Men tend to mask feelings, which isn't the best way of dealing with depression. Our post lists strategies that include behavioral activation.

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If you’re like many men, you don’t like to ask for help. You have a do-it-yourself attitude that any problem can be fixed. That’s also the mindset that many men have when it comes to dealing with depression. In general, experts say, men simply don’t discuss sadness or other feelings. Unfortunately, that attitude prevents many depressed men from getting the help they need.

A recent study suggests that many adults who test positive for depression are dealing with it on their own rather than receiving treatment that could benefit them. So, if you notice changes in your functioning that might signal depression, put aside your fix-it-yourself mentality and discuss your mood with your doctor.

Depression Treatment Gap

In the study, researchers analyzed data on more than 46,000 adults who completed surveys in 2012 and 2013. Among the survey respondents, 8.4 percent screened positive for depression; however, less than a third of them received depression treatment. Men were among the survey populations least likely to be treated for depression, the study found (JAMA Internal Medicine, Oct. 1, 2016).

The reasons for the treatment gap vary. Some people experiencing symptoms of depression might not believe they’re serious enough to require medical care, or they might not realize that treatment could help them. Insurance issues may come into play, as well. Psychological care often isn’t covered at the same rates that physical healthcare may be.

Oftentimes, questions about mood and depression may be low on a man’s list of health issues he discusses with his physician during an office visit. And, many men simply choose not to raise the issue, or deny that they have depression, out of concern about the social stigma attached to it.

Experts point out, though, that depression isn’t a sign of weakness, nor is it only “in your head.” Rather, it’s a condition with a biological basis.

Are You Depressed?

Any number of factors can cause you to be depressed, from a chronic medical illness to a loss of a loved one or a change in your life status. Even a lack of social interaction can cause you to feel isolated, which can contribute to depression.

When you think about depression, classic symptoms such as feeling “down in the dumps” come to mind, but men may exhibit other warning signs that might not be so obvious (see chart, “Recognize Depression Symptoms”). Plus, some men engage in high-risk behavior (like alcohol or drugs) or fall into workaholic patterns in order to mask their depression.

The U.S. Preventive Services Task Force recommends that all adults be screened for depression in a primary care setting equipped to provide follow-up care. Primary care doctors handle about half of all mental health concerns and can refer patients to more specialized care, if necessary. So, if you haven’t already, talk to your doctor about screening for depression.

Treating Depression

Non-pharmacologic treatments such as psychotherapy form the foundation of depression treatment. One approach, cognitive behavioral therapy, trains you to identify negative thoughts or behaviors and replace them with positive ones. Another psychotherapy strategy is behavioral activation, designed to combat depression by increasing your social engagement (see sidebar, “Get Busy with Behavioral Activation”).

If your functioning remains severely impaired despite non-pharmacologic therapy, your doctor may prescribe an antidepressant medication. Drugs known as selective serotonin reuptake inhibitors—paroxetine (Paxil) and sertraline (Zoloft) are examples—and serotonin and norepinephrine reuptake inhibitors, such as duloxetine (Cymbalta) and venlafaxine (Effexor), can provide an important “boost” to help you combat depression, Dr. Bea says.

He cautions that the drugs may cause side effects, such as drowsiness, dry mouth, nausea, and sexual dysfunction (e.g., ejaculation problems, low sex drive, and erectile dysfunction). Also, be patient with medical therapy, and don’t abandon it. You may need to use the medications for a few weeks before you notice improvements, and it may take some trial and error to find the antidepressant that works best for you.

Make a Change with “Behavioral Activation”

Behavioral activation (BA) is a form of psychotherapy used to treat depression and other mood disorders. It’s designed to decrease the social isolation that accompanies depression and increase participation in mood-boosting activities. One of the basic forms of BA is activity scheduling: creating a schedule of daily tasks you must complete. The key is to commit yourself to a schedule of behaviors, experts say, and follow through no matter how you’re feeling.
The accomplishment of completing tasks feels good; if done often enough, they provide an emotional boost.

The combination of practicing behavioral activation, following through, and making use of activity scheduling is a proven treatment for depression. It can affect the brain’s circuitry in a lasting way, more so than medication, experts say.

Try using a daily scheduler/organizer and set aside a few minutes each day to map out activities you’re going to complete the following day. List household chores, exercise, family time, or a new hobby you’d like to pursue—anything to keep you engaged.

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