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Depression and Suicide Warning Signs

There are warning signs you can watch for in hose who may be at risk of attempting suicide. Though there is no single type of person who may commit suicide, and the symptoms below are not exhaustive, these are the most common signs observed among people who may be contemplating taking their own life.

  • A change in personality, especially behaviors in social situations.
  • Withdrawal from interaction or communication with others.
  • Mood changes that are drastic, such as being very low mood one day to being in a very high mood the next.
  • Triggers such as life crisis or trauma in a person who is already suffering from depression.
  • Threats of suicide, or expressed negative wishes regarding life, such as wishing they'd "never been born."
  • Giving away of cherished belongings to friends and loved ones.
  • Deep depression (manic) observed that affects their ability to function socially or in the workplace.
  • Aggressive or risky behaviors, such as high-speed driving.



Depression is a serious medical illness; it’s not something that you make up in your head. More than a feeling of being “down in the dumps” or “blue” for a few days, the symptoms of Depression are severe and debilitating. Depression is characterized by feeling “down,” “low” and “hopeless” for weeks at a time. Factors that can contribute to the onset of Depression include stress, poor nutrition, physical illness, personal loss, relationship difficulties and the presence of other physical disorders.

Depression isn’t always easy to detect, and people with depressive conditions can experience different symptoms. It may be expressed through lack of appetite or overeating; insomnia or an unnatural desire to sleep; the abuse of drugs and alcohol; sexual promiscuity; or hostile, aggressive, or risk-taking behavior.

Depression symptoms can vary from mild to severe and can include

  • Persistent sad, anxious or “empty” feelings;
  • Feelings of hopelessness and / or pessimism;
  • Feelings of guilt, worthlessness and/or helplessness
  • Difficulty thinking, concentrating or making decisions
  • Irritability, restlessness;
  • Loss of interest in activities or hobbies once pleasurable, including sex;
  • Loss of energy or increased fatigue
  • Difficulty concentrating, remembering details and making decisions;
  • Trouble sleeping or sleeping too much. Insomnia, early-morning wakefulness, or excessive sleeping;
  • Changes in appetite — weight loss or gain unrelated to dieting. Overeating, or appetite loss.
  • Thoughts of suicide, suicide attempts;
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment.
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Thoughts of death or suicide

What is Depression?

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression. For more information: National Institute of Mental Health

Depression is a serious medical illness; it’s not something that you make up in your head. More than a feeling of being “down in the dumps” or “blue” for a few days, the symptoms of Depression are severe and debilitating. Depression is characterized by feeling “down,” “low” and “hopeless” for weeks at a time. Factors that can contribute to the onset of Depression include stress, poor nutrition, physical illness, personal loss, relationship difficulties and the presence of other physical disorders.

Depression isn’t always easy to detect, and people with depressive conditions can experience different symptoms. It may be expressed through lack of appetite or overeating; insomnia or an unnatural desire to sleep; the abuse of drugs and alcohol; sexual promiscuity; or hostile, aggressive, or risk-taking behavior.

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include

  • Persistent sad, anxious or “empty” feelings;
  • Feelings of hopelessness and / or pessimism;
  • Feelings of guilt, worthlessness and/or helplessness
  • Difficulty thinking, concentrating or making decisions
  • Irritability, restlessness;
  • Loss of interest in activities or hobbies once pleasurable, including sex;
  • Loss of energy or increased fatigue
  • Difficulty concentrating, remembering details and making decisions;
  • Trouble sleeping or sleeping too much. Insomnia, early-morning wakefulness, or excessive sleeping;
  • Changes in appetite — weight loss or gain unrelated to dieting. Overeating, or appetite loss.
  • Thoughts of suicide, suicide attempts;
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment.
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

  • In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
  • In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
  • For some people, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression co-exist, the grief is more severe and lasts longer than grief without depression. Despite some overlap between grief and depression, they are different. Distinguishing between them can help people get the help, support or treatment they need.

Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.

Several factors can play a role in depression:

  • Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
  • Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
  • Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
  • Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

How Is Depression Treated?

Depression is among the most treatable of mental disorders. Between 80% and 90% of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem. The evaluation is to identify specific symptoms, medical and family history, cultural factors and environmental factors to arrive at a diagnosis and plan a course of action.

Medication: Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.

Antidepressants may produce some improvement within the first week or two of use. Full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects.

Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used in along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviors and thinking.

Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy involves people with similar illnesses.

Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.

Electroconvulsive Therapy (ECT) is a medical treatment most commonly used for patients with severe major depression or bipolar disorder who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. ECT has been used since the 1940s, and many years of research have led to major improvements. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improve mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing mental health needs.

Related Conditions

  • Peripartum depression (previously postpartum depression)
  • Seasonal depression (Also called seasonal affective disorder)
  • Persistent depressive disorder (previously dysthymia)
  • Premenstrual dysphoric disorder
  • Disruptive mood dysregulation disorder
  • Bipolar disorders


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.

National Institute of Mental Health. (Data from 2013 National Survey on Drug Use and Health.)

Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593602.


According to the 5 th edition of the DSM, a person must exhibit at least five of the following characteristics to be diagnosed with a depressive disorder:

  • Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others (characterized by sadness, emptiness, or hopelessness).
  • Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day.
  • Significant weight loss when not dieting or weight gain.
  • Inability to sleep or oversleeping nearly every day.
  • Psychomotor agitation or retardation nearly every day.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  • In addition, the "symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" and the "episode is not attributable to the physiological effects of a substance or to another medical condition."

The above represent a "major depressive episode". The other two criteria as stated by DSM-5 is that "the occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders" and there has never been "a manic episode or a hypomanic episode."
Source: (Note: This web site shows photo leads to six stories under "Resources for Depression.. One of pills. Five of women, written by women. One includes a male as the clinician.

What are the symptoms of Depression?

According to the National Foundation of Depressive Illness, the symptoms of Depressive Illness are highly recognizable, both to those affected and to those closest to them, once they are told what to look for.

• Loss of energy and interest.
• Diminished ability to enjoy oneself.
• Decreased (or increased) sleeping or appetite.
• Difficulty in concentrating, indecisiveness, slowed or fuzzy thinking.
• Exaggerated feelings of sadness, hopelessness, or anxiety.
• Feelings of worthlessness.
• Recurring thoughts about death and suicide.

Think you might be suffering from depression? Try one of these free online quizes: and

Depression Symptoms and Warning Signs

How to Recognize the Symptoms and Get Effective Help?

Feeling down from time to time is a normal part of life, but when emotions such as hopelessness and despair take hold and just won't go away, you may have depression. Depression makes it tough to function and enjoy life like you once did. Just getting through the day can be overwhelming. But no matter how hopeless you feel, you can get better. Learning about depression—and the many things you can do to help yourself—is the first step to overcoming the problem.

How do you experience depression?

While some people describe depression as “living in a black hole” or having a feeling of impending doom, others feel lifeless, empty, and apathetic. Men in particular may even feel angry and restless. No matter how you experience it, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun.

Some people feel like nothing will ever change. But it’s important to remember that feelings of helplessness and hopelessness are symptoms of depression—not the reality of your situation. You can do things today to start feeling better.

What are the symptoms of depression?

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression.

Symptoms of depression include:
  • Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
  • Loss of interest in daily activities. You don’t care anymore about former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
  • Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
  • Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping.
  • Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
  • Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
  • Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
  • Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
  • Concentration problems. Trouble focusing, making decisions, or remembering things.
  • Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Is it depression or bipolar disorder?

Bipolar disorder, also known as manic depression, involves serious shifts in moods, energy, thinking, and behavior. Because it looks so similar to depression when in the low phase, it is often overlooked and misdiagnosed. This is a problem, because antidepressants for bipolar depression can make the condition worse. If you’ve ever gone through phases where you experienced excessive feelings of euphoria, a decreased need for sleep, racing thoughts, and impulsive behavior, consider getting evaluated for bipolar disorder. See: Bipolar Disorder Signs and Symptoms.

Depression and suicide risk

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and watch for the warning signs:

  • Talking about killing or harming one’s self
  • Expressing strong feelings of hopelessness or being trapped
  • An unusual preoccupation with death or dying
  • Acting recklessly, as if they have a death wish (e.g. speeding through red lights)
  • Calling or visiting people to say goodbye
  • Getting affairs in order (giving away prized possessions, tying up loose ends)
  • Saying things like “Everyone would be better off without me” or “I want out”
  • A sudden switch from being extremely depressed to acting calm and happy

If you think a friend or family member is considering suicide, express your concern and seek help immediately. Talking openly about suicidal thoughts and feelings can save a life.

The symptoms of depression can vary with gender and age

Depression often varies according to age and gender, with symptoms differing between men and women, or young people and older adults.

Depression in men. Depressed men are less likely to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. They’re also more likely to experience symptoms such as anger, aggression, reckless behavior, and substance abuse.

Depression in women. Women are more likely to experience symptoms such as pronounced feelings of guilt, excessive sleeping, overeating, and weight gain. Depression in women is also impacted by hormonal factors during menstruation, pregnancy, and menopause. Up to 1 in 7 women experience depression following childbirth, a condition known as postpartum depression.

Depression in teens. Irritability, anger, and agitation are often the most noticeable symptoms in depressed teens—not sadness. They may also complain of headaches, stomachaches, or other physical pains. Learn more

Depression in Children & Toddlers. Kids can have depression, too, even toddlers. ... Depression is a serious mental health issue that can affect even very young children. Depressed children are generally lacking in energy and enthusiasm. They often become withdrawn and are unable to concentrate or to enjoy life.

Depression in older adults. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression: things like fatigue, unexplained aches and pains, and memory problems. They may also neglect their personal appearance and stop taking critical medications for their health. Seniors' Depression Overlooked; Pandemic Stress and Jaw Pain

Types of depression

Depression comes in many shapes and forms. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatment.

