About

Let’s talk about the four basic kinds of stress.

• Acute stress has to do with the way you respond to individual situations or events. For example, getting a call from your child’s school telling you he’s being expelled, hitting every red light on your way to work, finding out you’re going to be audited by the IRS, or a huge project that’s due at the end of the week. With acute stress, you almost always know exactly what the cause is. And because the situation is usually resolved within a day or two, there isn’t enough time to do any long term damage. Still, acute stress can cause headaches, irritability, anxiety, pain in the jaw, back, or neck, adult acne, and some short-term stomach problems such as irritable bowels, diarrhea, and heartburn.

• Ongoing acute stress is similar to acute stress, except that the situation or event that’s causing the stress doesn’t end. What we’re talking about here is that pile of work that you’re never quite able to dig your way out from under, always being in a hurry but never managing to get anywhere on time, your inability to say “No” to people and then getting angry that you didn’t stand up for yourself, or the feeling you can’t seem to shake that something terrible is about to happen. People who have ongoing acute stress can seem nervous, and are often perceived as rude, short-tempered, tense, or abrupt. Physically, they can suffer from an increase in blood pressure and pulse, sweatiness, dizziness, headaches, chest pain, and difficulty taking a full breath.

• Chronic stress is like ongoing acute stress except on an even larger scale. Chronic stress can be caused by poverty, being trapped in an unhappy marriage, a job you hate but can’t quit because your family needs the money, or a chronic illness. It’s pretty hard not to notice acute stress, but chronic stress can become so much a part of your day-to-day life that it’s easy to ignore it and resign yourself to never finding a way out of your current situation. But ignored or not, chronic stress wears you down every day of your life and may cause many serious long-term physical and emotional health problems, including heart attack, stroke, violence towards others, and even suicide.

• Post-traumatic stress is the fallout from a terrifying or catastrophic event in your life, usually something where you, or someone close to you, were in danger of being seriously hurt or killed. It could be a car crash, being a witness or the victim of a violent crime, serving in combat, or living through a natural disaster such as a hurricane or earthquake. Many people who experience traumas recover quickly and get back to their normal lives. But not everyone. Some develop Post-Traumatic Stress Disorder (PTSD). They may re-live the event over and over, in nightmares at night and scary thoughts during the day. They may go to extraordinary lengths to avoid any reminder (people, places, smells, etc.) of the event. They may also develop symptoms of any or all of the other types of stress discussed above. Those symptoms, if they occur, usually appear around three months after the event, although it could be as much as a year or longer.

WHAT CAUSES STRESS?

Stress is your brain’s and body’s reaction to a situation you can’t (or don’t think you can) cope with. Acute or chronic stress can be caused by a lot of things, but we can divide them into three categories: at home, at work, and everywhere else. (Post-traumatic stress has other causes, which we’ll discuss below.) Let’s take a look at each group in detail.

Sources of stress at home:

• Death of your spouse or life partner
• Death of a close relative or friend
• Divorce, separation, or breaking up a long-term relationship
• A tense, rocky, or hostile relationship with your spouse
• Frequent heated arguments with other family members or neighbors Injury or illness—yours or anyone else’s close to you
• Money trouble—due to the loss of a job, high debts, home foreclosure, not having enough to meet your monthly expenses, or simply not having enough money to do the things you want to do
• Marriage—yours or the marriage of a close relative
• Pregnancy or the birth of a new baby (while this is usually a time of great joy, the increased responsibilities and pressures that go along with being a dad can be very stressful)
• Your children’s behavior at school or at home–or their grades.
• Moving to a new home—even if it’s in the same city.
• The slow build-up over time of many negative life events.

Sources of stress at work:

• Losing your job or having been unemployed for a long time
• A new job
• Your relationship with your coworkers
• Your relationship with your boss
• Trouble managing or training those under you
• The workplace atmosphere
• Whether you have a good friend at work
• The amount of pressure you’re under—deadlines, sales quotas, “making your numbers”
• How many hours you work—not enough or being forced to work overtime, weekends, or holidays
• Feeling unappreciated or not valued by your employer or boss
• Being passed over for a promotion or pay raise

Sources of stress everywhere else:

• Abusing drugs or alcohol
• Your overall environment—the size of your home or apartment, the neighborhood you live in, traffic, availability of public transportation, air or noise pollution, distance from parks and other recreation
• Fears about safety—your safety and the safety of those close to you
• Your mental health—depression and anxiety can cause and be caused by stress
• Feeling helpless
• Negative thinking—questioning your own judgment, feeling that you’re going crazy or are about to snap, considering yourself a failure, criticizing yourself for your perceived shortcomings
• Having unrealistic goals
• Loneliness or not feeling you’re important or a part of anything
• Trouble making friends or maintaining friendships
• A fight with a friend
• Worries about the political situation
• Poverty
• Feeling that you don’t have a support system, people to whom you can turn if you need help

Sources of post-traumatic stress:

PTSD has more extreme causes, usually a very disturbing or frightening experience such as:

• Surviving a serious accident—car or plane crash, boating accident, fire
• Surviving a natural disaster—hurricane, earthquake, tsunami
• Surviving a terrorist attack
• An event where you thought you were going to die
• Shooting or being shot at in combat
• Surviving a violent crime—mugging, assault, rape
• Sustaining a particularly sudden and devastating injury—an industrial accident, a severe shark bite, losing a limb
• Having seen any of the above happen to someone else
• Serving in a high-risk civilian occupation

FYI

Stress affects both the mind & body, and impacts overall health & well-being.

Unmanaged stress can increase the risk of conditions such as infection, illness, diabetes, obesity, and heart disease,  as well as depression and anxiety.

