In Spring 2006 the depression of two very successful men made newspaper headlines in Maryland: Phil Merrill, a renowned publisher, entrepreneur and diplomat in the Washington area took his own life. Eleven days later Montgomery County Executive Douglas Duncan withdrew his candidacy for governor of Maryland because of his struggle with depression. For weeks, newspapers covered male depression, including the stories of Abraham Lincoln, Winston Churchill, Archbishop Raymond Roussin, Mike Wallace, William Styron, Art Buchwald, and Robin Williams.

That was unusual. Because, in the majority of media stories and infomercials, depression is regarded as a feminine thing … a result of all of the hormonal shifts and baby-making stuff. The reality? Six million men, or seven percent of American men, suffer from depression, and millions more suffer silently because they either don’t recognize the symptoms, which can vary from women’s, or they are too ashamed to get help for what they see as a woman’s disease. These 12 techniques were written for men to address the hidden desperation so many feel, and to expose the truth about mood disorders and gender.

1. Get a male perspective.

When I hit bottom after the birth of my second baby, I was lucky enough to see Brook Sheild’s beautiful face on “Oprah” describing how I felt. In her book, and in Kay Redfield Jamison’s “An Unquiet Mind” and Tracy Thompson’s “The Ghost in the House,” I found female companionship, as they articulated what was happening to me. That alone made me less scared.

There are some wonderful books tackling the male perspective of depression. Among them: “I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression” by Terrence Real, “Unmasking Male Depression” by Archibald Halt, and, of course, the classic, “Darkness Visible” by William Styron. There are also an array of blogs by men on the topic of depression and mental health. For example, check out “Storied Mind,” “Chipur.com,” “Knowledge Is Necessity,” “Lawyers with Depression,” “Midlife-Men.com,” “Finding Optimism,” and “A Splintered Mind.”

2. Identify the symptoms.

Part of what makes male depression so misunderstood is that a depressed guy doesn’t act the way a depressed lady does, and the feminine symptoms are the ones most often presented in pharmaceutical ads and in glossy brochures you pick up at your doctor’s office . For example, it is not uncommon for a man to complain to his primary care physician about sleep problems, headaches, fatigue and other unspecified pain, some or all of which may be related to untreated depression. In her Newsweek article, “Men & Depression,” Julie Scelfo writes, “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.”
3. Limit the alcohol.

An interesting study by Yale University discovered that men and women respond to stress differently. According to lead scientist Tara Chaplin, women are much more likely to feel sad or anxious as a result of stress, whereas men turn to alcohol. “Men’s tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain,” she said. The tendency, however, puts men at more risk for alcohol-use disorders. And since alcohol is, itself, a depressive, you really don’t want a lot of it in your system. Trust me on this one.

4. Watch the stress.

You can’t drink away your worries, so what DO you do? I offer ten stress busters. But I imagine the most important way to manage stress for men is to work in a job and environment that isn’t … well … toxic. Unfortunately, the more impressive your title, the more stress brewing underneath your skin. Dr. Charles Nemeroff, a psychiatrist who treated both Tom Johnson (president of CNN during the 90s) and philanthropist J.B. Fuqua says stress is a major factor in male depression and a CEO’s (or any executive’s) higher stress level makes them more vulnerable to the illness. The pressure can become unbearable. Unfortunately, some men will have to choose between good mental health and the corner office.

5. Help another dude.

At age 46 Philip Burguieres was running a Fortune 500 company. Now he lends a hand to CEOs who are living lives of quiet desperation and have nowhere to turn. In an interview with PBS, Burguieres said, “I am open about my own experience, and I share my story with other CEOs in lecture settings several times a year [because] I have found that helping other people helps me, and keeps me healthier.” Art Buchwald, another very successful depressive, said in a “Psychology Today” interview some years back that talking about his depression helped him as much as the people he was talking to. It seems to me that the more misunderstood the illness, the greater the need to reach out and help each other.

