Depression, Why Stay Quiet? A Focus on Male Depression

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"It affects the way you think. It affects the way you feel. It affects the way you love... It's just a blanket that covers everything... and it's one that's just so asphyxiating. And at times you just say it's enough already. It just feels like enough.”1

Depression. A tough topic to talk about for many who experience it. Though when we begin to speak out about our truths as humans and allow ourselves to be vulnerable with those around us; more often than not we are met with understanding and empathy and a realisation that we are not alone and that many of us experience similar difficulties. Depression can affect anyone; it doesn’t discriminate and is increasingly on the rise. According to the Mental Health Foundation, it’s the “predominant mental health problem worldwide.”2 Further to this, acute depression is considered to be the second leading cause of disability across the globe and one of the primary contributors to suicide and ischemic heart disease.3 Current research from The World Health Organization (WHO) shows that depression is the number one cause of disability in teens and adults between the ages of 15-44.4 Depression is a condition a huge proportion of people live with on a daily basis; It’s experienced by a staggering 300 million people worldwide.5 Worryingly, rates of depression in young people in the UK have risen by 70% in the past 25 years, and one in four young people report experiencing suicidal thoughts.6 Furthermore WHO predict depression to be the second most prevalent medical illness globally by the year 2020.

It’s clear to see that those who live with depression are not alone. Although depression can be characterised by just this; overwhelming feelings of being alone, of feeling isolated and ultimately on your own in this world. With this in mind it’s crucial to take the next step; Depression needs to be accepted, owned and talked about. Depression needs to be shared and met with honesty, support, understanding, patience, hope and encouragement.

What is depression?

Depression is an illness which can manifest in a number of different ways. There are no set rules for this condition; no singular experience of depression. Instead it can be said to be characterised by commonality and differences.7 For many, depression is characterised by a deep and persistent sadness. Not everyone who has depression feels sad though. Depression can, for many, be dominated by feeling generally low and down. For some people depression makes them feel numb, angry or nothing at all; emotionless and empty. Depression can be constant and daily and continue for many years or indeed last a lifetime. It can also come in bouts and can be interspersed with happy moments, days or periods of time. Depression is usually accompanied by a disinterest in or withdrawal from life; coupled often with an inability, desire or motivation to carry out usual, daily activities or tasks; and a preoccupation with (negative aspects of) self; but with a lack of interest or inability to take care of one’s self (for example, eat well, exercise, sleep well) brought about by feelings of worthlessness, isolation, apathy about life, or a sense of hopelessness.

Depression steals the light. It steals the lightness of ‘being’ inside; both physically and mentally; and it steals the light out of life and living. So life feels heavy and dark. Body and mind feel heavy and dark. Living with depression can feel like a constant heavy weight. A constant sadness. A constant darkness. A constant feeling alone. This all makes it really hard to function on a daily basis and almost impossible to find the motivation or energy to carry out simple tasks such as keeping on top of the housework.”8

What causes depression?

In medical terms depression is caused by an imbalance of chemicals in the brain which directly affect our mood and emotional state; essentially a reduction in the number of specific neurotransmitters called monoamines, for example, serotonin, acetylcholine, dopamine, adrenaline, insulin and norepinephrine.9 There is the opposing view, however, that this is too simplified an approach at understanding depression; which is not merely down to a neurochemical imbalance. "Regarding depression as "just" a chemical imbalance wildly misconstrues the disorder."10 Low serotonin levels, for instance, could instead be a symptom of depression. Negative introspection and the withdrawal from participation in activities that make us feel good equates to reduced serotonin levels.11

  • Depression can also be caused by life events. Changes in what is ‘normal’ and changes that alter how we thought life was ‘going to be’ can cause huge shock to our emotional and mental well being, having a knock on effect on our physical well being.
  • Depression can kick in when a big life change occurs such as divorce or the breakdown of a relationship; death; the birth of a child; losing a job; stressful events; illness; loneliness; betrayal; bullying.