Symptoms

Stress can cause a huge variety of physical, emotional, and behavioral symptoms. When you’re dealing with acute, ongoing acute stress or the early stages of post-traumatic stress, you may experience one or more minor symptoms such as:

• Headaches
• Stomach trouble, nausea, indigestion, constipation, or diarrhea
• Shortness of breath
• Sleep issues—either too little or too much

But if you develop chronic stress or don’t get treatment for your post-traumatic stress, the symptoms may get progressively worse. These may include:

 Physical Symptoms:

• Chest pain or tightness
• Unintended weight loss or gain
• Aches and pains that seem to have no particular cause
• Acne and other skin problems
• Hair loss
• Loss of interest in sex
• Excessive sweating
• High blood pressure
• Heart disease
• Stroke
• Ulcers
• Diabetes
• Reduced immunity, which can result in infections and can aggravate conditions such as herpes, AIDS, and HIV
• Over reaction of your immune system, which can lead to asthma and psoriasis, or auto-immune conditions like rheumatoid arthritis and lupus.

Emotional Symptoms:

• Mood swings
• Feelings of anxiety, depression, or extreme frustration
• Feelings of apathy
• Nervousness
• Feelings or guilt, shame, or of being helpless or out of control
• Poor self-esteem or a lack of confidence
• Feelings of failure
• Constantly second guessing yourself and questioning your own judgment
• Eating disorders

Behavioral Symptoms:

• Irritability or outbursts of anger
• Maladaptive behavior, such as drinking too much, smoking, eating unhealthy food, and not getting enough exercise
• Inability to concentrate
• Memory lapses, forgetfulness, or short-term memory loss
• Problems with relationships
• Poor performance at work
• Inability to manage time effectively
• Overreacting to minor irritants

If you have PTSD, your long-term symptoms may also include:

• Anti social behavior. You may feel that you can’t trust other people, which could lead you to withdraw from friends or family, or cause relationship problems at home, school, or work.
• Intrusive symptoms, such as flashbacks and nightmares. These are often so vivid that it may feel like you’re going through the trauma again. You may feel as scared as you were when it actually happened. Instead of (or in addition to) flashbacks and nightmares, you may suddenly feel a wave of fear, panic, anger, or crying that comes completely out of the blue.

Avoidance of activities and situations that remind you of the event or that you worry might remind you or trigger a flashback. For example, if you served in combat, you would probably try to stay away from any place where there might be loud noises.

• A constant agitated state, which may include elevated blood pressure, muscle tension, difficulty falling or staying asleep, irritability, outbursts of anger, sweating, and being easily startled.
• Emotional numbness. In an attempt to avoid remembering or reliving the event, people with PTSD often shut down their emotions—the good ones as well as the bad ones.
• High—and gradually increasing—risk of committing suicide.
• Having other mental health issues.

About 80% of people with PTSD also suffer from depression and/or anxiety.  Although men and women both suffer from stress, we have very different ways of coping with it. Women generally do what mental health professionals call “tend and befriend,” meaning that they reach out to others around them, look for friends and family to lean on, and talk about what’s bothering them. Men, on the other hand, have a tendency to cope with stress in pretty much the same way as we cope with other problems. We bottle it up and refuse to talk about it; we escape, either by trying to get away physically or by denying to ourselves and everyone else that there’s a problem at all; we try to cover it up, often with illegal drugs or alcohol; or we get angry and aggressive.

As you’ve probably guessed, none of those approaches is particularly effective. In fact, they almost guarantee that the physical and emotional symptoms will get worse. Unfortunately, when that happens, most guys don’t take the hint and get help. Instead, they keep on ignoring their symptoms until a crisis—like severe chest pains —happens, and they add “worrying about my health” to the list of things that cause stress.

ARE YOU OVER-STRESSED?

Whether stress is good or bad depends on the situation and the people involved. For example, some of us love speaking in front of crowds, others cannot stand to do so. Some love the adrenaline rush that comes with riding in the front car of a roller coaster or jumping out of a plane, while for others, the mere thought of either one of those activities is enough to send their pulse through the roof. For some guys, two weeks on the beaches in Hawaii would be wonderfully relaxing. But for someone who can’t really afford to take the time off, or who’s worried about how much work he’ll find piled on his desk when he gets back to the office, every day of that “vacation” will be incredibly stressful.

With that in mind, read through the following statements and take note of how many apply to you:

• I recently got married, divorced, or separated
• I was recently injured or have been sick
• I’m having major financial problems, such as bankruptcy or a home being foreclosed
• I work more than 10 hours per day
• I was recently fired from my job
• I hate my job or some of the people I work with or for
• I haven’t had a vacation in three years or longer
• My partner is pregnant
• I always seem to be coming down with a cold or other illness
• A close friend or relative is ill
• I’ve got a child who’s leaving home for college
• My family recently moved to a new home
• I get less than six hours of sleep every night
• I’ve been getting into more and more arguments with my spouse, friends, or coworkers
• I hardly have any time to myself to read, exercise, or just relax
• It’s been a long, long time since I did something just for fun
• I’m always in a hurry but never manage to get anywhere on time
• I drink more than three caffeinated drinks every day
• I have trouble falling asleep, staying asleep, or think I have insomnia
• I don’t have any close friends or relatives I can turn to for emotional support
• I recently experienced or witnessed an event where I felt incredibly afraid or helpless
• At night I have nightmares about the event. During the day, memories keep popping into my head and I feel as though I’m reliving it over and over again
• I get very upset by anything that reminds me of what happened (my heart pounds, my muscles tense, I start to sweat or feel nauseated)
• I go to extreme lengths to avoid activities, places, or people who remind me of what happened
• I have a tough time trusting other people or allowing myself to feel close to anyone

Chances are, at least 5 or 6 of the above statements are true for you. And that’s no surprise. Stress is so widespread that many mental health professionals consider it to be America’s biggest health problem. The American Institute for Stress estimates that 75-90% of all visits to primary care healthcare providers are for stress-related issues.