6. Find an outlet.

One of my male friends who is a tad depressed right now says all he needs to feel better is 18 holes of golf. I’m not sure that chasing the little white ball has the same therapeutic faculties as a high-impact hour of counseling, but I trust that he knows himself better than I know him. What I do know without a doubt is that men are much happier when they can retreat into a “man cave” or a safe corner of the world and do their thing. Some might need a little assistance finding that happy place. So keep trying on those pastimes until one fits and lets you take a deep breath.

7. Tend to the marriage.

Depression leads women into affairs and divorce. But I suspect there are even more casualties with men’s depression. In a poignant blog post, John A. discusses his longing to leave a good marriage as the “active” face of the illness. He writes, “We often focus on the passive symptoms, the inactivity, the isolation, sense of worthlessness, disruption of focused thought, lack of will to do anything. But paradoxically the inner loss and need can drive depressed people to frenzied action to fill the great emptiness in the center of their lives. They may long to replace that inadequate self with an imagined new one that makes up for every loss.” Yet, by loving the partner beside you, even though it can feel counterintuitive and unnatural, you can protect yourself (to a certain extent) from the blows of depression and make yourself more resilient to future episodes.

8. Know the numbers.

Because men aren’t diagnosed with depression as often as women, we tend to downplay the wreckage this illness makes in their lives. Crying mothers makes for better footage on the evening news. So here’s a refresher on some sobering statistics you need to know: 80 percent of all suicides in the US are men; the male suicide rate at midlife is three times higher than women and for men over 65 seven times higher; more than four times as many men as women die of suicide in the United States; even though women make more suicide attempts during their lives, men attempt suicide using methods that are generally more lethal than those used by women; suicide accounts for 1 in 100 deaths, and, as noted above, the majority of those are men; the suicide rate among young men is increasing (not so among young women), and the majority of these men have not asked for help before their deaths.

9. Tune into the body.

According to the “Real Men, Real Depression” public education campaign of the National Institute of Mental Health (NIMH), approximately 12 percent of the patients seen by a primary care physician have major depression. Depression has been linked to heart disease, heart attacks, and strokes, which all affect men at higher rates and at earlier ages than women. Men with depression and heart disease are two or three times more likely to die than men who are not depressed. Moreover, because men’s depression symptoms often begin with fatigue, sleep problems, stomach aches, joint pain, headaches, or other pains, it is crucial for guys to tune into the body and to hear what it’s saying.

10. Exercise.

All I can say is “Run, Forrest, run!” This is especially true for moody men. How does a jog kill the pain? The technical answer is that all aerobic activity stimulates brain chemicals that foster the growth of nerve cells; exercise also affects neurotransmitters such as serotonin that influence mood and produces ANP, a stress-reducing hormone, which helps control the brain’s response to stress and anxiety. I realize the last thing you want to do when you’re depressed is hop on an exercise bike or lift weights. Getting a gym buddy who makes you accountable for your attendance might help, or, if you can afford it, hire a physical trainer to motivate you. Registering with a circuit-training program, or doing some other form of group exercise, is even better because you have the fellowship built in.

11. Start talking.

Women talk almost three times as much as men, with the average woman using up to 20,000 words a day, which is 13,000 more than a typical man uses. In her book, “The Female Brain,” Dr. Louann Brizendine explains that women devote more brain cells to talking than men, and that the chit chat triggers brain chemicals that assist with their emotions. So the more communication and jibber jab, the more sanity. Which is why depressed men need to learn the art of talking. Consider these words by Abe Lincoln: “The inclination to exchange thoughts with one another is probably an original impulse of our nature. If I be in pain I wish to let you know it, and to ask your sympathy and assistance; and my pleasurable emotions also, I wish to communicate to, and share with you.”

12. Become useful.

Being that the suicide rate has been shown to rise and fall with unemployment in a number of countries, I think it’s safe to say that losing a job can be a strong trigger for depression, especially in men. They are born with a need to be needed. Women, too. But that seems to be even more of a primitive trait in men. So, a huge depression buster is to become needed. A job is only one way to accomplish that. Contributing to society, or to a family, or both doesn’t necessarily have to come with a paycheck. Whatever gives you sense of purpose can bolster mental health and keep you more resilient.

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