higher than average, but at 65 and older, it is seven times higher.

In fact, also in the National Vital Statistics Report, suicide ranks as the eighth leading cause of death in this country, with one suicide death occurring every 17 minutes. According to the World Health Organization, by the year 2020, acute depression (not hunger or infectious diseases) will be the world’s second leading cause of death and disability trailing only heart disease.

The above numbers are shocking. Most men will not believe that these statistics apply to them because we are by nature prone to “emotional numbing.” As men, we become irritable and act out aggressively rather than admit emotional pain. Men in our society learn through modeling or social pressures to deny they have problems, because we are supposed to “be strong.” We tend to believe that being depressed is a sign of weakness or that it is a “feminine” problem.

This irrational belief sets us up for more pain and unnecessary suffering as we suppress our emotions and shut ourselves off from necessary intimacy with those that love us (our wives, children, friends, God). In our desire to escape our pain, we keep our minds distracted and look for quick fixes to feel good. We may turn to something we can be passionate about but doesn’t require much from us in return. As a result we engage in a world of “fantasy” or “affairs” which can include sports, pornography, sex, television, alcohol, even our jobs.

Joan came to counseling complaining that her husband, Jack, was irritable and distant but refused to come in with her because he believed she was the problem. He had lost his edge at work and at home. He just wanted to relax and watch television. He was not open to her sexual advances and was resistant to her pleas for time and attention. I (James) mentioned to her that I thought Jack was depressed and recommended she read —and try to get him to read —a book on male depression.

Two months later Joan discovered Jack’s affair with a co-worker and insisted on a separation. Faced with the consequences of divorce, Jack crashed, confessed and committed to addressing his depression and his relational “hiding strategies.” Depression can be a subtle enemy with many damaging side effects.

Twice as many women than men are diagnosed with clinical depression, but this does not necessarily mean that women are more prone to depression than men. Women tend to seek treatment far more readily than men, so they are more likely to be diagnosed. Also, the standardized criteria used to diagnose depression by counselors and physicians are more oriented to symptoms and manifestations of female depression than the symptom pattern displayed by men. Dramatic differences exist between the sexes in their outward display of depression.

In his book Unmasking Male Depression psychologist Archibald D. Hart offers some generalizations describing the differences between males and females in terms of how they may experience or express their depression:

A male will blame others for his depression, while a female will blame herself.

A man tends to act out his hostile and irritable emotions and attack when hurt, while a woman will feel her depression and withdraw when hurt.

A man wants to maintain control at all costs, while a woman has trouble maintaining control.

Men tend to turn to sports, television, sex and alcohol, while women turn to food and friends and will focus on their emotional needs.

A man is generally terrified to confront his weakness, while a woman often exaggerates or obsesses about her weakness.

A man will try to maintain a strong male image, while a woman may disintegrate at the slightest failure.
Can you relate to any of these? It has been said that for men, depression is a secret struggle. We are encouraged to play through our pain —not admit it, which often makes matters worse before we own up and get help.

But what causes depression? Where does it come from? A variety of possible sources exist and often more than one factor contributes. In general, however, the causes can be grouped into the following categories: biological-genetic, physical, spiritual, personality and interpersonal.

The Causes

Biological-Genetic and Physical Issues. Research is beginning to demonstrate that many depressive disorders are due to disturbances in brain biochemistry. They can be related to genetic influences, as well as environmental and life stress.

Serotonin is identified (along with the chemical messengers dopamine and norepinephrine) as being the primary neurotransmitters in the brain that account for variations in mood. In the last 15 years, the idea that abnormal levels of serotonin cause depression has been at the heart of most drug-development efforts. This hypothesis has been supported by the relative effectiveness of antidepressant medications that focus on increasing serotonin in the brain (also called SSRIs) such as Prozac, Paxil, Zoloft, Lexapro, and so on). Many researchers believe that this theory offers only a partial explanation.

According to a report in Science magazine, a “stress hypothesis” is creating new developments in depression research. The theory goes something like this: The hypothalamus in the brain produces corticotropin-releasing hormone (CRH) in response to stress. This hormone stimulates the pituitary gland, which triggers the release of glucocorticoids, such as cortisol. The problem is that excess cortisol damages existing brain cells (neurons) and impedes the growth of new brain cells.