“People born since 1945 are 10 times more likely to suffer from depression than those born before.” 12 This dramatic increase in the number of people affected by depression leads us to question changes in society that may have contributed to this society-wide mental health issue. Factors such as the dissolution of the extended family, bringing about a change in support structures; a dispersal of communities, leading to a lack of community belonging; an unhealthy increased focus on material wealth; a bombardment of news and media; significant numbers of people not having regular access to nature and green spaces; and an increase in the focus on 'the self' and ‘individualism’ have all been cited as major changes occurring over the last five decades contributing to the isolation of self and the increase in mental health conditions, specifically depression. Ultimately depression is “symptomatic of feeling isolated and cut off.”13

Signs and Symptoms of depression

  • Low, depressed mood.
  • Tearful and sad.
  • Apathy. Lack of motivation. Withdrawal.
  • Loss of interest or pleasure in activities or hobbies.
  • Feelings of guilt.
  • Low self-esteem. Low self-worth. Loss of confidence.
  • Disturbed sleep.
  • Changes in appetite.
  • Low energy.
  • Poor concentration and memory.
  • Feeling of imminent anxiety.
  • Irritability.
  • Sense of hopelessness.
  • Aches or pains, headaches, cramps, or digestive problems.
  • Suicidal thoughts.14

UK Statistics

In the UK one in four people will experience a mental health problem at some point in their lives and about one in 12 of the population in the UK are living with depression.15

Campaigns

There is a host of dedicated organisations who aim to increases awareness and understanding of depression, and a number of national and local campaigns are currently trying to change public attitudes to mental illness. These include the national voluntary sector campaign Time to Change: Be in Your mate’s corner’ a campaign focusing specifically on male depression and the WHO campaign; World Health Organization’s 2017 Campaign for Depression called ‘Depression: Let’s Talk’. Both campaigns focus on being vocal and talking about depression; not suffering alone.16

Men and Depression

According to research conducted by Time to Change, the mental health campaign led by charities Mind and Rethink Mental Illness, 1 in 4 men in the UK are affected by depression. Research shows that men have different attitudes towards mental health and specific social stigmas are attached to men and depression, making men less likely to receive help and get support. Research showed compared to women, men are:

  • Less knowledgeable about mental health
  • Hold more negative attitudes about mental health
  • Less likely to discuss depression
  • Less likely to discuss mental health problems with a professional
  • More likely to see depression as a weakness; to feel that depression is the result of a ‘lack of self-discipline and willpower’.

Three times more likely to take their own lives than women, with suicide being the leading cause of death in men under 45.17

Depression can become more severe in men because symptoms are not recognised or accepted as depression, so go ignored and the depression worsens. Men can experience depression in different ways to women. Depression is men is more likely to manifest itself in physical symptoms such as aches, pains, headaches, stomach cramps and digestive issues.18 According to the National Institute of Mental Health men may be more likely to feel exhausted and irritable and become despondent about their work, family, or interests. Men tend to have more difficulty sleeping than women who experience depression. Women with depression are more likely to attempt suicide, but men are more likely to die by suicide.19 Depression is more likely to manifest in anger, despondency and reckless behaviour in men. Perhaps brought about by intense feelings of isolation brought about by bottling it all up and not sharing the load with friends or family or a medical professional.20 It’s widely accepted that men are less likely to seek help for their depression and less likely to talk about it. This could be largely attributed to the social stigma surrounding depression and the misguided assumption that depression is a sign of weakness somehow. The strain of expectation that is often carried on the shoulders of the male population can provide a heavy burden. Responsibilities such as ‘making ends meet’, ‘putting dinner on the table’ ‘achieving at work’ and expectations of what is is to ‘be a man’ can cause men to feel bogged under and unable to cope. Because men are less likely to reach out to friends and family for help feelings of isolation symptomatic of depression are exacerbated. Research on men and mental health has shown that only a third of men (34%) would talk openly about their feelings, and one in five (18%) admitted they saw others showing emotions as a sign of weakness.21

It is possible to live with depression and it's even possible to live a reasonably normal life, but it's always there just over your shoulder like a big black cloud. Accepting it is the first hurdle, once you accept you have it and it has you, then you can start trying to find ways to cope.”22

Some current campaigns focussing on male depression:

Stigma and Understanding Depression

Reaching out to others and talking about depression can be very difficult. To experience a lack of empathy and sympathy from those who really do care, but just don’t understand can be isolating. Well meaning advice such as ‘pull yourself together’, ‘surely things aren’t as bad as they seem?” and “Just snap out of it girl” can be fundamentally damaging, exacerbating feelings of aloneness. It is hard to see someone you love depressed. All you want for them is to ‘just snap out of it’ It can be a really frustrating and heartbreaking experience to not be able to help. But just by ‘being there’ and listening loved ones can help. The taboo, ingrained over years, surrounding the topic of depression now needs to be lifted and kicked into the gutter. The only way forward is to talk about depression. To share the experience. It’s time to overcome stigma and promote awareness so we can reach real levels of understanding and acceptance of depression; its place in society and its impact. And in doing so help each other through. We each have a role to play; To reach out and to be there.