Major depression

Major depression is much less common than mild or moderate depression and is characterized by intense, relentless symptoms.

  • Left untreated, major depression typically lasts for about six months.
  • Some people experience just a single depressive episode in their lifetime, but major depression can be a recurring disorder.

Atypical depression

Atypical depression is a common subtype of major depression with a specific symptom pattern. It responds better to some therapies and medications than others, so identifying it can be helpful.

  • People with atypical depression experience a temporary mood lift in response to positive events, such as after receiving good news or while out with friends.
  • Other symptoms of atypical depression include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.

Dysthymia (recurrent, mild depression)

Dysthymia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood.

  • The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years).
  • Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.”
  • If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.”

Seasonal affective disorder (SAD)

For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 1% to 2% of the population, particularly women and young people.

  • SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love.
  • SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.

Depression causes and risk factors

While some illnesses have a specific medical cause, making treatment straightforward, depression is more complicated. Depression is not just the result of a chemical imbalance in the brain that can be simply cured with medication. It’s caused by a combination of biological, psychological, and social factors. In other words, your lifestyle choices, relationships, and coping skills matter just as much—if not more so—than genetics.

Risk factors that make you more vulnerable to depression include:

  • Loneliness and isolation
  • Lack of social support
  • Recent stressful life experiences
  • Family history of depression
  • Marital or relationship problems
  • Financial strain
  • Early childhood trauma or abuse
  • Alcohol or drug abuse
  • Unemployment or underemployment
  • Health problems or chronic pain

The cause of your depression helps determine the treatment

Understanding the underlying cause of your depression may help you overcome the problem. For example, if you are depressed because of a dead end job, the best treatment might be finding a more satisfying career, not taking an antidepressant. If you are new to an area and feeling lonely and sad, finding new friends will probably give you more of a mood boost than going to therapy. In such cases, the depression is remedied by changing the situation.

What you can do to feel better

When you’re depressed, it can feel like there’s no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.

What you can do

Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. He or she just needs to be a good listener—someone who’ll listen attentively without being distracted or judging you.

Get moving. When you’re depressed, just getting out of bed can seem daunting, let alone exercising. But regular exercise can be as effective as antidepressant medication in countering the symptoms of depression. Take a short walk or put some music on and dance around. Start with small activities and build up from there.

Eat a mood boosting diet. Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar, and refined carbs. And increase mood-enhancing nutrients such as Omega-3 fatty acids.

Find ways to engage again with the world. Spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one). You won’t feel like it at first, but as you participate in the world again, you will start to feel better.

10 tips for reaching out and staying connected

  • Talk to one person about your feelings
  • Help someone else by volunteering
  • Have lunch or coffee with a friend
  • Ask a loved one to check in with you regularly
  • Accompany someone to the movies, a concert, or a small get-together
  • Call or email an old friend
  • Go for a walk with a workout buddy
  • Schedule a weekly dinner date
  • Meet new people by taking a class or joining a club
  • Confide in a clergy member, teacher, or sports coach

For more information, see: Coping with Depression

When to seek professional help

If support from family and friends and positive lifestyle changes aren’t enough, find a therapist who can help you heal.

Therapy can help you understand your depression and motivate you to take the action necessary to prevent it from coming back.

Medication may be imperative if you’re feeling suicidal or violent. But while it can help relieve symptoms of depression in some people, it isn’t a cure and is not usually a long-term solution. It also comes with side effects and other drawbacks so it’s important to learn all the facts to make an informed decision.

Related HelpGuide articles

  • Parent's Guide to Teen Depression: Recognizing the Signs of Depression in Teens and How You Can Help
  • Teenager's Guide to Depression: Tips and Tools for Helping Yourself or a Friend
  • Depression in Men: Signs, Symptoms, and Help for Male Depression

Resources and references

Signs and symptoms of depression

Signs and Symptoms of Mood Disorders – Lists the common signs and symptoms of depression and bipolar disorder. (Depression and Bipolar Support Alliance)

What Does Depression Feel Like? – Provides a list of signs and symptoms and ways you might feel if you're depressed. (Wings of Madness)

When Depression Hurts – Article on the painful physical symptoms of depression, including what causes them and how treatment can help. (Psychology Today)

Male Depression: Don't Ignore the Symptoms – Learn about the distinct symptoms of depression in men and the dangers of leaving them untreated. (Mayo Clinic)

Types of depression

The Different Faces of Depression – Discussion of the different subtypes of depression, including atypical depression, melancholic depression, and psychotic depression. (Psychology Today)

Atypical Depression: What's in a Name? – Article on the symptoms, diagnosis, and treatment of atypical depression. (American Psychiatric Association)

Dysthymia: Psychotherapists and patients confront the high cost of “low-grade” depression – In-depth look at the causes, effects, and treatment of dysthymic disorder. (Harvard Health Publications)

Seasonal Affective Disorder: Winter Depression – Guide to seasonal affective disorder and its symptoms, causes, and treatment. (Northern County Psychiatric Associates)

Depression causes and risk factors

What Causes Depression? Page 1 & Page 2 – Learn about the many potential causes of depression, including genes, temperament, stressful life events, and medical issues. (Harvard Health Publications)

Depression and Other Illnesses – An overview of the mental and physical illnesses that often co-exist with depression, and how this impacts treatment. (Depression and Bipolar Support Alliance)

Co-occurring Disorders and Depression – How medical disorders can affect depression and vice versa. (Mental Health America)


Depression Diagnosis

To be diagnosed with depression, someone must display five of the following symptoms for at least two weeks:

  • sadness or depressed mood
  • lack of interest or pleasure in almost all activities, especially those that used to be pleasurable
  • trouble sleeping or sleeping all the time
  • fatigue or lack of energy
  • feelings of worthlessness and guilt
  • an inability to concentrate or focus
  • change in appetite
  • agitation or feelings of moving in slow motion
  • recurring thoughts of death


I Knew I had a Good/Bad Psychiatrist/Therapist When…

I thought it would be helpful and informative to share good/bad psychiatrist or therapist stories.

We’ll start out with my experiences…

My first experience with treatment was at the mental health clinic at the local hospital. I was fairly indifferent toward the first psychiatrist I had there, but I was unpleasantly jarred to find out that he was leaving after six months. Apparently they were on some sort of rotation. When I walked into the new psychiatrist’s office, I immediately got a bad feeling. It looked like he felt this was a temporary situation, as the office was completely bare except for the desk and two chairs. The reason for my visit was to ask him to raise my medication, as I was feeling the familiar signs of depression after being fairly stable for a year. He never even looked at me, and only asked me one question to determine whether I was depressed again or not, “Do you have thoughts of harming yourself or others?” I said, “Well, no, but I never have, so that’s not really an indication for me.” He ignored all the signs of depression I was recounting and refused to raise my medication. I absolutely hated him, and wouldn’t go back until he was gone six months later. This time when I walked into the new psychiatrist’s office I was very wary, but the difference he had made in that cold office was amazing. I’m a little fuzzy on the specifics, but I immediately noticed that the place smelled great. He had air fresheners in the office that made you want to inhale when you walked in. He had prints on the walls and (I’m pretty sure) healthy plants. I may be just remembering the plants because he was such a nurturing person. He also had a photo of himself with a child on his bulletin board, which I took as a good sign. He was very accessible, listened to me, and ordered a blood test to find out the level of meds in my blood, which indeed was too low. He stayed longer than six months before moving on, and I was very sorry to see him go.

I had trouble with severe mood swings for years and my condition was getting worse. Upon finding out that several close relatives were bipolar, I did some research and found that without a doubt I had the symptoms. I took my information and family history to a local psychiatrist. He stated with sarcasm, “If you went out and bought five Corvettes I’d believe you were bipolar, but you’re not.” I believed him, left and did not seek any further treatment as I descended deeper into a horrible depression. Finally I went to a local clinic, and talked to a nurse practitioner who believed me enough to give me a trial of lithium. Literally within days I rounded a corner. The medication literally saved my life. The moral of the story for me is; if at first you don’t get listened to, keep looking until you do. Also, I’d rather talk to a nurse who listens than an MD who doesn’t. – Kate from Idaho

OK, finally…I put off suicide until I could at least get in to see the psychiatrist. The Paxil that my GI put me on isn’t working. I’m slipping down a drain. I had 1 1/2 hours of sleep last night and in another 2 hours I have to go to work. But….I went to the shrink today like I promised. Told him of my plans to end it. Told him how close I came. Told him I was already dead inside. Told him I had 2 hours of sleep and had to work again. I told him I can hardly get through a day anymore. He said “increase the paxil to 1 1/2 tabs and come back in a month”. Oh well. I didn’t deserve the help anyway. – angelica

About six years ago I was suffering from incredible depression. (I have since been diagnosed w/Borderline Personality Disorder, and depression comprises only a part of this). At any rate, because I was cutting myself, wanting to die, and locking myself in my apartment for weeks at a time (where I would sleep for days on end), my employer (who happened to be my church–I was a church secretary) demanded that I see the licensed family therapist they had on staff. I went. He looked like a dish of spumoni–he wore mixed pastels (polyester), and a horrifyingly bad toupee. On top of everything else, he told me (I am quoting here), that I was evil, that God was protecting other people from me, and that he felt sorry for anyone who knew me because I really was a bad person. This, said to a severely depressed person by a supposed professional, is BAD. I quit seeing him, obviously.

