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Some of the major barriers to diagnosis and treatment of depression among men still include denial, social conditioning, family influences, and gender or cultural biases.

‘Don’t be a wimp” ... “Buck up” ... “Keep your problems to yourself — nobody wants to hear them” 85 “You’re the Man” ... “We’re counting on you.”

In the not so distant past, boys learned from toddlerhood on to suppress their emotions, project strength and confidence, and grin and bear it through all kinds of pain and sorrow. Parents, teachers, relatives, and peers reinforced the message. On the other hand, women were portrayed as the weaker sex needing the protection of strong, unwavering men. Not true today, we say, but beliefs and behaviors may not have changed as much as we think. Some of the major barriers to diagnosis and treatment of depression among men still include denial, social conditioning, family influences, and gender or cultural biases.^1,2,3,4

Men who’ve experienced childhood abuse or neglect, for example, are just as likely as their female counterparts to experience depression and other disorders in adulthood. Unfortunately, they are less likely to be screened and treated for it.⁴ Women are much more likely than men to be diagnosed with and treated for depression.

Family conditioning may significantly affect the reluctance of men to acknowledge or seek treatment for depression. Although family members may play an important role in encouraging male relatives with symptoms of depression to seek help, this happens more frequently with women.³

Compounding the problem, the media consistently portray depression as uncommon among men. When advertisements from 1981 to 2001 journals that targeted to prescribing professionals were examined for gender bias, the face of depression was predominantly white and female. Fifty-seven percent of advertisements for psychotropic drugs examined featured women, and 88% of depressed individuals portrayed were white. The lack of male representation and cultural diversity in advertisements may contribute to reduced awareness of and screening for depression among men and minorities of both genders.⁵

Once men and women begin treatment, research shows both similar and different responses to antidepressants. For example, one study of 385 patients with major depression (139 men and 246 women) revealed gender differences in the prevalence and presentation of depressive symptoms, but no difference in the response to antidepressant medications.⁶ However, pharmacokinetics research also shows that culture and gender are associated with differing metabolic actions and tolerance for many antidepressants.²

Unipolar depression is less common among men than women. Likewise, hormonal changes at the onset of puberty are believed to be a significant factor for the gender variance in depression incidence.¹

Outcomes, health conditions

Depressed men, unlike depressed women, experience more favorable outcomes after coronary artery bypass grafting (CABG) surgery⁷ and after admission for other cardiac conditions, such as acute myocardial infarction or congestive heart failure.⁸ Obesity is also less likely to be associated with major depression among men than women.⁹ However, the findings that men with comorbidities fare better than women should not diminish the importance of screening for and treating depression among men. Open dialogue with men and women is needed to facilitate diagnosis and treatment of depression. Another study of 460 patients with heart failure revealed depressive symptoms to be the strongest independent predictor of short-term decline in health status in men and women.¹⁰

Nurses must also pay close attention to male caregivers who, like women, have a high depression potential, especially when they are caring for someone with Alzheimer’s disease. Interventions that include counseling and support groups can reduce depressive symptoms among caregivers of either sex.¹¹

Unexplained fatigue in men may be one way depression manifests itself. However, if the symptom persists after medication therapy is under way, evaluation for obstructive sleep apnea is warranted, especially in those with hypertension.¹² Poor-quality sleep can result in psychological and physical manifestations that look like depression, and restoring a more healthy sleep pattern may help rule out that diagnosis. In addition, depression is an independent risk factor for ischemic heart disease and is often found among men after myocardial infarction.^13,14