Prevention

Eliminating stress from your life is not possible. What you can do, however, is pay close attention to the things that cause us stress and develop some healthy ways to cope. As with depression and anxiety, symptoms are only a problem when they affect you negatively or interfere with your enjoyment of life. If they do, do not ignore your symptoms. Untreated, your stress levels will get worse and can endanger your physical and mental health and your relationships with family, friends, and others.

Try to reducing the stress in your life. If you’re suffering from acute or ongoing acute stress, these activities may reduce—or eliminate—your symptoms. If you believe that you have chronic stress or PTSD, these activities will help, but we strongly suggest that you also see your primary care health care provider. Chronic stress and PTSD are extremely difficult to manage without medical intervention.

• Exercise. While any kind of exercise is good, aerobic exercise—say 20-30 minutes three or four times per week—is especially good. Studies have shown that aerobic exercise can reduce your stress by as much as 50%.
• Relax. Try to get some downtime every day, even if it’s only 10 or 15 minutes. Take walks, meditate, listen to music, or just sit and read. Biofeedback, massage, and acupuncture are also helpful.
• Eat healthy and take your vitamins. Getting good nutrition is key to managing your physical and mental health. In addition, some research shows that stress causes the body to use B and C vitamins too quickly. Taking supplements (with your healthcare provider’s approval) may help you cope better.
• Have some fun. Play a game, go to a movie, or do anything else that’s low on stress and high on enjoyment.
• Breathe. Sit or lie down in a comfortable place. Close your eyes and focus on your breathing, making your belly—not your chest—rise and fall. In, out, in, out. Inhale for five seconds, hold for one, exhale for five, hold for one, and so on.
• Rest. Try to get at least 6—and not more than 8—hours of sleep every night.
• Watch the caffeine. If you’re drinking more than three cups of coffee, tea, or other caffeinated drinks (like Coke or Red Bull), cut back. But don’t do it suddenly, otherwise you may get nasty caffeine withdrawal headaches.
• Quit smoking. Of course you already know that, but it’s hard to do on your own—especially if you’re depressed. If you’re having trouble quitting by yourself, or if you’ve quit and gone back to smoking, talk to your healthcare provider about whether you could benefit from one of the prescription medicines that help people get and stay off cigarettes.
• Don’t self-medicate. Abusing legal or prescription drugs and having more than seven drinks of alcohol per week will do you far more harm than good by damaging your health and raising your stress levels.
• Try not to worry about things you can’t control. Like the weather or someone else’s driving habits. Spend less time looking backwards at shoulda, woulda, coulda. What’s past is past and there’s nothing you can do about it now. Instead, spend time looking forward, at what you’re going to do in the future to make life more enjoyable.
• Talk. Having an ally, someone who’s got your back, is extremely important for your overall mental health and can greatly reduce your stress levels.
• Don’t compare yourself to others. Different people can—and do—respond differently to the exact same circumstances. This is especially true with PTSD: what one person finds traumatic might not faze the guy standing right next to him. It’s important to keep in mind that having PTSD or any other stress condition is not a reflection on your worth as a man. The real measure of your strength is whether you have the courage to ask for help when you need it.

Questions to Ask Your Health Care Provider

It’s important that you become a proactive partner in your healthcare in order for you to get the best treatment. Here are some questions you can ask your healthcare provider about stress.

• What’s the cause of my stress and how severe it is?
• What are the symptoms associated with this disorder?
• Are there other health conditions that could be causing or worsening my stress?
• What steps do you recommend that I take to better manage my stress and why?
• Should I see a psychiatrist, psychologist or other mental health provider?
• Would medication help? If so, is there a generic alternative to the medicine you’re prescribing?
• Do you have any printed material that I can take home?
• What local support groups do you recommend?

Treatments

If you’re suffering from stress or PTSD, and you’re afraid you’re going to snap or burn out, you must get help. The first thing your healthcare provider will do is try to rule out any of medical conditions that, as with depression and anxiety, can cause symptoms that look a lot like stress.

Here are some ways you healthcare provider may treat your stress:

• Medication
• Psychotherapy, either individual or group
• A combination of therapy and drugs.

FAMILY AND FRIENDS: HOW YOU CAN HELP

If you think your loved one is suffering from severe stress or PTSD and isn’t taking active steps to seek out treatment, he needs you. The most important thing you can do is to be understanding and supportive. Talk with him about what he’s feeling and remind him that stress—even PTSD—is treatable and doesn’t mean he’s weak or flawed in any way. Encourage him to go out for a walk with you, or suggest low-stress, just-plain-fun activities. Helping him keep his expectations and goals reasonable can be a huge help.

If you feel that your loved one needs more than you can provide, help him get what he needs. This may mean that you’ll have to take the initiative and make medical appointments for him, and take him there if he’s unwilling or unable to do it himself. Most important, be patient. Recovering from stress will take some time. And when it comes to PTSD, there is no quick cure. But the condition can be effectively managed and symptoms greatly reduced. Finally, be sure to take care of yourself. Your man’s stress can spill over into the lives of everyone around him. Caring for another person requires love, commitment, and patience. And you can’t possibly take care of someone else if doing so is stressing you out.