Here’s the REALLY juicy part: he then attempted to blackmail me with my patient records, which he said (I’m quoting again) that he would keep for his own protection, in case I said anything unflattering about him. He said he would make those records public if anything bad I said got back to him. I have since found out that in my state, ANYBODY can be a “licensed family therapist”, just by paying a fee for the license. Scary, huh? (NOTE: this loser has since been taken off the church staff, and I have long since gotten some QUALIFIED help. And I had a Government agency confiscate my records from his office–with my permission, because I work for a defense contractor and had to obtain a security clearance. I have no idea how many other people this pig damaged, though.) – Anita from Alabama

After reading your story, I started to think about my psych, he’s from India, he thinks I’m really off my rocker. He tells me to do other things from what my therapist tells me, and I think he uses me for his guinea pig. He’s been trying to start me on some of the strangest meds, and all I want to do was to get my Effexor refilled. Then he gave me a 2-week supply, but this medicine takes effect in about 30 days. When I go back and see him, what does he do, he prescribes me something else. I’m going to find another psych and keep my therapist. She’s more understanding of my problem. – Tom

Even though I had had depression for years and mild mania, I started off with a psychologist who did not refer me to a psychiatrist until it got so bad I had to be hospitalized. Thankfully, the psychiatrist knew what he was doing (actually at that point it had become quite obvious). So he became my doctor for the last 6 years and was great. Except in October he was too close to a tree that got hit by lightning and he had to stop practicing while they evaluated him. The doctor he left as a back-up was “too busy” for any sessions. I had to go out and interview doctors. That was fun. Finally, my doctor’s office called me and told me to call this other doctor, that he would see me. Well, he started off the conversation stating he was a “mood expert” and started diagnosing me over the phone. He tells me I have to increase my medications and I have to be totally reevaluated and maybe hospitalized (a week before the holidays). I told him that I had no problem raising the medication and that he would find that I took my medications as I was told. He actually said “That’s an oxymoron.” After that experience, I did the incredible. I actually called the insurance company and asked them to find me a doctor. They did, he was nice and he took care of me until my old doctor came back. No, I never did make my appointment with the “mood expert”. You should always interview a “doctor” before actually going into their office. In this state, a doctor has the power to hospitalize you if they think you are in danger or a danger to others. – Lourdes from Miami

I knew I had a bad shrink when he called me at home on Saturday morning to ask me my advice for how he should deal with his problems with his girlfriend. — Eee-gads! – Meg

It was my first experience with a psychiatrist, but I knew it was a mess when one of his assistants/office staff/next door neighbors/whatever kept walking into the office. On the second visit, the doctor spent most of his time on the phone with apparently his stock broker as they were talking all about money, selling this, buying that, etc. Needless to say, I did not go back, and shortly after that he was arrested for DWI and essentially run out of town on a rail. (Turns out I was not the only person that he’d “ignored” in favor of his stock broker.) Current primary care doctor wants me to see a psychiatrist again, and after one bad experience, I’m not sure this is a good idea. I called the insurance company just to clarify what the benefits were. Turns out that they really don’t want you to use their “mental health services.” I can’t use any doctor in the plan, nope, it has to be one who is also in their “merit services” program (which probably means money in one way or another). My other doctors (primary care doctor, orthopod, etc.) are located at the biggest hospital in the area — but none of their “merit services” people are, and they could only give me two names of anyone in town that I could *maybe* see! Needless to say, I won’t be seeing a psychiatrist, and I’m not terribly upset about that! – Laurie

When I first met Dr. X I had an almost unwelcome feeling. I felt like I should be paying for his services and only then he would treat me like I worthy of his therapy. Anyway, I told him that I wanted some sort of psychotherapy rather than drugs because of sideffects, etc. Although he listened to me he decided that drugs would be most useful in this case. Well I didn’t take them, but I did continue to see him. Being a psychology student I am sure my beliefs about drugs were emanating from my psyche. With time, however, I gained respect for this person with a British accent and snotty attitude. When he started sharing some of his personal history and I found that we had a bit of history in common I began to trust him. I guess trust was a real issue for me. I began taking the meds and gradually became healthier. We developed a bit of a friendship which was in the end briskly cut off by him. I guess because he didn’t want me to become too dependent on this one and only friendship. Anyway I still hear his voice once in while and find comfort in knowing that he knew me enough to get me to help myself. – Anonymous

I have been having a hell of a time, lately, with psychiatrists (i.e., finding one and keeping one) during this last bout of depression. My heart sinks when I walk into a practitioner’s office and it barely looks as if they write scripts there. We probably just can’t help it, but women are probably more sensitive to this. The past two pdocs I’ve seen (and didn’t go back to when I couldn’t take it anymore) hardly looked at me, either, except to say “these are the rules” type statements and ask me if was suicidal. Funny thing – it made no difference in their reaction if I said I was suicidal or swore I wasn’t. Not really very humorous. The psychiatrist I saw previously was (is!) a real human being, who listened, empathized, and did his damnedest to help me feel that I too, am a human being, defects and all. He had an office with “real” furniture, old worn oriental carpets, real works of art, including that of friends of mine. Offices of both my current individual therapist and someone my husband and I see occasionally are warm, inviting, not fancy, but with pictures of both their kids and “artwork” done by the same. In other words, if they see themselves as human beings, perhaps they can give us the same courtesy. I resolve to walk right out of the “robot” practitioner’s offices as soon as I walk in from now on! Our instincts may be all we have left…. – Robin

I have been to untold numbers of these people over the last 5 years that I have been suffering from depression. One told me that I could blame it all on my parents and that I should let them know. (Thank God that I did not do so). The next one would give me a depression test every week that I saw him. He placed me on different drugs over the years, all with the same results, but at least the data was of use.

I then found a good man who showed me how to use my brain to help control the pain in my left arm. Two years of little depression. Then he had a stroke. Depression back. Back to other psychiatrist, still more drugs.

Then last year a breakdown in public; result pending police charges (a man with one good arm with two assault police charges), depression deeper, placed in a psych hospital; depression even deeper.

Then my good man came to my rescue, got me out of the hospital and he now treats me (at no charge), ring or visit him at any time. – Anonymous

I refer to the first 3 psychiatrists I saw as quacks #1, #2, and #3. I suffer from severe, chronic clinical depression and have tried nearly every psychiatric medicine known with no permanent success. I was referred to the psychiatrists I saw by an EAP. It turns out that the only requirement to get on the EAP’s list was that these providers apply and send in copies of their licenses.

Quack #1 was relatively innocuous. She prescribed a combination of two tricyclics which gave me severe anxiety attacks. Every other doctor I have seen wonders why she combined those two drugs as no one seems to have ever heard of using them together. She left the area before doing any more damage.

Quack #2 apparently did not believe in taking blood levels. I wound up in the hospital (not once, but twice) with toxic blood levels at therapeutic dosages of the antidepressant I was taking. I later found out that that was not unheard of for those particular drugs.

Quack #3 used to fall asleep in therapy sessions and would tell me it was because my monotone voice put him to sleep. When I finally got angry enough to fire him, he told me I was leaving because we were finally getting to the root of my problems and I was afraid to address my issues. When I asked him what those issues were, he said that I needed to discover them myself. – Gal

I think I know she’s a good therapist because, when friends/family ask how my session went or what my therapist thinks of me, I can’t really give them a pat answer. In other words, she isn’t authoritative or didactic. She listens, responds non-verbally, and then when I’m finished with my latest spiel, she asks me questions about how what I’ve just said relates to past sessions, relationships, my experiences growing up, etc. It feels as if she is quite solidly on my side, no matter what, and I trust her. I’ve described our sessions as my weekly anchor to sanity (no advice from well-meaning friends, no belligerent orders to stop my behaviors, no fear or frenzy for one hour a week…).

I used to be very suspicious of therapy, I think, because of the bad press it gets in our culture. I assimilated this and thought of myself as a spoiled white female who couldn’t solve her petty problems and who wanted to run to therapy (even though she wasn’t “bad enough” to deserve treatment) so someone else could run her life. So I raged and screamed to get attention from my parents (alcoholic father, shy and enabling mother), fell into deep depressions at my lack of perfection, and cut my arm repeatedly to put my anger and pain into a place I could focus on.

Now I feel as if my life is my own and I don’t want to spend another second feeling bitter or loathing myself. I just want new tools and perspectives so I can keep searching. I take 50 to 100mg of zoloft daily (I also take short breaks from it as I see fit–my therapist and psychiatrist both accept my need to control my medication and don’t view my treatment as a power play). I still cut my arm occasionally, but we discuss it and don’t treat it as some terrible backslide. I feel very lucky. I look at my chronic depression and realize that, given my life’s circumstances, much of it was a sane response to insane situations. I feel that I’ve been easy to treat, but had I had a series of “nightmare” therapists, I’d be so much worse off. I’m very grateful to susan for her support. – Laura

I think the thing that amazes me the most about some of the doctors I’ve seen for my episodic depression is that they’ve been so cruel. I wouldn’t say some of the things they’ve said to me to my dog. The first time I got depressed, I was terrified. Therapy was urgent, because of my strong anxiety and complete inability to cope. Naturally, I was referred (by my kind, gentle therapist) to a psychiatrist, which was scary. Was I really that sick? I was highly resistant to the idea of meds, but she didn’t try to allay my fears. “What makes you think you don’t need medication?” she barked, “I think you do.” She convinced me, and I’m glad she did although I’ll never forgive her for treating a suicidal but intelligent teenager like an imbecile. Other doctors I saw were nicer, but there was one last year who was pure evil. I’ll always remember the disgust in her eyes when, in response to the question, “Can you tell me something about this drug I’m taking?” she said, “Don’t you want to have children someday? You are going to harm your children, destroy their lives, if you don’t fix your problems.” Ugh. I think the reason antidepressants take so long to work is that it takes you a month to get over your appointments with your psychiatrist. – Wendy from New Jersey

My first therapist was a social worker (MSW) whom my college roommate (also an MSW) recommended to me. I felt very comfortable with her, but after less than a year, I felt my therapy was at an impasse. (she had suggested meds, which petrified me) and I shut down after that.

