Guys diagnosed with both depression and anxiety take a double blow to their masculine self-image. In the clinch, though, accepting the fact and asking for help shows true guts.
By Jodi Helmer
When Kevin S. began to feel irritable, anxious and exhausted, he attributed the symptoms to his job, certain the long hours and high-pressure environment he faced as a banker on Wall Street were to blame for his moods.
“It started to weigh on me and affected my ability to get through the day,” says the 39-year-old, now an Internet entrepreneur in California. “I knew there was something wrong, that it wasn’t right to feel so sad and anxious for so long.”
Hobbled by fatigue, Kevin struggled to work the long hours his job demanded. Social anxiety made it hard to endure the “water cooler” atmosphere at the office. Instead of joining in for happy hour, Kevin withdrew from his colleagues, spending increasing amounts of time alone. He quit his job in 1998, but the symptoms persisted.
Reluctant to reveal his difficulties, Kevin tried to cope on his own for years. When he finally opened up to his doctor in 2004, he was diagnosed with depression and anxiety.
While a diagnosis of both disorders can feel like a double whammy, it’s common for depression and anxiety to occur together. A 1995 Columbia University Medical Center study which identified baseline figures in the general population noted that 85 percent of those with depression also experience symptoms of anxiety. Similarly, depression is diagnosed in up to 90 percent of those with anxiety disorders.
In fact, getting the double diagnosis actually may promote better recovery: “One key to successful treatment of patients with mixed depressive and anxiety disorders is early recognition of comorbid conditions,” concluded study author Jack M. Gorman, MD.
The fact that those disorders frequently co-occur doesn’t make receiving the diagnosis any easier, especially for men imbued with traditional notions of masculinity.
“There is a perception that it’s not OK for men to feel anxious or down,” explains John Ogrodniczuk, PhD, associate director of the psychotherapy program in the psychiatry department at the University of British Columbia. “Boys are taught not to cry, but to buck up and deal with it. Being diagnosed with a mood disorder can have a significant impact on a man’s self-esteem.”
Because women are diagnosed with both disorders at twice the rate of men, depression and anxiety are often perceived as “girl troubles”—but the numbers could be deceptive.
In an article drawing on a range of research into male depression, published in Canadian Family Physician in February 2011, Ogrodniczuk and his co-author noted that the lower incidence of depression among men could reflect their tendency to deny illness and their reluctance to talk to health-care providers about symptoms.
Men are supposed to pull themselves up by the bootstraps and get things done, not feel sad and anxious all the time.
Research on men’s “help-seeking” behavior has found that men typically do not disclose emotional concerns to their doctors, focusing instead on work problems or stresses in their lives.
“Men often fail to seek help because they perceive it as a sign of weakness,” says Ogrodniczuk.
Kevin admits he was embarrassed to reveal his problems to his doctor.
“It’s not something I was comfortable talking about,” he says.
While social norms encourage males to be stoic and self-sufficient, atypical symptoms also may contribute to the underdiagnosis of depression and anxiety in men, notes Diego A. Pizzagalli, PhD, associate professor of psychiatry at Harvard Medical School and director of the Center for Depression, Anxiety and Stress Research at McLean Hospital.
“There is some evidence that men manifest depression and anxiety differently than women,” adds Pizzagalli, “and that can make it more difficult to get an accurate diagnosis.”
Research published in the Journal of Abnormal Psychology in August 2011 found that among individuals diagnosed with anxiety disorders, women were more likely to withdraw and experience loneliness and depression while men tended to display aggressive, impulsive, coercive and noncompliant behaviors.
Kevin experienced few of the symptoms traditionally associated with his two disorders, such as crying, sleep difficulties and hypervigilance. Instead, he was irritable, antisocial and cynical.
“I knew something was wrong, but I didn’t think it was depression or anxiety,” he says.
There is another reason men may be reluctant to seek treatment: fear of sexual side effects associated with certain antidepressants.