Stress may lead to depression through these and related effects on neurons in the hippocampus (a brain structure that can actually start to atrophy). Although this may seem somewhat confusing, the bottom line is that untreated depression can lead to irreversible brain damage as well as increasing one’s risk for other medical problems (for example, hypertension, stroke and heart disease).

This theory also helps explain why men are so vulnerable to depression. When we drive ourselves hard and generate extra adrenaline to meet life’s threats and demands, the resultant stress on our bodies damages us physically and emotionally, and eventually we will crash. A lack of sleep and regular exercise, poor diet, overwork or exhaustion, or some physical conditions (for example, underactive thyroid, chronic illness or pain, diabetes, influenza, anemia) further contribute to depression.

We have a wonderful example in 1 Kings 19:4 of an “adrenal exhaustion” depression that Elijah suffered following the great victory on Mount Carmel— “Lord, just let me die!” This is a very normal physiological reaction following a peak period of adrenal usage. The purpose of the depression in this case is to remove us from further stress, to set us aside, and give us time for rest and recovery.

Spiritual Issues.

Sometimes depression appears to be the result of sin, although this does not mean that depression is always due to personal sin.

Possible sin-related causes of depression include negative attitudes or feelings such as bitterness and hatred, guilt and lack of repentance, turning away from God and His Word, fear of the future and lack of trust in God as sufficient provider.

A biblical example of this type of depression is found in 1 Kings 21. In the story of King Ahab, when he could not have Naboth’s vineyards, we are told that he ” …turned away his face and would eat no bread” (v.4, KJV). He displayed the typical signs of a severe depression when he could not get his own way.

Difficult, painful, stressful times of trial or struggle may lead to periods of depression. Such God-sent trials, however, are meant to purify us so we can bear more fruit (see John 15:2; 1 Pet. 1:6-7). We live in a fallen world and may be exposed to spiritual warfare. Satan and his demonic forces attack and oppress people, which can lead to depression.

Personality or psychological factors. When a person is lonely and fearful and resists interacting with others, he sets himself up for depression. When one has unresolved anger or hurt, these feelings are “stuffed” or repressed, and depression may result.

For many men, this psychological problem can also be the result of the spiritual problem of unforgiveness. Other situations that can trigger depression are insults, rejection or failure; a lack of positive, reinforcing or rewarding events; success (when it is very taxing or stressful); or learned helplessness (in which a person comes to believe they can do nothing to change life events). All of these circumstances can easily set men up for depression.

It may not just be these triggering situations that cause depression, but the way a person thinks in response to those situations. Perfectionistic, rigid ways of thinking, irrational misbeliefs (“I am in charge of my life”) or unbiblical self-talk (“this is hopeless”) can distort views of oneself, the world and the future. Depression often follows and continues unless such thinking is challenged and corrected with the truth.

Interpersonal Issues. When one is experiencing serious relationship problems (either at home or at work), they are prone to depression. It’s not surprising that 50 percent of depressed people also experience chronic marital discord. Research has shown that marital difficulties and family dysfunction have an effect on the course of depression, and relapse is more common among individuals whose families have a high degree of criticism in their communication.

Beating Depression

So how does the cause of depression relate to how I cope with it? When a person is depressed, something is wrong and needs to be addressed. Depression functions as a warning signal, letting us know that something is in need of attention. Think of a smoke alarm going off. It’s going off for a reason, and we need to respond.

Men have difficulty handling emotions, particularly the negative ones and the painful ones. I feel depressed for a reason and as long as I can identify the reason, or the trigger, and deal with what is causing the depression, then the depression is serving its purpose. It is important to recognize the function of depression and use it as an ally.

We’d like to do away with pain, but we need pain. Emotional pain tells us when we have reached our limits, when we reached the boundaries, when things need to be put right. The purpose of depression may be to slow us down so we can recover or move us to confess sin or strengthen our faith in a time of trial.

Depression can be a “healing emotion.” Since depression is legitimate, it must be experienced up to a point. Don’t fight or resist your depression. Don’t blame others for it. Force yourself to accept the idea that it is both normal and necessary, and allow yourself to be depressed. The sooner you recognize this, the quicker you will recover from depression.