I thought I could get along without a therapist but after a few months I realized it was not the case. The next therapist was a social worker too, with training in Freudian analysis, which I have since read is not very good for depression. She was not very empathetic. When I was worried about my parents’ finances because my mother has depression, she said don’t worry about it, they have health insurance and then tried to change the subject, despite the fact that I was worried because their insurance wasn’t paying for some very expensive x-rays. And she wanted to know why I was so upset to find out my mother has lung cancer. (Depressives tend to get overly upset at things, but really, she’s my MOTHER!)

After being with her for almost a year, I realized I needed to do something or I would end up dead. I went to my primary care physician for a referral to a psychiatrist. He asked me a few questions, and a few minutes later he wrote a prescription for Paxil and told me to come back in 6 months.

Well, after that, I called my health insurance, got names of some psychologists. Our first session was an interview, I followed some suggestions from one of my books and asked her a lot of questions — how often she treats depression, etc., etc. I began seeing her and saw a psychiatrist that she recommended. It’s been a hard time finding meds for me (PAXIL was a bad choice for me and it’s taking a while to wean me off.) But all in all I am comfortable with both my psychologist and psychiatrist. – Susan from NYC

I recently had a panic attack. I went to the local clinic and was given Paxil. I found a shrink in the yellow pages, it’s a small town and there was only a choice of two. The one just worked on state cases. I choose shrink number two.

I just got his bill for three sessions. Are you ready for this…$890. My first session I asked his charges. He said $125 for a 50 minute hour, and the first session would go longer, getting background etc. My second session lasted over two hours until I finally said, hey doc, I gotta go. I’m thinking, hey it’s a small town, he’s not busy, maybe he’s interested in my case.

Session number three was going into two hours and I just excused myself, never thinking he has got the clock running.

To sum up, I’ve written the state board of medicine and spoken to their ombudsman, whose first comment was “Jesus”. I’ve flushed the dope down the toilet, and I feel much better thank you very much. – Rodger

How to Help Someone with Depression

What You Can Do to Support a Friend or Loved One’s Recovery

When a family member or friend suffers from depression, your support and encouragement can play an important role in his or her recovery. However, depression can also wear you down if you neglect your own needs. These guidelines can help you support a depressed person while maintaining your own emotional equilibrium.

Helping a depressed friend or family member

Depression is a serious but treatable disorder that affects millions of people, from young to old and from all walks of life. It gets in the way of everyday life, causing tremendous pain, hurting not just those suffering from it, but also impacting everyone around them.

If someone you love is depressed, you may be experiencing any number of difficult emotions, including helplessness, frustration, anger, fear, guilt, and sadness. These feelings are all normal. It’s not easy dealing with a friend or family member’s depression. And if you don’t take care of yourself, it can become overwhelming.

That said, there are steps you can take to help your loved one. Start by learning about depression and how to talk about it with your friend or family member. But as you reach out, don’t forget to look after your own emotional health. Thinking about your own needs is not an act of selfishness—it’s a necessity. Your emotional strength will allow you to provide the ongoing support your depressed friend or family member needs.

Understanding depression in a friend or family member

Depression is a serious condition. Don’t underestimate the seriousness of depression. Depression drains a person’s energy, optimism, and motivation. Your depressed loved one can’t just “snap out of it” by sheer force of will.

The symptoms of depression aren’t personal. Depression makes it difficult for a person to connect on a deep emotional level with anyone, even the people he or she loves most. In addition, depressed people often say hurtful things and lash out in anger. Remember that this is the depression talking, not your loved one, so try not to take it personally.

Hiding the problem won’t make it go away. Don’t be an enabler. It doesn’t help anyone involved if you are making excuses, covering up the problem, or lying for a friend or family member who is depressed. In fact, this may keep the depressed person from seeking treatment.

You can’t “fix” someone else’s depression. Don’t try to rescue your loved one from depression. It’s not up to you to fix the problem, nor can you. You’re not to blame for your loved one’s depression or responsible for his or her happiness (or lack thereof). Ultimately, recovery is in the hands of the depressed person.

Is my friend or loved one depressed?

Family and friends are often the first line of defense in the fight against depression. That’s why it’s important to understand the signs and symptoms of depression. You may notice the problem in a depressed loved one before he or she does, and your influence and concern can motivate that person to seek help.

Be concerned if your loved one...

Doesn’t seem to care about anything anymore. Has lost interest in work, sex, hobbies, and other pleasurable activities. Has withdrawn from friends, family, and other social activities.

Expresses a bleak or negative outlook on life. Is uncharacteristically sad, irritable, short-tempered, critical, or moody; talks about feeling “helpless” or “hopeless.”

Frequently complains of aches and pains such as headaches, stomach problems, and back pain. Or complains of feeling tired and drained all the time.

Sleeps less than usual or oversleeps. Has become indecisive, forgetful, disorganized, and “out of it.”

Eats more or less than usual, and has recently gained or lost weight.

Drinks more or abuses drugs, including prescription sleeping pills and painkillers.

How to talk to a loved one about depression

Sometimes it is hard to know what to say when speaking to a loved one about depression. You might fear that if you bring up your worries he or she will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.

If you don’t know where to start, the following suggestions may help. But remember that being a compassionate listener is much more important than giving advice. You don’t have to try to “fix” the person; you just have to be a good listener. Often, the simple act of talking to someone face to face can be an enormous help to someone suffering from depression. Encourage the depressed person to talk about his or her feelings, and be willing to listen without judgment.

Don’t expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent.

Ways to start the conversation:

"I have been feeling concerned about you lately."

"Recently, I have noticed some differences in you and wondered how you are doing."

"I wanted to check in with you because you have seemed pretty down lately."

Questions you can ask:

"When did you begin feeling like this?"

"Did something happen that made you start feeling this way?"

"How can I best support you right now?"

"Have you thought about getting help?"

Remember, being supportive involves offering encouragement and hope. Very often, this is a matter of talking to the person in language that he or she will understand and respond to while in a depressed mind frame.

What you CAN say that helps:

  • You are not alone in this. I’m here for you.
  • You may not believe it now, but the way you’re feeling will change.
  • I may not be able to understand exactly how you feel, but I care about you and want to help.
  • When you want to give up, tell yourself you will hold on for just one more day, hour, minute—whatever you can manage.
  • You are important to me. Your life is important to me.
  • Tell me what I can do now to help you.
  • What you should AVOID saying:
  • It’s all in your head.
  • We all go through times like this.
  • Look on the bright side.
  • You have so much to live for why do you want to die?
  • I can’t do anything about your situation.
  • Just snap out of it.
  • What’s wrong with you?
  • Shouldn’t you be better by now?

Source: The Depression and Bipolar Support Alliance

Taking care of yourself

There’s a natural impulse to want to fix the problems of people we love, but you can’t control a loved one’s depression. You can, however, control how well you take care of yourself. It’s just as important for you to stay healthy as it is for the depressed person to get treatment, so make your own well-being a priority.

Remember the advice of airline flight attendants: put on your own oxygen mask before you assist anyone else. In other words, make sure your own health and happiness are solid before you try to help someone who is depressed. You won’t do your friend or family member any good if you collapse under the pressure of trying to help. When your own needs are taken care of, you’ll have the energy you need to lend a helping hand.

Tips for taking care of yourself

Think of this challenging time like a marathon; you need extra sustenance to keep yourself going. The following ideas will help you keep your strength up as you support your loved one through depression treatment and recovery.

Speak up for yourself. You may be hesitant to speak out when the depressed person in your life upsets you or lets you down. However, honest communication will actually help the relationship in the long run. If you’re suffering in silence and letting resentment build, your loved one will pick up on these negative emotions and feel even worse. Gently talk about how you’re feeling before pent-up emotions make it too hard to communicate with sensitivity.

Set boundaries. Of course you want to help, but you can only do so much. Your own health will suffer if you let your life be controlled by your loved one’s depression. You can’t be a caretaker round the clock without paying a psychological price. To avoid burnout and resentment, set clear limits on what you are willing and able to do. You are not your loved one’s therapist, so don’t take on that responsibility.

Stay on track with your own life. While some changes in your daily routine may be unavoidable while caring for your friend or relative, do your best to keep appointments and plans with friends. If your depressed loved one is unable to go on an outing or trip you had planned, ask a friend to join you instead.

Seek support. You are NOT betraying your depressed relative or friend by turning to others for support. Joining a support group, talking to a counselor or clergyman, or confiding in a trusted friend will help you get through this tough time. You don’t need to go into detail about your loved one’s depression or betray confidences; instead focus on your emotions and what you are feeling. Make sure you can be totally honest with the person you turn to—no judging your emotions!

Encouraging your loved one to get help

Beating depression, one day at a time

You can’t beat depression through sheer willpower, but you do have some control—even if your depression is severe and stubbornly persistent. The key to depression recovery is to start with a few small goals and slowly build from there. Feeling better takes time, but you can get there if you make positive choices for yourself each day and draw on the support of others. Read: Coping with Depression

While you can't control someone else’s recovery from depression, you can start by encouraging the depressed person to seek help. Getting a depressed person into treatment can be difficult. Depression saps energy and motivation, so even the act of making an appointment or finding a doctor can seem daunting. Depression also involves negative ways of thinking. The depressed person may believe that the situation is hopeless and treatment pointless.

Because of these obstacles, getting your loved one to admit to the problem—and helping him or her see that it can be solved—is an essential step in depression recovery.

If your loved one resists getting help:

Suggest a general check-up with a physician. Your loved one may be less anxious about seeing a family doctor than a mental health professional. A regular doctor’s visit is actually a great option, since the doctor can rule out medical causes of depression. If the doctor diagnoses depression, he or she can refer your loved one to a psychiatrist or psychologist. Sometimes, this “professional” opinion makes all the difference.

Offer to help your depressed loved one find a doctor or therapist and go with them on the first visit. Finding the right treatment provider can be difficult, and is often a trial-and-error process. For a depressed person already low on energy, it is a huge help to have assistance making calls and looking into the options.