When I was off sick with depression several years ago, my line manager called to say that she had told the rest of the staff that I had a bad case of the flu. I replied that I was very happy for them to know the truth. She found it very difficult to understand that I would want to admit to having a mental illness.”23

Coping with Depression

Sunlight is an essential for serotonin levels and ensuring we get some sunshine on our skin can go a long way to helping to lift the mood. Finding activities which help us to relax and bring us happiness can help reduce stress levels and make living with depression less stressful. Talking to someone you feel you can trust will help to lessen the weight of depression. Daily exercise which gets the heart pumping is known to help induce feelings of well-being. Eating well and ensuring we are getting the required amounts of essential nutrients via diet can help enormously with mood.

The depression, is always there, for me to live with it, I have to welcome it in, know it's there and have learned to work with it and around it, removing life stresses helps, adjusting your work life balance whatever that is also helps.”24

Dietary changes and supplements for depression

Research has shown that some supplements can be beneficial for people with depression and that a combination of nutrients can help reduce certain symptoms in some mental health conditions, such as depression, by improving cognitive processing, for example, and that correcting deficiencies can improve brain metabolism, mood and psychopathology. 25

5-HTP

5-HTP is a vital naturally occurring compound in the body and is the most important active ingredient of the Griffonia Simplicifolia plant. Griffonia Simplicifolia is a vine plant that best grows on mountain slopes and termite hills of Central and West Africa. It’s been employed in this part of the world for centuries as a traditional herbal medicine, esteemed for its therapeutic and healing properties for a range of diseases. 5-HTP converts directly into serotonin and melatonin in the human brain. These are neurotransmitters which are believed to help mood, brain activity, appetite, concentration, and regulate sleep patterns. 5-HTP is thought to help aid insomnia; The conversion of 5-HTP into serotonin and melatonin in the brain can help promote a healthy sleep pattern. Melatonin has been cited as the hormone that helps regulate our wake-sleep cycle. Try coupling this with Green tea tablets, a great source of theanine which can help improve sleep; and these two supplements could help alleviate symptoms of depression, such as help to improve mood and concentration and help to regulate sleep patterns.

Vitamin B complex

Research has shown the Vitamin B complex (the 8 essential water-soluble B Vitamins) could support brain metabolism and be a beneficial treatment for depression.26

Whilst many of the B vitamins work in tandem, each has its own specific benefit to our health. Essentially B Vitamins are crucial nutrients needed by the body for growth, development, and a range of other important functions. The Vitamin B complex supports the promotion of normal energy metabolism leading to a reduction in fatigue associated with depression (Vitamins B1,B2,B6,B12); normal nervous system function leading to overall improvement of psychological function (Vitamins 1,B2,B3,B6,B8,B9,B12); blood flow to active tissues (Vitamin B3) and can also prevent oxidative stress, caused by free radicals; and offers support and maintenance of the immune system; all beneficial capabilities with regard to symptoms of depression.

Eating foods rich in vitamin B such as broccoli, bananas and tomato juice in addition to taking the B vitamin complex can assist with the overall effects.

Vitamin B12 Tablets

Vitamin B12 is also known as Cobalamin, and it’s comprised of Cobalt. Due to it being categorised as a B-vitamin, it is water soluble in nature. The body has the ability to store B12 in the liver. Vitamin B12 can only be absorbed if gastric “intrinsic factor” is present.

Ensuring we get adequate amounts of all essential vitamins in our diet, in particular, B Vitamin rich foods, such as vegetables and fruits, whole grains, beans, nuts, seeds is essential for everyone and research indicate there could be a link between a deficiency in the B Vitamins and low mood. Green vegetables, beans, lentils, nuts and seeds are all rich in folic acid and Vitamin B12 can be obtained from dairy produce, meat, fish and eggs.

Vitamin B12 helps to contribute to normal energy metabolism and yield, which promotes normal neurological and psychological function while reducing fatigue. Vitamin B12 deficiency has been linked to depression, irritability, anaemia, fatigue. Vitamin B12 has also been clinically shown to contribute to homocysteine metabolism and the formation of red blood cells. In addition, B12 has been shown to promote cell division and contribute to the healthy function of the immune system.27

Theanine

Theanine is an amino acid that has been shown to influence brain function. Studies have also shown that Theanine can help increase attention and improve memory and can also help improve sleep. In a case study, results showed that an intake of L-theanine for a period of 8 weeks improved depressive symptoms, anxiety, sleep disturbance and cognitive impairments in patients with major depressive disorder. 28

Omega oils

The Omega Oils are essential fatty acids (EFAs), "essential" simply means we cannot produce them in our body so we must consume them for optimal health.