Kevin knew medication might dampen his sex life, but decided it was worth the risk. When he did experience the sexual side effects he’d discussed with his doctor, Kevin made another appointment to address the problem.
“Depression and anxiety had already made sex less enjoyable because I had less drive, and performance anxiety,” he explains. “The [antidepressants] made me feel better and I treated the sexual side effects, and now sex is a lot better.”
Myths of manhood
When Michael V. was diagnosed with depression and anxiety in 1978, he wasn’t relieved to put a name to the symptoms that had troubled him for years. Instead, he felt like a failure.
“Men are supposed to pull themselves up by the bootstraps and get things done, not feel sad and anxious all the time,”
The 59-year-old from Carson City, Nevada, was plagued by headaches, sore muscles and lethargy in his teens and 20s—symptoms he associated with the flu. He made several visits to his medical doctor between 1970 and 1976 looking for a cure, but the barrage of medicines he was prescribed didn’t help.
Asking for support is the manly thing to do, a sign that you’re taking control of your life.
In addition to his physical symptoms, Michael began to feel angry and irritable most of the time. He also experienced constant nervousness and occasional panic attacks.
“At times, the anxiety was so intense that I started to believe something dangerous was going to happen and I had to escape whatever situation I was in,” Michael recalls.
As his condition worsened, Michael turned to a psychiatrist. When he got his double diagnosis, he worried that others would see him as a freak.
“I was embarrassed to tell my friends,” he recalls, “so I stayed in my room and listened to music, hiding.”
Michael admits he still feels some embarrassment about not conforming to ideals of masculine fortitude. Societal expectations that a man should be a good breadwinner also weigh heavily on him. After working more than 40 different jobs in his 20s and 30s, from forklift operator to massage therapist, Michael applied for disability benefits.
“When I meet other men and they ask what I do for a living, I make up stories,” he says. “The fact that I’m not working really depresses me.”
Kevin, meanwhile, acknowledges that having anxiety and depression has hindered his professional success.
“It’s holding back my career,” he says. “I should be going to conventions, meeting potential clients and promoting my [company], but the thought of putting myself out there like that makes me really anxious.”
Research shows that when anxiety and depression occur together, the course of illness is often more chronic and more severe, with greater impact on quality of life than with either disorder alone. And treating one but not the other may worsen symptoms of both.
“Both the anxiety and the depression must be addressed in order for treatment to be successful,” Pizzagalli says.
Not seeking treatment at all, meanwhile, can have serious health consequences. Men who are diagnosed with anxiety face double the risk of developing diabetes, and are four to six times more likely to die from sudden heart failure.
There are other life-threatening factors to consider as well: “The risk of not being diagnosed or not addressing the underlying issue is the risk of depression and anxiety progressing to a dark place,” notes Ogrodniczuk.
According to Pizzagalli, the temptation to self-medicate is also a big issue for men.
“Men with mood disorders have higher rates of alcohol and drug abuse,” he explains. “It’s a maladaptive way of coping that can lead to other problems,
Men with mood disorders have higher rates of alcohol and drug abuse. It’s a maladaptive way of coping that can lead to other problems, including addiction.
Michael numbed his symptoms with alcohol for decades before he quit drinking in 2000.
“I started drinking and smoking anything I could get my hands on to relieve the anxiety and sadness, but the symptoms just escalated,” he recalls.
He now uses yoga, meditation and therapy to help him relax and combat low moods. Because resources are limited in his rural community, he participates in a weekly group counseling session over the telephone.
“I live for that call,” says Michael. “It helps me so much to know that I’m not alone.”
Despite the fact that men are more apt to be guarded, studies have shown that group therapy—especially in all-male groups—helps men overcome emotional isolation, fosters interpersonal connectedness and offers a safe environment to express vulnerable emotions.
“Peer support is extremely valuable,” notes Dave Gallson, associate national executive director for the Mood Disorders Society of Canada. “It provides the opportunity to learn how others have recovered from the illness, hear valuable lessons about what worked for other people and, most importantly, it offers the benefits of hearing directly from people who will let you know that you are not alone.”