Encourage the person to make a thorough list of symptoms and ailments to discuss with the doctor. You can even bring up things that you have noticed as an outside observer, such as, “You seem to feel much worse in the mornings,” or “You always get stomach pains before work.”

Supporting your loved one's treatment

One of the most important things you can do to help a friend or relative with depression is to give your unconditional love and support throughout the treatment process. This involves being compassionate and patient, which is not always easy when dealing with the negativity, hostility, and moodiness that go hand in hand with depression.

Provide whatever assistance the person needs (and is willing to accept). Help your loved one make and keep appointments, research treatment options, and stay on schedule with any treatment prescribed.

Have realistic expectations. It can be frustrating to watch a depressed friend or family member struggle, especially if progress is slow or stalled. Having patience is important. Even with optimal treatment, recovery from depression doesn’t happen overnight.

Lead by example. Encourage your friend or family member to lead a healthier, mood-boosting lifestyle by doing it yourself: maintain a positive outlook, eat better, avoid alcohol and drugs, exercise, and lean on others for support.

Encourage activity. Invite your loved one to join you in uplifting activities, like going to a funny movie or having dinner at a favorite restaurant. Exercise is especially helpful, so try to get your depressed loved one moving. Going on walks together is one of the easiest options. Be gently and lovingly persistent—don’t get discouraged or stop asking.

Pitch in when possible. Seemingly small tasks can be hard for a depressed person to manage. Offer to help out with household responsibilities or chores, but only do what you can without getting burned out yourself!

The risk of suicide is real

What to do in a crisis situation

If you believe your loved one is at an immediate risk for suicide, do NOT leave the person alone.

In the U.S., dial 911 or call the National Suicide Prevention Lifeline at 1-800-273-TALK of the Crisis Text Line at 741741 text SOS.

In other countries, call your country’s emergency services number or visit IASP to find a suicide prevention helpline.

It may be hard to believe that the person you know and love would ever consider something as drastic as suicide, but a depressed person may not see any other way out. Depression clouds judgment and distorts thinking, causing a normally rational person to believe that death is the only way to end the pain he or she is feeling.

When someone is depressed, suicide is a very real danger. It’s important to know the warning signs:

  • Talking about suicide, dying, or harming oneself; a preoccupation with death
  • Expressing feelings of hopelessness or self-hate
  • Acting in dangerous or self-destructive ways
  • Getting affairs in order and saying goodbye
  • Seeking out pills, weapons, or other lethal objects
  • Sudden sense of calm after a depression

If you think a friend or family member might be considering suicide, talk to him or her about your concerns as soon as possible. Many people feel uncomfortable bringing up the topic but it is one of the best things you can do for someone who is thinking about suicide. Talking openly about suicidal thoughts and feelings can save a person’s life, so speak up if you're concerned and seek professional help immediately!

Related HelpGuide articles

Resources and references

Helping a depressed person

Helping Someone with a Mood Disorder – Covers how to support a loved one through depression treatment and recovery. (Depression and Bipolar Support Alliance)

Helping Someone Receive Treatment – What to do (and not to do) when trying to help a loved one get help for depression. (Families for Depression Awareness)

Helping a Friend or Family Member with Depression or Bipolar Disorder – How to help your loved one while also taking care of yourself. (Depression and Bipolar Support Alliance)

What is the role of the family caregiver? – Tips on how families can work together to manage depression treatment. (Families for Depression Awareness)

Helping a suicidal person

How to Help Someone in Crisis – Advice on how to deal with a depression crisis, including situations where hospitalization is necessary. (Depression and Bipolar Support Alliance)

Suicidal helplines

National Suicide Prevention Lifeline – Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).

Crisis Text Line - US 24/7 confidential line for any crisis. 741741 text SOS

Samaritans UK – 24-hour suicide support for people in the UK and Ireland call 116 123. (Samaritans)

Lifeline Australia – 24-hour suicide crisis support service at 13 11 14. (Lifeline Australia)

Crisis Centers Across Canada – Locate suicide crisis centers in Canada by province. (Canadian Association for Suicide Prevention)

IASP – Find crisis centers and helplines around the world. (International Association for Suicide Prevention).

International Suicide Hotlines – Find a helpline in different countries around the world.


What to do if you are depressed?

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Mild exercise, going to a movie, a ball game, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition-change jobs, get married or divorced-discuss it with others who know you well and have a more objective view of your situation.
  • People rarely "snap out of" a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
  • Let your family and friends help you.

For more information: National Institute of Mental Health

Where can I get more information about Depression?

National Institute of Mental Health Information Resources and Inquiries Branch, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663, 301.443.4513, FAX: 301.443.4279, TTY: 301.443.8431, FAX4U: 301.443.5158 or or

National Alliance for the Mentally Ill (NAMI), Colonial Place Three , 2107 Wilson Blvd., Suite 300 , Arlington, VA 22201, 800.950NAMI (6264) or 703.524.7600 or

A support and advocacy organization of consumers, families, and friends of people with severe mental illness-over 1,200 state and local affiliates. Local affiliates often give guidance to finding treatment.

Depression & Bipolar Support Alliance (DBSA), 730 N. Franklin St., Suite #501, Chicago, IL 60610-7204, 312.988.1150, Fax: .312.642.7243 or

Purpose is to educate patients, families, and the public concerning the nature of depressive illnesses. Maintains an extensive catalog of helpful books.

National Foundation for Depressive Illness, P.O. Box 2257, New York, NY 10116, 212.268.4260; 800.239.1265 or

A foundation that informs the public about depressive illness and its treatability and promotes programs of research, education, and treatment.

National Mental Health Association (NMHA), 2001 N. Beauregard Street, 12th Floor, Alexandria, VA 22311, 800.969.6942 or 703.684.7722, TTY 800.443.5959,

An association that works with 340 affiliates to promote mental health through advocacy, education, research, and services.


Depression Hotline

Depressed man hugging pillow looking down considering calling hotlineThe World Health Organization estimates that as many as 300 million people suffer from depression worldwide.1 In the United States alone, more than 15 million people (or 6.7% of the population over the age of 18) suffer from major depressive disorder.2

Many people who have depression turn to drugs and alcohol to make them feel better or to numb themselves from their feelings—estimates state that approximately 10.2 million adults live with a co-occurring mental health and addiction disorder.3 This relationship between mental health and addiction is dangerous, particularly because substance abuse can worsen depressive symptoms.

But there are many ways to find help, including calling a depression hotline for information about treatment centers and 12-step programs.

The connection between depression and substance abuse can place you at a higher risk for self-harm, injury, and suicide, so having a 24-hour depression hotline crucial for many people who are in crisis. You can be assured that all calls are private and confidential and that you will speak to a person with experience in helping people with similar issues.

Depression is a significantly debilitating mental health condition that can prevent you from living life to your fullest potential because you feel hopeless, sad, and tired. Additionally:1

There are effective ways to manage depression; calling a hotline can help you or a loved one begin your search for treatment.

What Questions Should I Ask?

When you call a 24-hour depression hotline, it is important that you share as much information as possible with the person on the other end of the line so they can better gauge your situation and provide relevant treatment information.

Before you call a depression helpline, you may want to write down questions you have, which might include:

  • What forms of treatment are available?
  • What happens when you go to treatment?
  • What are the next steps in getting help?
  • How can I find 12-step groups in my community?
  • What programs are available for depression and substance abuse?

If you are concerned about a family member, significant other, friend, classmate, or colleague, it can take an emotional toll on you. When calling a depression helpline, you can ask:

  • Where should I start if I think my loved one needs help?
  • How do I talk to them about their depression?
  • What resources are available for friends and family of depressed people?

When you call, you may be asked your first name as well as your age, which helps the counselors figure out what types of programs you are eligible for. You may also be asked any of the following questions when you call:

  • Are you safe?
  • How can I help?
  • How are you feeling?
  • What is going on?
  • Are you in immediate danger?
  • Who do you go to for support?
  • Are you using any drugs or abusing alcohol?

Should I Call a Hotline?

Most people experience periods of sadness in their lives after major events, such as a job loss, a divorce, or the death of a loved one. However, clinical depression is different than regular sadness or a period of grief. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depression is diagnosed when you have 5 or more of the following symptoms in a 2-week period:4

  • Depressed mood most of the day
  • Loss of interest in almost all activities
  • Significant weight loss or decrease in appetite
  • Insomnia or hypersomnia (excessive sleepiness)
  • Feelings of restlessness
  • Fatigue or loss of energy
  • Feeling worthless or guilty (sometimes for no reason)
  • Trouble thinking or concentrating
  • Recurring thoughts of death or of committing suicide (without a specific plan)

Mental Health Information

If you have depression and a substance abuse disorder, it can be very difficult to pick up the phone and ask for help. If you feel nervous and aren’t sure you can talk to someone on the phone, you can always try another time. Because all calls are confidential, you can feel safe about being open and honest—the person you speak to has experience and training and understands what you need.

If you want information about mental health in general, these resources can help:

Other Depression Hotlines

For many people, depression is an extremely lonely experience. Calling a hotline gives you the opportunity to talk to a caring person who can help you work through whatever negative thoughts or feelings you have.

If this is an emergency and you need immediate assistance, please call 911.

