It’s the dead of winter. You wake up in darkness and go home in darkness. You find yourself more irritable, short tempered. Your energy and enthusiasm for things you typically enjoy starts to fade. Food selection gets skewed, in some cases comfort eating takes place, and others a tendency to miss meals may occur.
You may find yourself feeling a sense of existential angst. Maybe, you even find yourself becoming tearful with mild provocation. Your interest in sex may diminish. Your ability to fall asleep and stay asleep may be disrupted. Often times, men slip into depression with atypical symptoms. They may not experience the overwhelming sense of sadness and tearfulness that is classically associated with depression.
Dr. Stephen Petteruti explains the causes of depression:
As best we can understand it, depression is a disorder of neurochemistry. Somehow the chemicals that communicate an impulse from one nerve to the other become imbalanced. These chemicals are known as “neurotransmitters “. They travel across the synapse- that is the small gap between one nerve and the next – in order to maintain a continuous, balanced, neurological state.
Neurochemicals such as norepinephrine, serotonin, dopamine and others must be produced and balanced in order to maintain optimum mood. This complicated system of neurochemistry can be thrown out of balance by many factors. Certain drugs are known to deplete neurochemicals in a way that promotes depression.
Traumatic injuries to the head, even if they don’t rise to the level of a concussion can also have an effect on neurochemistry. Depressed mood can complicate a post head trauma patient and require medical therapy.
Persistent psychological stress can ultimately exhaust norepinephrine and serotonin in our brains, ultimately making us more likely to experience depressive symptoms as our body has difficulty maintaining healthy levels in the face of overwhelming demand.
Chronic sleep deprivation, like that sometime seen in third shift workers, can also predispose us towards imbalanced chemistry.
Deprivation from inadequate exposure to sunlight and fresh air is another manageable risk factor for depression. It also seems that our brains thrive on social interaction. Prolonged isolation can tilt neurochemistry towards depression.
If you recognize the symptoms in yourself or a loved one, how should you respond?
First a word of caution on suicide; as men, we tend to take action and have a higher rate of success at this desperate act. A passive hope for a calm termination of life can sometimes accompany depression. This is typically captured by the feeling that it wouldn’t be so bad if you didn’t wake up the next morning. However, if this passive thought turns to an active plan, that’s a sign of severe depression that requires immediate attention with professional help.
Assuming such is not your state, you may be suffering from a milder form of the disorder. Sometimes termed “adjustment disorder” this term refers to a reaction to negative events. Death, divorce, loss of income or status to name a few. These events often are followed by a cycle of depression typically lasting up to six months from which we can recover with our own initiative in most cases.
Another mild form of depression is “seasonal affective disorder” better known as the winter blues.
When you know the symptoms of depression, you start by treating it like any other illness. You must have three square meals a day. You must physically use your body every day, either going to the gym or pursuing vigorous physical activities. It is important to attempt to sleep well. Avoid things that disrupt your sleep cycle. Social interaction is essential. A tendency toward isolation can amplify depression. Pursue these activities even if you don’t feel like it. Consider them as treatment for your illness. Have faith that what you are suffering is transient. It will get better.
At what point should you consider professional help?
I recall a patient I encountered while I was practicing medicine in the army. By the time I saw him, he had been to multiple specialists seeking a resolution for his “chronic sinus pain”. He had been on multiple antibiotics; he even had several sinus surgeries performed with no relief. Over the course of taking his history, I began to notice some signs of depression within him. Trouble sleeping, strain with his wife, short temperedness, raised the suspicion that his chronic pain may have been a manifestation of depression.
After explaining my theory to him, he was willing to try a cycle of antidepressant medication. He came back several weeks later, his pain fully resolved. His wife, who was also my patient, thanked me for giving her back the man she had married.
In some cases, pharmacologic therapy can help to improve the neurochemical imbalance that is at the root of depression. Consider it like a tow truck pulling you out of a rut. Once you are safely back on the road, it becomes possible to maintain that pathway. This is where pharmacotherapy can combine with counseling to achieve the best outcome.
If you start to lose functional ability, it’s time to seek help. Missing work, significant weight gain, domestic stress, chronic pain, are signals that it’s time to seek help. Becoming tearful in your car on the way home may be a tolerable symptom, becoming tearful in the middle of a workday in front of colleagues or customers becomes a red flag for immediate help.
If you do seek consultation with your physician, be slow to embrace antidepressant medications. Many of these drugs can dull your response to all stimuli, good and bad. If overwhelming emotion and tearfulness are afflicting you and interfering with your function, these medications may have a role. If your symptoms are less severe, I would recommend avoiding drug therapy. Too often, I’ve seen patients start an antidepressant drugs lose their edge, become more dependent on the comfort the pharmacology brings and therefore avoid developing their own innate coping skills.
If drug therapy is required, you may want to consider the herbal remedy St. John’s Wort. This has been shown to have antidepressant value. Within the antidepressant class, Wellbutrin is known to have fewer blunting side effects, less weight gain and no adverse effects on sexual function. Paxil is to be avoided, (it carries a risk of weight gain and sexual dysfunction).
If drug therapy is started, you can expect affect to set in between two and four weeks. In some cases, upward titration of dose will be required. The total cycle of treatment will typically span between six and 18 months. Be sure your doctor is checking you for hypothyroidism as well as low testosterone levels. Either condition can make depression more difficult to cope with.
Being depressed is inevitable in the course of every man’s life. Learning how to remain functional, despite the depression is an essential skill. Knowing when to seek physician’s care and consider medication can be essential to better living. Remember, other people are counting on you. You can become a role model on how to deport yourself through difficult times simply by persevering.
All men will navigate through cycles of depression in the course of their lives. Your ability to sustain yourself will serve you well as you walk through each season of your life.
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