Resources

To find out more about stress visit the following:

Medline Plus
National Institutes of Mental Health
The American Institutes of Stress
Men’s Health Network

About

Anxiety disorders fall into several broad categories:

• Generalized Anxiety Disorder (GAD). People with GAD are worried about something — money, health, their boss or their children — almost every waking moment. They know the situation isn’t as bad as they fear it is, but they can’t shake the feelings of impending doom. They often have trouble falling or staying asleep and may suffer from a host of problems such as sweating, twitching, inability to concentrate and/or irritability.
• Obsessive Compulsive Disorder (OCD). If you’re suffering from OCD, your day is marked by unwanted thoughts and behaviors that you can’t seem to control. For example, you might be so worried about germs that you’ll spend hours and hours washing your hands over and over and over and you might avoid touching anything or anyone for fear that you’ll get contaminated. Or you might become consumed with worry that you’ve left your front door unlocked and you’ll come back home dozens of times every day to check. Or you might get extremely upset if everything in your home or office isn’t arranged perfectly symmetrical. In the short run these rituals help ease the anxiety but eventually they take over and make things worse.
• Panic Attacks and Panic Disorder. A panic attack is a sudden onset of overwhelming terror, which seems to come out of nowhere and for no particular reason. These attacks usually last less than 15 minutes and are often accompanied by sweating, nausea, rapid heartbeat, chest pain, the sensation of being smothered and an intense fear that you’re going to lose control or die. Many people who have panic attacks have only one. For others, they happen repeatedly but are completely unpredictable, which makes the situation worse. If you had a panic attack in a grocery store or in your car once, you might do everything you can to avoid shopping or driving. About a third of those who have frequent panic attacks collect so many fears that they develop a condition called agoraphobia, leaving them terrified of leaving their own home. Fortunately panic disorder is easily treatable and symptoms can be controlled with medication or certain types of psychotherapy.
• Social Anxiety or Social Phobia. A phobia is an exaggerated fear of specific objects or situations such as spiders, flying or swimming. Many of us have experienced stage fright or worried about failing in front of others. That’s normal. But sometimes those fears can last for weeks and can become so severe that they it’s almost impossible to work,  go to school or have almost any encounters with other people. Besides the feelings of dread, people with social anxiety or phobias may have almost uncontrollable blushing, sweat profusely, have a rapid heartbeat and hardly be able to speak. People with severe, untreated social phobias also have an especially difficult time forming relationships with others are less likely to get married and are more likely to drop out of school.

FYI

WHAT CAUSES ANXIETY DISORDERS?

As with depression, no one is completely sure what causes anxiety disorders. Most experts agree, however, that it’s probably a combination of factors, including:

• Genetics. Anxiety often runs in families.
• Your environment. Where you live, how much money you make, whether or not you’re happy at work and in your personal relationships.
• Your personality. If, for example, you see yourself as a victim or as powerless to influence your own life, you’re likely to see the world as a very dangerous place.
• A trauma or significant stress.
• A major physical problem or illness.
• The build-up over time of many small, negative, life events.

Symptoms

DO YOU HAVE AN ANXIETY DISORDER?

The key to telling the difference between normal behavior and something that might require professional help is the impact it has on your life. If you’re doing well at work or school, have good friends, get over your nervousness and tension pretty quickly and feel that you’re functioning well; chances are you’ve got nothing to worry about. But if your worries or anxieties are interfering with your work or school life, make it hard for you to have friends or maintain relationships and affect your ability to enjoy life, you may have an anxiety disorder.

The following is a list of symptoms you may experience if you have one or more of the anxiety disorders we discussed above. If you have more than three or four on a regular basis, schedule an appointment with your healthcare provider as soon as possible.

• Intense feelings of worry, fear, confusion or nervousness that have lasted more than two months
• Frequent spells of apprehension, uneasiness or dread
• Frequent feelings of self-consciousness or insecurity
• Fear that you are about to die or that you are losing control or going crazy
• Fear that something terrible is going to happen
• Fear that you’ll have a panic attack
• A frequent — and very strong — desire to escape
• Avoiding social situations or fear of being embarrassed or humiliated in public
• Difficulty concentrating, either generally or only in specific situations
• Shortness of breath
• Palpitations or pounding heart
• Chest pain or discomfort
• Frequent headaches, muscle tension, pain, or upset stomach that doesn’t respond to ordinary treatment
• Trembling, shaking, restlessness, jumpiness, twitches, or feeling on edge
• Dizziness, nausea, or queasiness
• Hot flashes or chills
• Irritability
• Cold and clammy hands
• Profuse sweating
• Fatigue
• Trouble falling or staying asleep

Prevention

There are a number of steps you can take to reduce your anxiety.

• Get plenty of exercise. Yoga, jogging, cycling, racquetball, basketball, or anything that gets your heart rate up is good.
• Take a class in meditation or relaxation techniques. Spend time doing activities you really enjoy.
• Try to spend time with people you feel comfortable around.
• Join a support group. Knowing you’re not alone is extremely helpful and reassuring. There are general groups for people with a variety of anxiety issues. In addition, there are many groups that focus on specific types of anxiety. For example, if you get petrified at the thought of having to speak in front of a group, you might consider joining Toastmasters.
• Get plenty of sleep
• Eat well

Diagnosis

Men are less likely than women to be diagnosed with anxiety disorders but that’s in part because men are less likely to report them. Unfortunately, this could be because it’s more acceptable in our society for a man to see a healthcare provider for a physical problem such as chest pain, than it is to admit being nervous or anxious. And we have a tendency to believe that those traits affect women, not men. For that reason, if after reviewing the symptoms listed above, and you think you have an anxiety disorder; it’s essential that you contact your healthcare provider. One important reason for this is that anxiety symptoms can sometimes be caused by a physical condition such as heart problems, migraines or epilepsy.

Symptoms can also be caused by food (caffeine), medication (some decongestants, drugs for blood pressure and ADD or weight-loss pills) or illegal drugs (cocaine and others).

If able to rule out physical conditions, your healthcare provider may do some extensive screening to determine the type and severity of your anxiety. Although a team of researchers recently developed a blood test that may help diagnose anxiety disorders, it’s years away from being widely available. So healthcare providers have to do their diagnosing the old fashioned way: by asking you a series of questions and/or having you take a number of written tests.

Questions to Ask Your Health Care Provider

It’s important that you become proactive in your healthcare in order to get the best treatment. Here are some questions you can ask your healthcare provider about anxiety.