  • National Suicide Prevention Lifeline, (800) 273-TALK (8255), Live Online Chat: This 24-hour suicide prevention helpline specializes in handling all situations related to suicide and emotional distress.
  • Crisis Text Line, Text SOS to 741741: This 24/7 crisis text line for anyone in crisis connects you with a trained counselor via text.
  • Disaster Distress Helpline, 1-800-985-5990: If you are experiencing depression, anxiety, or stress as the result of a disaster, call this number to speak to someone.
  • National Child Abuse Hotline, 1-800-422-4453: Depression often exists in situations where child abuse is present, and this 24/7 national hotline exists to prevent child abuse. You can reach professional crisis counselors at any time in more than 170 languages, using an interpreter.
  • Rape, Abuse and Incest National Network (RAINN), 1-800-656-4673: This free, confidential, and national sexual assault hotline is operated 24/7 by RAINN, which partners with local sexual assault service providers all over the U.S.
  • The Trevor Project, (866) 488-7386: A 24-hour depression hotline for suicidal LGBTQ youth.
  • Veterans Crisis Line, 1-800-273-8255, Text a message to 838255: Many vets struggle with depression and other debilitating mental health issues. Veterans and their families can call, text, or chat online 24/7 for support.
  • National Hopeline Network, 1-800-442-4673: This 24-hour depression hotline is for people who are depressed and thinking about suicide. When you call, you will be connected with a crisis hotline volunteer.


1. World Health Organization. (2017). Depression.
2. Anxiety and Depression Association of America. (2016). Facts & Statistics.
3. National Alliance on Mental Illness. (n.d.). Mental Health By The Numbers.
4. DSM-5 Diagnostic Criteria. (2013). Major Depressive Disorder.

Seniors' Depression Overlooked; Pandemic Stress and Jaw Pain — News and commentary from the psychiatry world

Why are many older folks left behind when it comes to depression treatment? (Forbes)

After an advisory panel voted in favor of approval, the FDA declined to okay the investigational ALKS 3831 (olanzapine/samidorphan), a schizophrenia and bipolar I disorder treatment, after issues were raised about the tablet-coating process at its manufacturing site, Alkermes announced.

Antibiotic use in infants may increase their risk for a host of chronic conditions, including attention deficit-hyperactivity disorder. (ScienceDaily)

Overactivation of the subgenual anterior cingulate cortex could be the source of many people's depression and anxiety. (PsyPost)

A Mendelian randomization study found a genetic link between prescription opioid use and an increased risk for major depressive disorder. (JAMA Psychiatry)

Another adverse outcome of COVID-19-related stress and anxiety? Teeth grinding and jaw pain. (MedicalXpress)

One possible way to help stave off Alzheimer's disease: deep sleep. (NPR)

Depression: Here's How Bad It Is for Heart Health: Baseline depressive symptoms associated with CVD incidence

Depression takes a toll on the heart, and international researchers quantified just how much in a meta-analysis.

Drawing upon pooled data on over 162,000 participants (mean age 63 at baseline; 73% women) in 21 cohorts from the Emerging Risk Factors Collaboration, each one standard deviation higher that people scored on a depression scale was tied to 6% increased risk (HR 1.06, 95% CI 1.04-1.08) for a composite of coronary heart disease (CHD) and stroke, reported Lisa Pennells, PhD, of the University of Cambridge in England, and colleagues.

When broken down, each standard deviation higher in depression score was associated with 7% increased risk for fatal or nonfatal CHD and 5% increased risk for stroke during a median 9.5-year follow-up, they wrote in JAMA.

As measured by the Center for Epidemiological Studies Depression scale (score of 16-plus indicates possible depressive disorder), incidence rates for heart events were far higher among people who fell into the highest quintile for depressive symptoms (average score of 19) versus the lowest quintile (average score of 1):

  • Total events: 62.8 (highest quintile) vs 53.5 events (lowest quintile) per 10,000 person-years of follow-up
  • CHD events: 36.3 vs 29.0 events per 10,000 person-years of follow-up
  • Stroke events: 28 vs 24.7 events per 10,000 person-years of follow-up

Pennells' group further analyzed data on over 400,000 participants from a single cohort in the U.K. Biobank, which showed very similar findings. Over a median 8.1-year follow-up, these participants saw a 10% (95% CI 1.08-1.13) higher risk for having any CV event per each standard deviation higher in depression score.

Similar to the data on the previous 21 cohorts, this was driven by slightly more fatal or nonfatal CHD risk. Each standard deviation higher in depression score was tied to an 11% and 10% higher risk for CHD and stroke, respectively.

The U.K. Biobank utilized the two-item Patient Health Questionnaire-2 to measure depressive symptoms, scored on a scale of 0-6, with a score of 3 or higher indicating a possible depressive disorder. And similar to the previous findings, incidence rates for heart events during follow-up were higher for those who scored 4 or higher on this scale versus those who scored zero:

  • Total events: 36.2 vs 24.5 events per 10,000 person-years
  • CHD events: 20.9 vs 14.2 events per 10,000 person-years
  • Stroke events: 15.3 vs 10.2 events per 10,000 person-years

"Depressive symptoms, even at levels lower than what is typically indicative of potential clinical depression, were associated with risk of incident cardiovascular disease although the magnitude of the association was modest," Pennells' group stated.

They also noted that these associations cannot simply be explained by just the traditional CV risk factors, like blood pressure, cholesterol, BMI, diabetes, and lifestyle.

"Previous studies have proposed mechanisms including altered brain and neuronal function affecting neuroendocrine pathways, autonomic nerve dysfunction, immune responses, platelet activation and thrombosis, life behavior, and cardiac metabolic risk factors," the authors stated.

One question that still remains is whether treating depression -- even mild cases of depression -- could reduce CV risk, they concluded.

Study limitations included the fact that it was not a systematic review and that depressive symptoms were evaluated at a single baseline examination, the authors noted.


Is Depression Different in Women and Men? Understanding the Subtle Differences

Depression is characterized by a core set of symptoms including low mood, lack of motivation, loss of pleasure in activities and hobbies, changes in appetite, sleep disturbances, feelings of guilt, and difficulty concentrating.1

Most people with depression experience at least a few of these hallmark symptoms, though they may not have them all and they may have others. Research has suggested that individual factors combine to determine what someone’s experience of depression looks and feels like.2?

No two people with depression will have identical experiences, but understanding how each contributing factor affects a person's risk and symptoms could lead to more effective treatment.

Biological Sex, Gender Identity, and Depression

Biological sex and gender identity are among these contributing factors. It's long been thought that men and women experience and express depression in different ways, but that doesn't mean the condition could be divided into two distinct forms. It’s more akin to the way mental illness can manifest differently in children and teens than it does in adults.

On their own, biological sex and gender differences may not have a powerful impact. When combined with other factors, such as life stressors, sexism, toxic masculinity, trauma, and co-occurring mental health conditions like anxiety, substance use disorders, or eating disorders, these influences may make a person more prone to depression.

Are Some People More Prone to Depression?

Biological Sex

In 2018, a study published in the journal Biological Psychiatry proposed that there are molecular differences in the brains of men and women with depression; the study only looked at the brains of cisgender men and women.3

For the study, researchers examined postmortem brain tissue samples from 50 subjects to see if there were any differences between the brains of people who had been diagnosed with major depressive disorder and those who had not. Although previous studies had set out to explore the same question, most only looked at the brains of cis men. The 2018 study looked at both cisgender men and cisgender women.

The researchers evaluated the level of gene expression in the brain tissue, specifically looking at how genes were expressed in three regions of the brain linked to mood regulation. According to their findings, brains contained different gene variants. These variants were also different from those of people who didn’t have depression.

Most of the genetic changes the researchers noted occurred in only the male or female brains, but not both. One of the major differences researchers noted was that the female brains expressed more of the genes that determine synaptic activity (the electrical impulses that brain cells use to communicate).

The Chemistry of Depression

Researchers made an interesting discovery about the genes that were altered in both male and female brains: The same gene might have changed, but those changes weren’t necessarily the same.

In fact, in some cases, the change observed in the male brain was the opposite of the change seen in the female brain. For example, if a certain region showed increased gene expression in the female brain, gene expression in that region of the male brain was decreased.

The findings were intriguing, but the researchers concluded that more research is needed to understand their value. The study did have limitations—most notably that the brains were only examined after death. Therefore, it's not clear what genetic changes in the brain would mean for people living with depression.

While molecular and physical evidence of a difference is fairly new, doctors and mental health professionals have long suspected that men and women experience and express depression in different ways.

A 2019 study published in the journal Progress in Neurobiology proposed that biological sex differences could influence not just how depression manifests in men and women, but how it responds to treatment.4

The researchers paid specific attention to the effect of pregnancy and the postpartum period on depression risk for biologically female subjects. The results of the study provided supportive evidence that a person who is biologically female is more at risk for depression directly after giving birth than at any other period in their life.

It's likely that the hormonal changes of pregnancy, childbirth, and lactation, combined with the psychological stress of becoming a parent, increase a postpartum individual's vulnerability to depression.5 Similarly, menopause—another time of hormonal change—was also associated with an increased risk of depression.6

Research has repeatedly indicated that women are twice as likely as men to be diagnosed with depression.7 One possible explanation is that hormonal changes that are specific to the female body could influence the onset of depression. Studies in support of the theory also indicate that there is a disparity in depression risk between males and females that peaks in adolescence.8

Teens and young adults of either sex face a cascade of shifting hormones and social stressors that can contribute to depression, as well as other mental health conditions like anxiety, eating disorders, substance use disorders, and suicide.9

Gender Roles and Identity

It may not be that a greater number of women are depressed, but rather, that a woman is more likely to receive a diagnosis. Research has indicated that women who are depressed are more likely to show “typical” (or recognizable) emotional symptoms, such as crying. Women also tend to show more symptoms of depression than men.10

This observation is one example of how social factors influence the way people experience and express their emotions. While there may be a pattern, it’s not a strict relationship: Some women struggle to express their feelings while some men may be comfortable doing so.

The Different Types of Emotional Responses

But broadly speaking, Western society’s traditional gender roles accept women openly expressing their feelings. Women tend to be more likely to talk about how they feel with a partner or friend, as well as seek help for symptoms of depression by sharing their concerns with a doctor or therapist.

Conversely, society often pressures men to take a more stoic approach. Men can be less likely to express or demonstrate their emotions openly and are often more reluctant to ask for help.11

When someone cannot freely express their feelings, these emotions may emerge in other forms. For example, sadness that's been pushed down might eventually “bubble up” to the surface as anger.