When we cooperate with depression it produces a curative change in our values, our lifestyles and our commitments. Sometimes we won’t change through any other means. Anyone who has experienced victory over depression is likely to agree. The following suggestions will help you cope with and heal depression:

1. Learn to recognize your depression, and let your family and friends help you. This may seem obvious, but men may not notice they’re depressed unless someone else draws attention to it. Contract with people close to you to tell you whenever they think you are depressed. Try to be with other people and confide in someone; it is usually better than being alone and secretive. If you find yourself losing interest in all your activities, withdrawing from loved ones or escaping into bad habits, admit your depression and label it as such.

2. Don’t wait to seek medical attention. Men are notorious procrastinators when it comes to going to the doctor. Depression may be the result of another medical condition. If medication is necessary, your doctor can discuss this option with you. Don’t rule out talking with a counselor. Therapy is not a sign of weakness but represents strength in being proactive about your mental health. Counseling can help resolve personal and relational stressors.

3. Set realistic goals, and assume a reasonable amount of responsibility. Break large tasks into small ones, set some priorities, and do what you can as you can.

4. Clarify your values. All loss is related to values. If we don’t value something, it is not a loss when it is taken away. Am I majoring on the minors of life, or is my focus on what really matters? Do I have causes worth living for and life goals that bring meaning?

5. Participate in activities that may make you feel better. Mild exercise, going to a movie or participating in church and social activities may help. Try to avoid activities that tend to rev up your adrenaline, as these will make your depression worse or prolong your recovery.

6. Expect your mood to improve gradually, not immediately. Feeling better takes time. People rarely “snap out of” a depression. They feel a little better day by day. It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition —changing jobs, getting married or getting divorced —discuss it with others who know you well and have a more objective view of your situation.

Depression is inevitable for most of us, especially if we live demanding and active lives. You don’t have to suffer in secretive silence. Courageously embrace your depression and discover the message God has in it for you. Bring God and others in to help you recapture your heart, and move through to a place of true strength, healing and an abundant life.

The Male Brain: Wired for Depression?

Millions of men leave themselves wide open to depression and they don’t even know it. When you drive yourself hard (and most guys do), your brain triggers chemicals to meet life’s threats and demands. The resulting stress on your body damages you physically and emotionally until, eventually, you crash. This helps explain why men are so vulnerable to depression. Look under the hood and see for yourself:

When faced with a stressor, the pituitary gland in your brain cues the adrenal glands to release several types of hormones, including epinephrine (adrenaline) and cortisol. Adrenaline, the “emergency hormone,” prepares your body to deal with sudden danger or stress.

Adrenaline increases the rate of your heartbeat and breathing, raises your blood pressure and increases the sugar in your blood (as an energy source). This energy source goes to the muscles. Because you’re breathing faster, you have more oxygen in your lungs and muscles.

Glucose stored in your body is released to give extra energy —power to the muscles. Some of the blood and nutrients stored in your internal organs go to your heart, lungs and muscles. Your brain switches to a “super charged” state. Your senses are at their sharpest, and you’re aware of the slightest change around you.

This chronic state of readiness shuts down functions such as metabolism, causing indigestion, heartburn, fatigue, weight gain and decreased sex drive. The cortisol produced during the stress response makes you a target for a wide range of physical maladies: from cold and flu to heart disease and stroke.

The excess cortisol damages existing brain cells (neurons) and impedes the growth of new brain cells. Stress may lead to depression through these and related effects on neurons in the hippocampus (a brain structure that can actually start to atrophy). Untreated depression can lead to irreversible brain damage as well as increasing one’s risk for other medical problems (for example, hypertension, stroke and heart disease).

Eating right and exercising helps control stress and so does getting enough rest. You also need a strategy for dealing with the stress in your life. (Check out Richard A. Swenson’s book Margin if you need help with this.) You can’t avoid stress, but learning to manage it is essential if you want to steer clear of depression.

This article was originally featured in the former publication, New Man Magazine. Its source: the book, “Men’s Health for Dummies,” published by IDG Books Worldwide.

James Childerston is a psychologist in private practice in Hagerstown, Maryland. Doug Rosenau is a psychologist and sex therapist in Atlanta.