• What’s the cause of my anxiety?
• What are the symptoms associated with this disorder?
• Are there other health conditions that could be causing or worsening my anxiety?
• What medical tests do I need?
• What type of treatment options do you recommend and why?
• What are the side effects and benefits of the available treatment options?
• What can I do to help myself feel better during treatment for depression?
• Should I see a psychiatrist, psychologist or other mental health provider?
• Would cognitive behavioral therapy help me?
• Would medication help? If so, is there a generic alternative to the medicine you’re prescribing?
• Do you have any printed material that I can take home?
• What local support groups do you recommend?

Treatments

Once the correct diagnosis is made, anxiety disorders generally respond very well to treatment and you should start that treatment as soon as possible. At the very least, it will improve your quality of life. In addition, long-term, untreated anxiety increases your risk of hardening of the arteries (atherosclerosis), headaches, asthma, irritable bowel syndrome, ulcers, high blood pressure, and suicide. The specifics of your treatment will be based on your symptoms — how severe they are, how long they’ve lasted, what (if anything) triggered them and any other conditions you may have such as depression, diabetes, or alcoholism.

Nevertheless, those treatments will fall into 3 categories:

• Medication. The most common are specific anti-anxiety drugs, but antidepressants and some types of beta blockers (which help reduce performance jitters and anxiety) can also be helpful. Antidepressants often take a few weeks before they fully kick in and can be taken on a long-term basis. Anti-anxiety drugs are usually given only for a limited time because it’s possible to build up a tolerance, meaning you would need more and more to get the same effect over time. Remember that sharing another person’s medication is not a good idea. You may be taking the wrong thing for the wrong period of time.
• Psychotherapy, in particular cognitive behavioral therapy (CBT). Unlike traditional talk therapy, CBT is far more action-oriented and focuses on changing your thinking patterns by changing your behavior. You’ll learn what’s keeping you from functioning the way you’d like and you’ll learn new ways of dealing and coping by confronting your fears in a safe environment.
• A combination of medication and psychotherapy.

Resources

To find out more about anxiety visit the following:

Anxiety and Depression Society of America
Medline Plus
National Institute of Mental Health
Men’s Health Network

About

Generally speaking, there are 3 kinds of depressive disorders:

• Major depression. If you’re suffering from major depression, just getting through the day is a constant, uphill battle. It can undermine your performance at work, damage or destroy your relationships with family and friends, leave you feeling overwhelmed or cause you to do harm to yourself or someone else. Major depression could be triggered by a single event such as a divorce, the death of a loved one or a financial crisis. It’s also possible for major depression to appear for no clear reason.
• Minor depression (also called dysthymia). The symptoms are less severe with minor depression but they can last a lot longer and can leave you feeling less-than-good for months or years at a time. Having dysthymia also puts you at risk for major depression.
• Bipolar disorder (formerly called manic depression). People suffering from bipolar disorder cycle between severe depression and extreme, unnatural excitement.

WHAT CAUSES DEPRESSION?

No one is 100% sure what causes depression. Most experts agree, however, that it’s probably a combination of factors including:

• Genetics (depression often runs in families)
• An imbalance of certain brain chemicals (called neurotransmitters) which help brain cells communicate with each other.
• A disorder of the part of the brain that regulates mood, sleep, appetite, behavior, and thinking
• Major life events, such as the death of a loved one, divorce, financial problems, or the birth of a child.
• The build-up over time of many, smaller, negative life events.

Depression can also be caused by any number of other personal issues, especially those having to do with your family and work lives. For example, you might become depressed if you’re having ongoing conflicts with your partner about childrearing or if she continually makes you feel that you aren’t living up to her expectations. You could become depressed if you feel inadequate as a father, perhaps because your children get poor grades, are in trouble, you don’t have enough money to send them to better schools or simply because they’re growing up and don’t seem to need you as much as they used to. You might become depressed — even if you’re wealthy — because you don’t have as much as you feel you need or because you’re having trouble “keeping up with the Joneses.” Or you might feel depressed if you’re worried that a second (or third) marriage or relationship might not work out, if you don’t get along with her children from a previous relationship or she doesn’t get along with yours. For a lot of men, identity and masculinity are connected with job performance and salary. You could easily become depressed if you’re disappointed with where your career is at this point in your life, you hate your job or your boss, you aren’t earning as much as you think you should, you’re worried about your job security, you don’t have enough control over your work environment or because your boss or coworkers are making unreasonable demands.

For older men, retirement can be especially difficult. It’s not easy to lose the self-esteem and pride that come from working and earning money and it’s tough to make the transition from top performer to mentor and guide. However one thing is for sure: depression is not a “normal” or an inevitable part of aging. Most older men feel content with their lives.

DEPRESSION AND SEXUAL HEALTH

Depression can be treated with medications. You may also be taking medicine for anxiety, high blood pressure, spasticity, sleeping problems or allergies. Addressing these medical concerns can increase your sex drive. But know that some medication can also have side effects that interfere with your sex life. If your ability to enjoy sex has decreased since your stroke, talk with your healthcare provider about medicines that have fewer sexual side effects.

FYI

According to the National Institutes of Health, at any given time, an estimated six million men in the United States are suffering from one or more types of depression. In addition, somewhere between 10 and 25% of new fathers become depressed during that hectic first year of fatherhood. Overall, new dads are twice as likely as other men their age to have symptoms of depression.

Depression can strike at any age, from childhood into late life, and is responsible for a lot of unnecessary suffering.

Symptoms

One of the most difficult and confusing aspects of depression is that the symptoms can crop up in so many areas including mood, appetite, sleep patterns, sex drive, behavior, memory and concentration and more. As you read through each of the statements below, think about whether it applies to you.