Research has indicated that men are often more likely to express depression in ways that differ from the more “classic” presentation. This difference may be one reason why depression in men is often missed or attributed to other causes.12

Men may be more likely to express depression in the following ways:

  • Misusing alcohol or other substances
  • Irritability, frequent outbursts, or “explosive” anger
  • Risk-taking (such as reckless driving or substance-impaired driving)
  • Escapism (e.g., working late, spending more time at the gym, playing video games for hours)
  • Controlling, violent, and unpredictable behavior can be a sign of a mental health condition such as depression or a substance use disorder in any person. However, mental illness does not justify abuse.

If you suspect a loved one needs treatment for depression, but they are abusive, you need to put your safety first. There are resources available that can help you stay safe and get your loved one the help they need.

Sexual Minorities

Biological and social stressors can also be overwhelming for people in sexual minority groups. Studies have consistently shown that the rates of depression, anxiety, and suicide are high in the LGBTQ+ community.13?

Research also indicates that the increased risk of depression in transgender people, including those who are nonbinary, starts young. A 2018 study found that the prevalence of depression, anxiety, and suicidal ideation in transgender and gender non-conforming youth was sevenfold higher than their cisgender peers.14

Studies have also shown that kids and teens experiencing gender dysphoria and/or questioning their sexual orientation are more vulnerable to depression.15

To further compound these difficulties, people in sexual minority groups often lack equitable access to health care, including mental health services. While they may begin in youth, these disparities can persist into adulthood.

The rate of depression in transgender adults is high and often linked to cissexism (the assumption that most people are cisgender) and transphobia, as well as a lack of knowledge in health care providers.

Transgender people seeking gender affirmation surgery who are unable to access support and treatment are at an even greater risk for depression and suicide. However, research has shown that gender-affirming hormone therapy can improve the mental and physical well-being of people navigating gender dysphoria.16

Impact on Depression Treatment

One of the foremost questions for researchers is whether studies on the effect of biological sex and gender could lead to improved treatment for everyone with depression. While each person's experience of depression depends on many factors—not just biological sex or gender identity—identifying important differences could help doctors prescribe treatments or even lead to new treatments.

For example, many medications (including those commonly prescribed to treat mental illness) are dosed according to weight. Female bodies tend to have a higher body fat percentage than male bodies, which can affect how medications are metabolized.

Hormonal fluctuations that occur throughout the lifespan of a person with a functioning uterus can also influence how medications work.17 The specific events that are often associated with changes, such as puberty, pregnancy, and menopause, need to be considered when deciding on any form of treatment for depression.

Every person dealing with depression can benefit from learning about the different approaches to treating the condition, including psychotherapy, medication, and interventions like cognitive behavioral therapy (CBT) or electroconvulsive therapy (ECT).1

If you're dealing with depression, the first step is to discuss your symptoms and concerns with your doctor or mental health care provider.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

From there, you can consider the risks and benefits of each treatment and make an informed decision about the safest and most effective choice for you.

Find Help With the Best Online Resouce

New Tools for Assessing Suicide Risk

The DSM-5 does include new scales for assessing suicide risk: one for adults and one for adolescents.4 These scales are intended to help clinicians identify suicide risk in patients as they are developing treatment plans.

The tools are included in the new Section III of the DSM-5 and are intended to better support clinicians in identifying risk factors for suicide as well as scales for assessing suicidal behaviors (which includes differentiating self-harm from suicide attempts).5

Whitemore A. Understanding the changes in DSM-5. Clinical Advisor. Published November 14, 2013

DSM-5 Fact Sheets: Changes in the New Edition. Section III. American Psychiatric Association (APA) website. Published 2013.

Men and Depression: Current Perspectives for Health Care Professionals


Epidemiological and health care utilization rates document potential underidentification and under-treatment of men who may suffer from major depression. Limitations in diagnostic criteria may prevent health care professionals from clearly recognizing depression in the men they treat. Societal norms related to masculine gender role socialization may create barriers to help seeking for men who could benefit from treatment for depression. This review integrates up-to-date research with clinical reports and offers recommendations for health care professionals. The primary goals of the recommendations are to increase sensitivity to male patients who may suffer from depression and to equip professionals with scientifically informed strategies for recognizing and responding to men who are identified with depression.

Mental health professionals view about the impact of male gender for the treatment of men with depression - a qualitative study


Background: The underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals’ attitudes towards men’s depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective.

Methods: Semi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients’ depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs’ treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis.

Results: The professionals’ reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals’ point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental

Conclusions: In order to improve mental health among men, gender-specific services should be offered.

Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs’ education and their daily implementation of mental health treatment practices.

Gender and Mental Health


Men and women experience different kinds of mental health problems. While women exceed men in internalizing disorders such as depression and anxiety, men exhibit more externalizing disorders such as substance abuse and antisocial behavior, which are problematic for others. These differences also vary by race and social class: for example, African Americans possess better mental health and, thus, a smaller gender gap in psychiatric problems. What explains these differences? We concentrate on conceptions of gender and gender practices. Research on gender and mental health suggests that conceptions of masculinity and femininity affect major risk factors for internalizing and externalizing problems, including the stressors men and women are exposed to, the coping strategies they use, the social relationships they engage in, and the personal resources and vulnerabilities they develop. This chapter investigates explanations in these areas for gender differences both in general and by race and class.

Men and Depression


Background: It is often reported that men have lower rates of depression than women, but this does not necessarily signify better overall mental health in the male population.

Objective: This article discusses the presentation of depression in men and how it may differ from that of women. It also provides strategies for improving the assessment of depression in men.

Discussion: Men's lower overall rate of depression than women reflects a number of issues, including psychosocial barriers to seeking help. Depression rates vary according to age groups, and certain subgroups of men may be particularly vulnerable. Men often display different symptoms and behaviours in response to depression and experience anxiety disorders less frequently. Men's greater risk taking and substance abuse have health outcomes that can impact on depression later in life. Women have greater emotional literacy and are more likely to volunteer how they feel, while men are more likely to do something about their negative affect. While men are usually wary about talking about their depression, they will discuss their feelings if provided with a safe environment in which to do so.
Source: /

Depression in men: communication, diagnosis and therapy


Women are diagnosed with depressive disorders twice as frequently as men, and yet evidence from differential rates of substance abuse, incarceration, and especially suicide calls into question the assumption that men are less susceptible than women to depression. It is possible that there is a “masculine” form of depression that is under-diagnosed and under-treated. Health professionals should work toward a greater understanding of cultural masculinity in the service of conceptualizing, diagnosing and treating male clients/patients who may be suffering from a disguised form of this common mental illness. Therapists who treat conventionally gendered male clients/patients should educate these men about masculinity as an important context of their problem, and should attend closely to issues of emotional expression, premature termination of therapy, and grief.

Men, depression and masculinities: A review and recommendations


Fewer men than women are diagnosed with depression, although commentaries about men's depression suggest that the lower reported rates may be due to the widespread use of generic diagnostic criteria that are not sensitive to depression in men, as well as men's reluctance to express concerns about their mental health or access professional health care services. This article provides an overview of the connections between depression and masculinities and, based on that literature, recommendations are made for how we might better understand, identify and treat men's depression in gender-sensitive ways.

Barriers in Diagnosing and Treating Men With Depression: A Focus Group Report


This study reports on the experiences of 45 male focus group participants with a history of depression. Men responded to questions addressing the interaction between the male role, masculinity, depression, and experiences with treatment for depression. Using a qualitative, thematic-based coding strategy, three primary themes emerged. First, participants described aspects of the male gender as being in conflict or incongruent with their experiences of depression and beliefs about appropriate help-seeking behaviors. Second, men outlined alternative symptom profiles that could interfere with the recognition of depression and willingness to seek help. Finally, men expressed a range of positive and negative reactions toward depression treatment and treatment providers. Implications for health care providers are provided.

Gender-sensitive recommendations for assessment and treatment of depression in men.


Psychologists increasingly recognize depression as a serious, albeit often undiagnosed, condition in men. In fact, undiagnosed and untreated depression in men may be one reason why many more men than women commit suicide. However, because of cultural conditioning that discourages expression of depressed mood in men, assessment as well as treatment of depression in men are sometimes difficult. Use of gender-sensitive assessment strategies and interventions will assure that more men will be identified and treated for depression. This article integrates scientific findings related to depression in men with specific gender-sensitive assessment and psychotherapeutic intervention strategies designed to enhance psychologists' skills in working with this significant problem in men.

A preliminary examination of the "Real Men. Real Depression" campaign.

This study reports on a preliminary evaluation of the National Institute of Mental Health (NIMH)-sponsored "Real Men. Real Depression" (RMRD) campaign. Two-hundred-nine men with a range of help-seeking attitudes and gender-role conflict (GRC) reviewed the RMRD brochure, a similar brochure excluding gender references, or a depression brochure currently in distribution at college counseling centers. Results generally suggest similar and favorable evaluations of all 3 materials. However, men with low GRC and negative help-seeking attitudes endorsed more favorable evaluations of the RMRD materials. A qualitative analysis, addressing the most and least helpful components of the brochures, suggested further areas of research and development. The results are discussed in terms of literature addressing marketing mental health to men and barriers to help seeking. (APA PsycInfo Database Record (c) 2018 APA, all rights reserved)

Big boys don't cry: depression and men


Men are a numerical minority group receiving a diagnosis of, and treatment for, depression. However, community surveys of men and of their mental health issues (e.g. suicide and alcoholism) have led some to suggest that many more men have depression than are currently seen in healthcare services. This article explores current approaches to men and depression, which draw on theories of sex differences, gender roles and hegemonic masculinity. The sex differences approach has the potential to provide diagnostic tools for (male) depression; gender role theory could be used to redesign health services so that they target individuals who have a masculine, problem-focused coping style; and hegemonic masculinity highlights how gender is enacted through depression and that men's depression may be visible in abusive, aggressive and violent practices. Depression in men is receiving growing recognition, and recent policy changes in the UK may mean that health services are obliged to incorporate services that meet the needs of men with depression.

