Depression and Men: Unique Considerations

The field of mental health is constantly changing, and is often mired in debates over diagnosis, symptomatology, and ethics. Despite the seeming lack of clarity, the pace of research and experience chugs onward giving clinicians and individuals new insights and considerations. With this in mind, the difference in expression of mental and emotional struggles between men and women should be seen as an important consideration for counselors. 

Defying Depression Stereotypes

Common knowledge of depression paints a stereotypical picture which includes bouts of tearfulness, feelings of sadness, and feelings of worthlessness. While these are valuable clues, they may not be present in men who are actually struggling with depression. With this in mind, here is a short list of symptoms more likely to be experienced by men: 

• loss of interest in favorite activities or hobbies
• change in appetite (increase or decrease)
• sleep disturbances
• feelings of apathy 
• lack of motivation

Depression Counseling for Men

In addition to differences in the expression of symptoms for men, we should also take care to consider how counseling may differ for men. Men may be less likely to seek out treatment because of their concern that they will have to engage in a level of emotional disclosure or "touchy feely stuff" than they would be comfortable with. With this in mind, the following approaches may benefit men when looking for and engaging in treatment for depression:

• concrete goal setting
• behavioral activation therapy
• cognitive behavioral approaches
• exercise or engagement in regular physical activity 
• focus on physical health including diet and sleep hygiene

While there is certainly more to consider when treating men with depression, consideration of these concepts is important for clinicians and men looking for treatment. For further reading please consider the following links: 

http://www.mayoclinic.org/diseases-conditions/depression/in-depth/male-depression/art-20046216?pg=2

http://www.apa.org/research/action/men.aspx

The Winter Blues

Seattle, and the Northwest as a whole, is an amazing place to live but comes with a yearly price tag in the form of a dark and rainy winter (can I say dark again?). Some individuals may find that they feel a little less motivated, less energized, or just a little "down". Others may feel these and more, with much more intensity, otherwise known as SAD (seasonal affective disorder) now considered a subtype of major depressive disorder in the DSM 5. In order to get away from the pop psychology understanding about this condition, it is helpful to discuss exactly what SAD is and what we can do about it. 

What Is Seasonal Affective Disorder? 

When folks talk about SAD, they are really talking about major depressive disorder which continues to occur during seasonal changes (winter being the most common), but is alleviated with the change in seasons. Symptoms may include increased sleep (20% more than usual), overeating, weight gain, prominent energy, and craving carbohydrates. These symptoms are also not explained by a seasonal job loss, school schedule, or any other extraneous circumstance tied to seasonal change. 

What Can Help?

Like many other forms of depression, medication has been a proven form of treatment and can be discussed with your primary physician or psychiatrist. Light therapy, or phototherapy,  has also been shown to alleviate symptoms of seasonal affective disorder as well, but care must be taken to discuss with your primary care provider as to which light box is appropriate and how it should be used. 

What About Counseling? 

Psychotherapy has also been shown to be an effective treatment method for SAD, and is often recommended in unison with medication and/or light therapy treatments. Working with a counselor who utilizes cognitive behavioral therapy to identify negative thought patterns and resulting feelings and behaviors can alleviate symptoms and give individuals the tools to combat symptoms of SAD in the future. 

What Now?

If you are concerned about SAD, or feel it may explain feelings of sadness and depression you experience seasonally, please feel free to contact me to discuss counseling options. Also, below are a list of resources to find out more about SAD. 

http://www.apa.org/helpcenter/seasonal-affective-disorder.aspx

http://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

http://www.apa.org/monitor/feb06/sad.aspx

Expectations

In the last few years of my life I have come to appreciate the power of expectation and how it can literally define much of my waking experience. Expectations are a big focus of my work with clients, particularly when working with cognitive behavioral therapy principles. We are all familiar with the concept of an expectation, but it is not until I have stopped to really consider how my expectations could contribute to my discontent that I began taking things seriously. 

Expectations create a narrow set of circumstances for happiness and satisfaction

An expectation is not hard to understand. We expect something to happen or use it to define the way someone should behave. It seems simple enough, an expectation being a situation we define as satisfactory which will lead to at the very least contentment, and at the most genuine happiness and ease. However, by setting an expectation we have unwittingly defined a very narrow window in which we will be satisfied, and limitless others which are now outside the bounds of satisfaction.

Expectations are a part of life, but we must determine when they are reasonable

As an example, if I expect that every time I go into a restaurant I will be served with a smile and an urgency that communicates the server is interested in my happiness, I will be satisfied. But, at the same time, this expectation also means I will not be happy if my experience is anything else. With this scenario, it seems I will likely be more unhappy with my restaurant experiences given how the world actually works. 

When our expectations take over our experience, we lose control of our thoughts, feelings, and actions

To put this in different terms, I like to think about the expectation as a literal chunk of my happiness. Whenever I place an expectation on a person, place, thing, etc. I essentially give over a chunk of my happiness and expect that that person/place/thing will nurture and maintain it to my liking. This illustrates the biggest issue with expectation, which is that an expectation is ultimately the loss of power over our own emotions. Someone, or something, else is in control.

Engaging in thoughtful monitoring and evaluation of our expectations can lead to more positive and meaningful experiences

Letting go of certain expectations frees us to experience things for what they truly are.  Simple things like driving in traffic or waiting in line become an accepted reality of life rather than another daily obstacle. It isn't easy to challenge our long held expectations, but doing something so simple can have great impact ourselves and those around us. 

For further reading about other cognitive behavioral therapy principles, see my resources page here.