• I frequently feel tired or have low-energy
• I find myself getting angry, irritated, restless, or frustrated easily
• I think I’ve lost my sense of humor
• I find myself spending a lot of time at work as a way of avoiding doing other things
• I drink too much or abuse drugs or prescription medication
• I take unnecessary risks (such as driving too fast, extreme sports, or unprotected sex)
• I often feel ashamed
• I don’t take good care of myself or go to the healthcare provider even when I know there’s something wrong
• I lose my temper easily or have been verbally or physically abusive to someone close to me
• I get into a lot of arguments
• I have a history of broken relationships
• I can’t seem to stay at a job more than a year
• I have lost interest in people and things I used to enjoy (such as work, activities, friendships, and sex)
• I have sleep problems (either falling asleep, getting up early and not being able to get back to sleep, or oversleeping)
• I feel isolated and avoid spending time with family and friends
• I often feel completely overwhelmed by life
• I often feel guilty, that no one cares about me, or that life is worthless
• I have lost a lot of weight recently without trying
• I am frequently late to work, school, or appointments
• I frequently feel sad, emotionally empty, or just can’t bring myself to care about things
• I sometimes cry for no reason
• I think about death or killing myself
• I have trouble concentrating or remembering things
• I have trouble making decisions or choices
• People describe me as cold or aloof
• I have few or no close friends
• I’m a new father
• My children are afraid of me
• I have frequent headaches, chronic pain, or stomach trouble that doesn’t seem to ever go away and doesn’t respond to ordinary treatment

If you answered “yes” to more than 3-4 of the questions above, you may be suffering from depression—and you’re far from alone.

Prevention

It may be hard to prevent depression and you may experience mild depression from time to time. However, there are several things that you can do to minimize the impact it may have on your life. This involves:

• Reaching out to family and friends, especially when you may have something stressful  going on in your life.
• Seeing your healthcare provider as soon as you notice any symptoms of depression to help prevent depression from worsening.
• If diagnosed with chronic depression, consider long-term treatment to help prevent a relapse of symptoms.
• Eating a healthy diet, exercising, taking time to relax, not overworking, and doing things you enjoy with your loved ones, are all effective strategies that can help to minimize depression.

Diagnosis

With proper diagnosis and treatment, the vast majority of men with depression can be helped and will go on to lead normal, happy lives. However, the condition is often misunderstood and many men don’t recognize, admit or seek help for their depression. As a result, they don’t get the treatment they need. In addition, healthcare providers are less likely to suspect depression in men than in women, in part because men and women often have very different symptoms and ways of coping. In a sentence, women get sad and men get mad. For example, a woman who feels down, helpless, worthless, hopeless, or guilty will probably visit her healthcare provider. But a man who’s feeling tired, irritable, angry or discouraged, is having trouble sleeping or has lost interest in his work or hobbies will usually do one of three things:

• Deny to himself and everyone else that he might have a problem.
• Try to mask the problem by turning to drugs or alcohol or throwing himself into his work in an attempt to avoid dealing with the issue.
• Act out by behaving hostilely or aggressively or doing something dangerous or self-destructive.

Unfortunately all of these behaviors make it harder for men to get diagnosed and treated and can actually make the depression worse. If left untreated, the symptoms of depression can last for years, getting progressively worse with time. This is especially true if you’re a military veteran. Military veterans have a higher incidence of depression and other mental health problems.

One study found that 1 in 5 soldiers who served in Iraq or Afghanistan has suffered from major depression or Post-Traumatic Stress Disorder. Besides making everything in life less enjoyable and making you less fun to be around, your depression can reduce your productivity at work (which can threaten your job), hurt your relationships with friends and family and increase your risk of getting divorced.

Depression can also severely damage your physical health and even shorten your life. To start with, many men turn to drugs or alcohol to cope with their depression. They may act out their depression by behaving recklessly, taking unnecessary risks or committing crimes. According to the Mayo Clinic, men with depression are more than twice as likely as men without depression to die of any cause. Men are four times more likely to commit suicide than women and veterans are more than twice as likely as other men to commit suicide. And contrary to popular belief, older men — not teenagers or young men — have the highest suicide rate of all.

Questions to Ask Your Health Care Provider

It’s important that you become proactive in your healthcare to get the best treatment. Here are some questions you can ask your healthcare provider about depression.

• Why do you think I have a depressive disorder and what form of depressive disorder do you think I have?
• What are the symptoms associated with this disorder?
• Might there be another cause for my depression symptoms, such as medication or a medical condition?
• What factors do you think may have contributed to my depression?
• Might this type of depression be hereditary or related to environmental factors? If so, are other members of my family at increased risk for developing a depressive disorder?
• What type of treatment options do you recommend and why?
• What are the side effects and benefits of the available treatment options?
• What can I do to help myself feel better during treatment for depression?
• About how long do you expect it to take for my condition to respond to treatment?
• Do you recommend medications to treat my depression? Why or why not?
• What types of severe side effects may occur?
• What should I do if my condition worsens or I experience severe medication side effects?
• If my depression symptoms do not improve or return after treatment, what other therapies or medications may be prescribed?
• Do you recommend that I do to therapy? If so, what type of therapy?
• Can you recommend any support groups or other local resources to help me manage my condition?

Treatments

Look at the symptoms of depression. If you honestly feel that one or more of the symptoms you checked have lasted for more than a few weeks or are interfering with your life in any way, it’s important to start making some changes right now.

The simplest place to start is with yourself. There are a number of things you can do on your own that have a good chance of improving your symptoms. For example:

• Get some exercise. It doesn’t really matter what you do, just as long as you do it for 20-30 minutes three or four times a week. (Of course if you haven’t exercised in a while or you have any physical limitations, check with your healthcare provider before you run that marathon). In the short term, exercise can boost your mood immediately. In the long term, exercise can make you feel better about yourself, and several studies have found that exercise may be as effective as anti-depressant medications.
• Spend time with other people. Suffering alone won’t help and will make you feel even worse. It’s important to find friends and family who you know will be supportive and encouraging. You may even want to seek out people who have some experience with depression. Those who haven’t might not truly “get” it and the last thing you need to hear right now is, “Snap out of it.”
• Do something you enjoy — even if you have to force yourself. Doesn’t matter whether it’s seeing a movie, going to a ball game, taking a walk around the block or having sex.
• Don’t make any major decisions now. Wait until you’re feeling better.
• Prioritize. Of all the things you need to do on any given day, which ones are the most important and which can wait? And honestly, what would happen if you didn’t do a few of the tasks on your list at all?
• Set realistic goals. Setting the bar too high — and then not reaching it — will feed your depression and make you feel even less confident. Breaking tasks down into smaller pieces and celebrating your small achievements will make you feel much better about yourself.
• Be patient with yourself. Chances are your depression didn’t happen overnight and it’s not going to go away overnight either — even with medication and therapy.

