Depressed man

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We all know women like chocolate and a good gabfest while men prefer a cold beer and a good video game. Okay, so that’s a cheesy generalization, but it does soften you up for today’s hard topic: Men are different than women when it comes to depression. Brain imaging studies show women recall emotionally laden experiences more vividly and intensely than men. (This is no surprise to any marriage counselor who has witnessed the woman recounting in exact detail every nuance of a conflict while the man looks on dumbfounded.)

There is actually an evolutionary reason for this. Women’s greater emotional sensitivity has helped them keep their young safe, while men’s tendency to be out to lunch on this has helped them keep their minds squarely on the hunt. Add to this the finding that women also tend to ruminate more on emotionally negative events and you can see why women would be more likely to be depressed.

In fact, by most surveys across all demographics, women weigh in with twice the rate of depression as men. However, the consequences of depression are particularly dire for men, especially as they age.

Pay attention, guys (and all you guy-lovers out there): A nationwide health survey found that men over 65 are eight times more likely to commit suicide than women of similar age. The same survey, published in the Archives of Internal Medicine, found that depressed men were more likely to die of heart disease than women with heart disease.

Here is how it shakes down. When women become depressed, they reach out and share the pain. When men get down in the dumps, they withdraw, go stoic, or act out in some way.

And because women tend to be more "out there" with their feelings, more willing to share them with their friends or with a therapist, male depression will often go undiagnosed. Midlife is a particularly vulnerable time for men as they start having to deal with the inevitable limitations to their prowess that comes with greater age. After all, we guys have to be ready for the battle, even though whatever battles that need to be won have probably already been won (if they're is going to be won at all) by this time. Better to pound the chest while speeding down the coast’s highway in a spiffy sports car with a new blonde in tow than break down, crying like a big baby on the ninth hole of the golf course.

Many men will do anything to stay in the game, which is why so many try to avoid the more typical symptoms of depression, such as experiencing feelings of sadness, anxiety, guilt, and worthlessness. Often, however, they can’t avoid other symptoms like trouble with sleeping, concentrating, remembering, or changes in appetite and energy levels. There are other symptoms that are especially hard for depressed men to avoid manifesting; they include angry, violent, reckless, or compulsive behavior, digestive problems, and physical pain.

It should be obvious that women will benefit from psychotherapy when it comes to depression. After all, they are better at sharing emotional material with others. But studies support this as an effective treatment for men as well, although they often are more resistant to initiating treatment (it’s simply not macho to tell a stranger you are not feeling like the stud you once were). Most research in what constitutes effective treatment for both men and women support a combination of psychotherapy — especially when it is either cognitive-behavioral or interpersonal therapy — along with antidepressant medication. This has been shown to be more effective than medication alone.

Dr. Michael O.L. Seabaugh is a licensed clinical psychologist with a psychotherapy practice in Santa Barbara. Comment at healthspan@mac.com and visit his Web site/blog at HealthspanWeb.com for more information on the topics covered in this column.

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