Men & Depression: Facing Darkness

For decades, psychologists believed that men experienced depression at only a fraction of the rate of women. But this overly rosy view, doctors now recognize, was due to the fact that men were better at hiding their feelings. Depressed women often weep and talk about feeling bad; depressed men are more likely to get into bar fights, scream at their wives, have affairs or become enraged by small inconveniences like lousy service at a restaurant. "Men's irritability is usually seen as a character flaw," says Harvard Medical School's William Pollack, "not as a sign of depression." In many cases, however, that's exactly what it is: depression.

If modern psychologists were slow to understand how men's emotions affect their behaviors, it's only because their predecessors long ago decided that having a uterus was the main risk factor for mental illness. During the last two centuries, depression was largely viewed as a female problem, an outgrowth of hormonal fluctuations stemming from puberty, childbirth and menopause. Even the most skilled psychologists and psychiatrists missed their male patients' mood disorders, believing that depressed men, like depressed women, would talk openly about feeling blue. "I misdiagnosed male depression for years and years," says psychologist Archibald Hart, author of "Unmasking Male Depression."

Some of the symptoms of depression are so severe, like gambling addiction or alcoholism, they are often mistaken for the problem. David Feherty, the affable CBS golf commentator and former golf pro, began drinking at such a young age it became part of his personality. "I drank a bottle of whisky in order to get ready to start drinking," he jokes. By his 40s, he routinely consumed two bottles of whisky a day, and was in such physical pain, he thought he suffered from "some kind of degenerative muscle disease." During that period, he maintained a jovial front, and kept up a steady stream of on-air wisecracks during golf tournaments. "It was a problem that just, I don't know, ate itself up and got bigger and bigger and then, one day, bang, I disappeared." When he finally learned in 2005 that he suffered from depression, he felt a combination of shock and relief. "That was the most stunning thing. I just thought I was a lousy husband and miserable bastard and a drunk," says Feherty, now 48. "A mental illness? Me? I had no idea."

The widespread failure to recognize depression in men has enormous medical and financial consequences. Depression has been linked to heart disease, heart attacks and strokes, problems that affect men at a higher rate and an earlier age than women. Men with depression and heart disease are two or three times more likely to die than men with heart disease who are not depressed. Lost productivity due to adult depression is estimated at $83 billion a year. Over the past 50 years, American men of all ages have killed themselves at four or more times the rate of women, depending on the specific age range.

A general practitioner is usually the first—and often, the only—medical professional a depressed man encounters. In 1990, when Mark Totten began sleeping a lot, refusing food and acting sullen, his sister, Julie, suggested he see a doctor, but never for a moment did she think it was life threatening. "I didn't know anything about depression back then," says Julie. In November of that year, Mark, 24, lay down on an Iowa train track and ended his life. Totten learned afterward that her brother had indeed visited his primary-care physician but complained only of stomachaches, headaches and just generally "not feeling so great," she says. The doctor didn't make the connection.

Confronted with a patient making vague medical complaints who is unwilling (or unable) to talk about his feelings, the hurried primary-care physician often finds it difficult if not impossible to assess a patient's emotional state. To help clear that hurdle, researchers developed a simple screening test for doctors to use: Over the last two weeks, have you been bothered by either of the following problems: (a) little interest or pleasure in doing things? or (b) feeling down, depressed or hopeless? If a patient responds "yes," seven more questions can be administered, which result in a 0 to 27 rating. Score in hand, many physicians feel more comfortable broaching the subject of depression, and men seem more willing to discuss it. "It's a way of making it more concrete," says Indiana University's Dr. Kurt Kroenke, who helped design the questionnaires. "Patients can see how severe their scores are, just like if you showed them blood-sugar or cholesterol levels."