YOU AND YOUR HEALTHCARE PROVIDER:  TREATMENT OPTIONS

If you think you’re depressed and you don’t notice any improvement after trying the steps above, call your healthcare provider’s office, tell them you’re feeling depressed and ask for an appointment within the next few days. If you’d prefer not to mention your depression over the phone, just say that you’re feeling weak and tired —  the appointment length for evaluating those symptoms is the same as it would be for depression.

Once you’re in the office, talk frankly and honestly with your healthcare provider. He or she should be your safest ally — if not, start looking for a different healthcare provider. You may feel uncomfortable talking about your mental health with your friends or co-workers but no matter how ashamed you feel, you can always talk about these issues with your healthcare provider. He or she has definitely heard it all before, so don’t feel shy or ashamed to discuss what’s going on — or at least what you think is going on in your health. A trusted healthcare provider needs to know everything about what you’re feeling, when your symptoms started and your family’s history of depression.

Please note that if you live in a rural area or a small town, getting help may be especially difficult. There may not be a healthcare provider nearby. Or, if the person you’d turn to is a friend, a neighbor or a member of your place of worship, you may worry about whether what you tell him will stay between the two of you. These are all common concerns. However, we strongly encourage you to keep looking until you find the right person. And rest assured, anything you say to a medical professional will remain completely confidential.

One thing to consider is that you may simply have a hormone deficiency — something as basic as an underactive thyroid gland. In addition, many men over 50 have low testosterone levels and replenishing that hormone may make you feel better. If you do have a medical condition, you and your healthcare provider will work together to come up with an action plan for how to deal with it. If the medical tests come back negative, talk with your healthcare provider about getting a depression screening Admitting that you need help takes a lot of courage but you can’t get better if you don’t admit it.

Once your diagnosis of depression has been confirmed, you’ll have three basic treatment options:

• Psychotherapy, either individual or group
• Antidepressant medication
• A combination of therapy and prescription medication is an option that is usually more successful than either of the other options.

STARTING YOUR TREATMENT

Just as every man’s depression is unique, so is his treatment—there are dozens of different therapy and medication options out there—and it’s essential that you take an active role in your own treatment. This means:

• You may need to interview several different mental health professionals before you find the one whose personality and approach “click” with you. So make appointments with more than one, and don’t feel that you have to go with the first person your healthcare provider recommends.
• You may need to try several different medications, doses, or combinations before finding the one that’s best for you. Most drugs have minor side effects that generally disappear within a few weeks. These may include insomnia, tiredness, headaches, feeling jittery, and sometimes sexual problems (reaching orgasm, achieving an erection, or a decreased sex drive).
• Keep your healthcare provider in the loop. Once you start feeling better, it can be tempting to quit therapy or stop taking the medication. Do not do either without consulting your healthcare provider first.
• Never take anyone else’s medication. What works for a friend may not work for you—and could potentially cause severe problems.
• Ask your healthcare provider to think outside the box. Meditation, relaxation, herbs, massage, and other alternative therapies have been shown to be effective in reducing symptoms of depression in some cases. However, before starting any of these non-traditional approaches, be sure to discuss it fully with your healthcare provider.
• Keep your expectations realistic. Regardless of the method of treatment you and your healthcare provider decide on, it’s important to understand that you’re probably not going to see results overnight. So, talk with your healthcare provider about how long it might take before you start to feel better.

FAMILY AND FRIENDS: HOW YOU CAN HELP

If someone close to you is experiencing more than two or three of the symptoms of depression and is not taking active steps to seek out treatment, your loved one needs you. The most important thing you can do is to be understanding and supportive. Talk with him about what he’s feeling and remind him that depression is treatable and doesn’t mean he’s weak or flawed in any way. Encourage him to go out for a walk with you or to participate in an activity that he used to enjoy. And remember that comments like, “Snap out of it!” are not helpful. One of the major symptoms of depression is lack of energy and motivation. Your support and gentle pushing could be enough to get the man in your life on the path toward recovery.

If you feel that he needs more help than you can provide, help him get what he needs. This may mean that you’ll have to take the initiative and make medical appointments for him and take him there if he’s unwilling or unable to do it himself. Most importantly, be patient. Recovering from depression will take some time.

Finally, be sure to take care of yourself. Your man’s depression can spill over into the lives of everyone around him. Caring for a depressed person requires love, commitment, and patience. And you can’t possibly be an effective caregiver if you’re slipping into depression yourself.

Resources

Visit the following to find out more about depression:

Anxiety and Depression Society of America
Medline Plus
National Institute of Mental Health
Men’s Health Network

About

PTSD affects about 7.7 million American adults, but can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters and many other serious events. Not everyone with PTSD has personally experienced a dangerous event. Some people get symptoms of PTSD after a friend or family member has experienced trauma, and the sudden, unexpected death of a loved one can also trigger PTSD.