Building informal support networks, meanwhile, can be especially challenging for men because of their socialized need not to appear needy or vulnerable. Many men are reluctant to disclose their diagnosis even to friends.
“Admitting to having depression and anxiety is the mental health equivalent of coming out of the closet,” says William B., 37. “It feels like such a big deal and you’re never certain how other people are going to react.”
William, a consumer researcher from Charlotte, North Carolina, was initially pretty secretive about his 2004 diagnosis of depression and anxiety.
At the time, he was certain that a cascade of stressful life events—including losing his job and learning his mother had cancer—were to blame for his condition. William agreed to a medication regimen and therapy to get through what he saw as a temporary rough patch, expecting his symptoms of sadness, fatigue, hopelessness and anxiety would disappear when his circumstances improved.
“I thought, ‘I need [help] now to get out of this spot and once I’m back on my feet, things will go back to normal,’” he recalls.
Admitting to having depression and anxiety is the mental health equivalent of coming out of the closet.
When traces of his symptoms lingered despite treatment and lifestyle changes, William realized his need for medication and counseling might be ongoing. He decided it was time to tell his friends.
“I resigned myself to the fact that I couldn’t do this alone,” he says. “When I told them, it was, surprisingly, not a big deal.”
Though Kevin suspects his friends wouldn’t judge him for his diagnosis, he still feels uncomfortable talking about it.
“I wouldn’t want them to feel weird around me or worry that they needed to do something to help me,” he says. “I just don’t know what I would gain from it.”
According to Ogrodniczuk, there is plenty to gain from seeking the support of friends and family.
“Fear is really self-defeating,” he says. “You need to perceive your willingness to seek treatment to deal with depression and anxiety as a sign of strength. Asking for support is the manly thing to do, a sign that you’re taking control of your life.”
“Everyone I told was supportive,” he recalls. “It was a good reminder that they weren’t going to let news of my diagnosis define me. All they cared about was wanting me to feel better.”
Sidebar: When symptoms overlap
Although depression and anxiety seem like opposites, many symptoms are common to both mood disorders. In fact, research published in the quarterly International Journal of Pharma World Research in spring 2010 found that the overlap in symptoms often leads health care providers to mistakenly diagnose either depression or anxiety instead of giving an accurate double diagnosis.
A list of overlapping symptoms from the Anxiety Disorders Association of America includes:
- Difficulty concentrating
- Muscle tension
- Sleep disturbances
- Obsessive worry, fear provoked by certain situations (social gatherings, plane travel, public speaking) and the heart-racing, sweat-dripping occurrence of panic attacks point more clearly to an anxiety disorder.
Sidebar: Are hormones to blame?
Researchers may have discovered one of the reasons that men are diagnosed with depression and anxiety half as often as women: body chemistry.
“A difference in hormones could be the reason that men have lower rates of mood disorders,” explains Mohamed Kabbaj, PhD, an associate professor in the College of Medicine at Florida State University who specializes in researching gender differences in depression and anxiety. “Testosterone appears to be protective.”
In lab studies, Kabbaj found that lowering testosterone levels in male rats led the animals to develop depression-like symptoms, including less interest in pleasurable activities. Injecting the males with testosterone had the same effect as a shot of antidepressant drugs, reversing the impact of depressive symptoms; injecting female rats with testosterone did not improve symptoms of depression.
In a separate study, he looked at the brains of male and female rats exposed to anxiety-provoking situations. Researchers found differences in activity in the medial prefrontal cortex, an area of the brain associated with emotional expression. Males had higher levels of activity in the gene zif268, which has been linked to learning, memory and drug addiction. When researchers reduced the gene’s activity, the male rats became more anxious.
Kabbaj believes that testosterone keeps levels of zif268 higher in males than in females, possibly leading the males to experience anxiety less often.
Identifying such gender differences in depression and anxiety could lead to better treatments, he says. For example, understanding testosterone’s protective role in depression and anxiety could suggest different pathways in the brain for new medications to target.