Ask the Doctor: Gender’s Effect on Depression; Money Worries & Cognition; Lowering Blood Sugar

Q: Is it true that men have different symptoms of depression than women?

A: While both men and women are vulnerable to many of the same symptoms of major depression—e.g., loss of pleasure in formerly enjoyable activities, fatigue, and feelings of hopelessness—a recent study has found that men may be more likely to report nontraditional symptoms that, if recognized, might increase the number of men diagnosed with the mood disorder. Women have traditionally been thought to be more vulnerable to depression, but according to a study published in the Aug. 28, 2013 is-sue of JAMA Psychiatry, this may be because current indications for a depression diagnosis tend to include symptoms more likely to be exhibited by women, such as sleep problems, sadness, and crying. When researchers analyzed data from a nationwide mental health survey that also included less traditional symptoms more common in men—such as anger, aggression, irritability, risk-taking behavior, self-destructive behavior, and substance abuse—they found no significant difference in rates of depression between the sexes. It is possible that including male-type symptoms in the traditional description of major depression may help men recognize their own need for treatment and seek help.

Q: My 68-year-old husband is unemployed and very worried about money. Lately, he’s having trouble concentrating, remembering things, making decisions, and planning ahead. Can money issues affect a per-son’s cognition?

A: Many factors including medical conditions, poor sleep, neurological conditions, and psychological problems can cause cognitive problems. Recent research has added financial worries to that list. The study, published in the Aug. 30, 2013 issue of Science, asked participants with average incomes and others with low incomes to deal with hypothetical challenges that required monetary solutions, and then take tests of cognitive function. When the hypothetical financial challenges involved smaller amounts of money, such as $150, the groups performed comparably. However, when the financial challenges involved larger amounts of money, such as $1,500, the lower-income participants did significantly worse on the cognitive tests. The results suggest that financial worries—which may necessitate making difficult choices, managing pres-sure, and making trade-offs—can potentially impair the ability to focus on other matters. Your husband should consider seeking a medical assessment to rule out other possible causes of his cognitive problems, and for advice on ways to reduce stress and anxiety, such as learning relaxation techniques or engaging in regular exercise. He might also contact local community organizations to learn whether financial or other counseling is available free of charge.

Q: I recently read about a study that found that high-normal levels of blood sugar are associated with greater risk for dementia. How can I find ways to lower blood sugar?

A: Research published Aug. 8, 2013 in the New England Journal of Medicine linked elevated blood sugar levels in older adults—even those without diabetes—with heightened risk for dementia. The increased risk was not great, but it seems best to avoid elevated blood sugar levels, if possible. If you are not a person with diabetes, which requires medical supervision, you may be able to lower your blood sugar on your own through diet and exercise. Experts recommend consuming a nutritious, low-fat diet that limits starches and refined carbohydrates linked to rapid rises in blood sugar levels (e.g., breads and pastas made with white flour, table sugar, and sweets). You should also increase your consumption of fiber-rich foods such as nuts and whole-grain breads and cereals. Exercise (at least 30 minutes a day, five days a week) can also help lower blood sugar.

—Editor-in Chief Maurizo Fava, MD

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