FYI

PTSD is the fallout from a terrifying or catastrophic event in your life, usually something where you, or someone close to you, were in danger of being seriously hurt or killed. It could be a car crash, being a witness or the victim of a violent crime, serving in combat, or living through a natural disaster such as a hurricane or earthquake. Many people who experience traumas recover quickly and get back to their normal lives. But not everyone. Some develop Post-Traumatic Stress Disorder (PTSD). They may re-live the event over and over, in nightmares at night and scary thoughts during the day. They may go to extraordinary lengths to avoid any reminder (people, places, smells, etc.) of the event. They may also develop symptoms of any or all of the other types of stress discussed above. Those symptoms, if they occur, usually appear around three months after the event, although it could be as much as a year or longer.

Why seek help?

• PTSD is treatable. You do not need to suffer from the symptoms of PTSD alone.
• Early treatment is better.
• PTSD can impact your family life.
• PTSD can be associated with other health issues.
• It may not be PTSD.

Symptoms

• Surviving a serious accident
• Surviving a terrorist attack
• An event where you thought you were going to die
• Shooting or being shot at in combat
• Other stressful events

Many people who survive events like these will feel normal after time. But, for some people, the stress from a traumatic event stays with them and might even get worse. These people may get PTSD.

Long-term symptoms may also include:

• Anti social behavior. You may feel that you can’t trust other people, which could lead you to withdraw from friends or family, or cause relationship problems at home, school, or work.
• Intrusive symptoms, such as flashbacks and nightmares. These are often so vivid that it may feel like you’re going through the trauma again. You may feel as scared as you were when it actually happened. Instead of (or in addition to) flashbacks and nightmares, you may suddenly feel a wave of fear, panic, anger, or crying that comes completely out of the blue.

Prevention

If you think you may have PTSD, it’s important to get checked out. Here are some ways to get help:

• Get evaluated for PTSD by a psychiatrist, psychologist, or anyone trained to asses psychological problems. Or, talk with your doctor.
• Contact your local VA Hospital or Vet Center.
• If you feel that your condition may improve over time, you may take a wait-and-see approach. If you get better on your own, you won’t need treatment.
• Talk to a friend or family member. He or she may be able to support you and find you help.

Diagnosis

Things to consider:

• I have symptoms of re-experiencing or reliving the traumatic event:
  • Have bad dreams or nightmares about the event or something like it.
  • Act or feel like the event were happening all over again (flashbacks).
  • Have a lot of intense feelings when I am reminded of the event.
  • My body responds when I am reminded of the event (for example, my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I’m going to lose control).

• I have symptoms of avoiding reminders of the traumatic event:
  • Avoid thoughts, conversations, or feelings that remind me of the event.
  • Avoid people, places, or activities that remind me of the event.
  • Have trouble remembering some important part of the event.

• I have noticed these symptoms since the event happened:
  • Have lost interest in, or just don’t do, things that used to be important to me.
  • Feel detached from people; find it hard to trust people.
  • Feel emotionally “numb” and find it hard to have loving feelings even toward those who are close to me.
  • Have a hard time falling or staying asleep.
  • Am irritable and have problems with my anger.
  • Have a hard time concentrating.
  • Think I may not live long and feel there’s no point in planning for the future.
  • Am jumpy and get startled easily.
  • Am always “on guard.”

• I experience these medical or emotional problems:
  • Stomach problems
  • Intestinal (bowel) problems
  • Gynecological (female) problems
  • Weight gain or loss
  • Pain, for example, in back, neck, or pelvic area
  • Headaches
  • Skin rashes and other skin problems
  • Lack of energy; feel tired all the time
  • Alcohol, drug, or other substance use problems
  • Depression or feeling down
  • Anxiety or worry
  • Panic attacks

Questions to Ask Your Health Care Provider

• What’s the cause of my PTSD and how severe it is?
• What are the symptoms associated with PTSD?
• Are there other health conditions that could be causing or worsening my stress?
• What steps do you recommend that I take to better manage my stress and why?
• Should I see a psychiatrist, psychologist or other mental health provider?
• Would medication help? If so, is there a generic alternative to the medicine you’re prescribing?
• Do you have any printed material that I can take home?
• What local support groups do you recommend?

Treatments

PTSD can be treated. If you think you have PTSD, it might help to talk to your healthcare provider. Maybe it’s hard to talk about what happened. You can begin by recording episodes that you experience and bringing them to your appointment.

Explain when you experienced or saw a traumatic event and felt extreme fear, helplessness or horror. When did this happen (day/month/year) and what was it that happened?

Here are some ways you healthcare provider may treat your PTSD:

• Medication
• Psychotherapy, either individual or group
• A combination of therapy and drugs

FAMILY AND FRIENDS: HOW YOU CAN HELP

If you think your loved one is suffering from severe stress or PTSD and isn’t taking active steps to seek out treatment, he needs you. The most important thing you can do is to be understanding and supportive. Talk with him about what he’s feeling and remind him that PTSD—is treatable and doesn’t mean he’s weak or flawed in any way. Encourage him to go out for a walk with you, or suggest low-stress, just-plain-fun activities. Helping him keep his expectations and goals reasonable can be a huge help.

If you feel that your loved one needs more than you can provide, help him get what he needs. This may mean that you’ll have to take the initiative and make medical appointments for him, and take him there if he’s unwilling or unable to do it himself. Most important, be patient. Recovering from stress will take some time. And when it comes to PTSD, there is no quick cure. But the condition can be effectively managed and symptoms greatly reduced. Finally, be sure to take care of yourself. Your man’s stress can spill over into the lives of everyone around him. Caring for another person requires love, commitment, and patience. And you can’t possibly take care of someone else if doing so is stressing you out.

Resources

US Department of Veterans Affairs
1-800-827-1000

Veterans Affairs National Center for PTSD
(802) 296-6300

Veterans Affairs Facilities Locator

National Institute of Mental Health
1-866-615-NIMH (6464) toll-free

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Find treatment services near you: 1-800-662-HELP (4357)

National Suicide Prevention Lifeline
1-800-273-TALK

Men’s Health Network– Your Head Booklet

Men’s Health Network – PTSD