Consuming essential omega 3 and 6 fatty acids are thought to be helpful for those with depression. Considered ‘brain food’, research has shown links between essential omega 3 and 6 fatty acids and improved cognitive function. Containing brain supportive omega fatty acid eicosapentaenoic acid, EPA , which has been shown in studies to have a positive effect on behavior and mood.29 These essential fatty acids are generally good for us and considered crucial for maintaining a healthy heart, mainly because they contribute to normal blood cholesterol levels; have the ability to stop blood clotting; and contribute towards a healthy and regular heart rhythm. Salmon, tuna, mackerel and halibut are good sources as well as avocado, sunflower oil, flax, linseed oil and walnuts.


Vitamin D

Vitamin D is one of the fat-soluble vitamins. The benefit of fat soluble vitamins is that they can be consumed in smaller quantities than the water-soluble vitamins because they have greater long-term storage capacity in the body. There are a few forms of Vitamin D, including Ergocalciferol (D2) and Cholecalciferol (D3). There is much debate about which is the most potent and important form to humans. Recently, data has shown that D3-Cholecalciferol is the most beneficial and has the highest bio-efficacy in the body.

Vitamin D3, in this form, can be derived from the sun, specifically, the UVB rays which causes a conversion of 7-dehydrocholesterol in the skin. It is then stored in the liver of many animals, hence, why liver specifically cod liver oil and oily fish are a great source of Vitamin D3. Vitamin D can be made inside the body as well as consumed, however, in countries such as the UK, the sun cannot provide this level of sunshine to consistently produce Vitamin D within the body. Dietary sources of Vitamin D include cod liver oils, sardines, salmon, eggs and sunflower seeds.30

A link has been found between low levels of vitamin D in the blood and depression. Vitamin D receptors are present in the areas of the brain that have been linked to the development of depression and that vitamin D affects the levels of monoamines, such as serotonin, and how they function in the brain.31

Time to talk

Depression is serious. It’s not something that can be ignored. It affects all of us, directly or indirectly; and it’s a condition that we should share as a society and as human beings. It is something we now need to face together and be for real about. Social stigma is a huge thing. Mistruths attach themselves to illnesses, particularly mental health problems, so there can be a lot of misconceptions surrounding depression and depressed people. Discrimination brought about by social stigma can have a hugely negative impact on how a depressed person copes with their condition. “Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.”32 Society has pigeon-holed depression, generating stereotyped views about mental illness and how it affects people. By reducing social stigma more people will be able to reach out about depression without fear of being misunderstood. Social acceptance and feeling like we belong is vital for all of us. Concern, warmth, acceptance and empathy are incredibly important responses. Awareness is key. Bringing depression out of the dark into a transparency can only be a positive thing, especially in terms of finding ways of coping with and living with depression. A problem shared is a problem halved. This may not be strictly true of depression, but what is certain is not feeling alone can be of huge significance to someone who is depressed. It can make all the difference.

 

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1 Steve Lappen, Writer.

3 Whiteford, H. A. et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 382 (9904). pp. 1575-1586. Retrieved from: https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide

8 Anonymous

9 RCPsych. (2015).Depression. Retrieved from: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/depression.aspx.

10 Psychology Today, March 1999. Depression: Beyond Serotonin: https://www.psychologytoday.com/articles/199903/depression-beyond-serotonin?collection=10044

21 Mind’s Anxiety poll, 2015. Populus online interviews with 2,063 GB adults.

Retrieved from: https://www.time-to-change.org.uk/news/be-in-your-mates-corner

22 Anonymous. Male with depression, in his mid 40’s.

23 Anonymous female with depression

24 Anonymous male with depression

26 Vitamin deficiencies and mental health: How are they linked? http://www.mdedge.com/currentpsychiatry/article/64985/depression/vitamin-deficiencies-and-mental-health-how-are-they

Vitamin B6 as add-on treatment in chronic schizophrenic and schizoaffective patients: a double-blind, placebo-controlled study: https://www.ncbi.nlm.nih.gov/pubmed/11838627

Randomized multicenter investigation of folate plus vitamin B12 supplementation in schizophrenia: https://www.ncbi.nlm.nih.gov/pubmed/23467813

28 Effects of chronic l-theanine administration in patients with major depressive disorder: an open-label study: https://www.ncbi.nlm.nih.gov/pubmed/27396868

29 Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids: https://www.ncbi.nlm.nih.gov/pubmed/18072818

31 Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain: https://www.ncbi.nlm.nih.gov/pubmed/15589699

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