Men and depression is a complicated and contentious issue and many will even disagree about whether clinicians should concern themselves with it, because the prevalence of depression is greater in women. Although the work of the mythopoetic men's movement in using fairy tales such as Iron John (Bly, 1990) to explore archetypes of gender, for example, may be overzealous and naive, it does not mean that we have to be equally overzealous in ignoring men with mental health issues. Despite the greater prevalence of depression in women, there are three important reasons for exploring depression in men.

First, even if men represent a numerical minority group among patients with depression they still require effective interventions. Second, although healthcare services find that they are diagnosing and treating many more women with depression than men, community surveys suggest that this disparity is disproportionate. In the UK, for example, figures from general practice for 1994–1998 show a male:female ratio of 0.4:1.0 for depression (Office of National Statistics, 2000), and data from a national household survey in 2000 show a ratio of 0.8:1.0 for depressive episode and disorders (Singleton et al, 2000). The greater prevalence of depression in women might, for example, be an artefact of how depression is recognised and treated or of how men self-diagnose and seek help. Third, mental health issues such as alcohol dependency (Alcohol Concern, 2005) or being subject to compulsory detainment and treatment (Healthcare Commission, 2007), which predominantly involve men, might be related to emotional distress and depression. Worldwide, the rate of suicide mortality for men is four times higher than that for women (White & Holmes, 2006) – China is the only country where women's suicide mortality is greater than men's (Hawton, 2000) – and research by Möller-Leimkühler (2003) argues that suicide is linked to depression in men.

Current approaches to men and depression draw on theories of sex differences, gender roles and hegemonic masculinity explored in this article.

Sex differences: ‘male’ depression

When introducing sex differences it is important to define the term ‘sex’ and its relation to the term ‘gender’. However, providing definitions is difficult because the research that we have drawn on here uses these terms in different ways. It is therefore perhaps better to outline the general approaches to these terms. Broadly, ‘gender’ denotes the sexual distinction between male and female that is an amalgamation of biological, cultural, historical, psychological and social factors, although the word is often used deliberately to exclude biological factors. In terms of gender, ‘sex’ refers to just those biological factors that distinguish male and female, and ‘sex differences’ are factors (biological, cultural, etc.) related to sex. It is important to emphasise that a sex difference is not necessarily biological, although it does rest on an assumed common understanding of a biological distinction between men and women.

Establishing sex difference in research is simple and powerful (perhaps because of its simplicity), particularly in depression. As with epidemiological studies on depression, more specific studies on symptoms have found that women experience more symptoms of depression than men but that there are no sex differences in the quality of symptoms. A 15-year prospective community study found no sex differences in the number or duration of depressive episodes but, importantly, women reported more symptoms per episode (Wilhelm et al, 1998). In clinical samples, however, sex differences in the number of symptoms are less marked and show similar functional impairment and global severity (Young et al, 1990), but women are more likely to have a history of treatment for depression (Kornstein et al, 2000).

The reduction in sex differences from community to clinical samples seems to suggest that diagnostic procedures or self-care practices are resulting in a population of depression that is not representative. More specifically, there might be underdiagnosis of men, overdiagnosis of women, or systematic misdiagnoses of both men and women, which could be explored by looking at what happens in routine clinical practice. It is interesting to note that where studies have found a symptom to occur more frequently in one sex, it is the symptoms for women that appear in diagnostic criteria. In depressed women, symptoms that have been found to occur more frequently are worry, crying spells, helplessness, loneliness, suicidal ideas (Kivelä & Pahkala, 1988), augmented appetite and weight gain (Young et al, 1990). Non-diagnostic symptoms found more frequently in depressed women are bodily pains and stooping posture (Kivelä & Pahkala, 1988). However, symptoms that have been shown to occur more frequently in depressed men are slow movements, scarcity of gestures and slow speech (Kivelä & Pahkala, 1988), non-verbal hostility (Katz et al, 1993), trait hostility (Fava et al, 1995) and alcohol dependence during difficult times (Angst et al, 2002), which are not common to diagnostic criteria for (adult) depression. Increased hostility might be indicative of a conduct disorder mixed with depression (ICD–10 F92.0; World Health Organization, 1992), but is limited to onset in early childhood. International diagnostic criteria and non-diagnostic symptoms for depression are listed in Box 1, with footnotes showing which symptoms the sex differences research shows to be more prevalent in men or women. These criteria may not be entirely representative of contemporary mental health practice – for example, aggression may be recognised as part of adult depression by many practitioners – but the list at least provides a useful summary of this body of research.

Box 1 Diagnostic criteria and non-diagnostic symptoms for depression

ICD–10 F32 Depressive episode (World Health Organization, 1992)

  • Depressed mood
  • Loss of interest or enjoyment
  • Reduced energy, leading to increased fatiguability and diminished activity
  • Marked tiredness after slight effort
  • Reduced concentration and attention
  • Reduced self-esteem and self-confidence 1
  • Ideas of guilt and unworthiness
  • Bleak and pessimistic views of the future
  • Ideas or acts of self-harm or suicide 1
  • Disturbed sleep
  • Diminished appetite 1

DSM–IV Major depressive episode (American Psychiatric Association, 1994)

  • Depressed mood
  • Loss of interest or enjoyment
  • Weight loss
  • Insomnia or hypersomnia
  • Psychomotor agitation
  • Fatigue
  • Feelings of unworthiness 1
  • Reduced concentration
  • Slow movements 2
  • Slow speech 2

Non-diagnostic symptoms

  • Alcohol dependence during difficult times 2
  • Bodily pains 1
  • Hostility (non-verbal) 2
  • Hostility (trait) 2
  • Scarcity of guestures 2
  • Stooping posture 1

Although differences in symptom presentation may be explained as different behavioural patterns of depression or dimensions of distress, it is not entirely implausible that there might exist a form of depression that has hitherto remained absent from international diagnostic criteria. Indeed, this possibility has led some to theorise a ‘male depressive syndrome’ (Rutz et al, 1995; van Pragg, 1996) that is characterised by sudden and periodic irritability, anger attacks, aggressive behaviour and alexithymia. The Gotland Scale of Male Depression (Zierau et al, 2002) has been developed with such a syndrome in mind. In an out-patient clinic for alcohol dependency, standard diagnostic criteria identified major depression in 17% of male patients, whereas the Gotland Scale found depression in 39%. In a clinical sample, the Gotland Scale could find no gender differences (Möller-Leimkühler et al, 2004). However, the Gotland Scale looks for signs that are not usually understood as symptomatic of depression so it is not surprising that there is little difference between men and women diagnosed with depression using this scale. Nevertheless, in the clinical sample there was a greater intercorrelation of symptoms of male depression in men, which is something that could be explored in community samples. This scale, when utilised in a study of 607 new fathers, identified a prevalence of 6.5% suffering what could be classed as post-natal depression and of these, 20.6% were not identified by the use of the Edinburgh Post Natal Depression Scale alone (Madsen & Juhl, 2007).

The sex differences approach to depression in men has the potential to provide the diagnostic tools to allow psychiatric services and clinicians to recognise and treat a new form of (male) depression. Nevertheless, it is unclear how such an approach might be used to inform treatment, for example whether antidepressants will be appropriate or effective. In addition, focusing on sex differences can mean that differences between men, such as socio-economic status, are ignored.

Gender roles – ‘masked depression’

Gender role theory sees gender in terms of the cultural and historical ways in which biological sex differences are played out at the individual and social level. As cultural constructs, gender roles rarely provide an accurate description of any individual man or woman; rather, they are social lenses (Bem, 1993) through which men and women perceive themselves and each other. Roles are learnt through processes of socialisation – such as modelling (copying) one's parents – which means that gender roles self-perpetuate and come to constitute material reality. For example, family law often deals with cases of child abuse and domestic violence, and requires its legal professionals and their clients to deal unemotionally with the facts of the case – no matter how upsetting these may be (Pond & Morgan, 2005). Successful professionals are those that can negotiate the system by the use of reason while keeping any sentiment private, which proliferates a particular way of being a professional. This creates what we might call the ‘role’ of a legal professional and illustrates how aspects of that role may be learnt (e.g. through rewarding professionals that stick to the facts) as a function of the structure (such as the ‘factual’ requirements of evidence in court) in which the role is enacted. Presumably, given the right context anyone can enact any role, which means that men can enact male and female roles, and women can enact female and male roles. Epidemiological sex differences in the symptoms of depression may be evidence not of a different type of depression but of ways of expressing or coping with depression that are appropriate to a particular gender role.

The male and female roles are understood as norms that individuals aspire to and enact differently. An individual can adhere strictly to one role (masculine or feminine), weakly to both roles (androgynous), strongly to both (undifferentiated) or to neither (ambiguous). Although the definition of a particular role may be culturally dependent we can presume that because gender roles are self-perpetuating through processes of socialisation they are rarely subject to substantial change. For issues of mental health and illness the coping style of each gender role is particularly apt. In gender role theory, the feminine style of coping is to deal with the emotion associated with the stressor (emotion focused), whereas the masculine style is to deal directly with the stressor (problem focused) (Li et al, 2006). Feminine, emotion-focused coping is associated with higher levels of depression than masculine problem-focused coping (Compas et al, 1988; Ebata & Moos, 1991). However, the research on sex differences mentioned above suggests that diagnostic criteria fail to include a male depressive syndrome, which may mean that depressive symptoms in masculine, problem-focused individuals have remained hidden. Indeed, Good & Wood (1995) point out that the masculine role is antithetical to recognising and expressing depression and to utilising emotion-focused interventions such as psychotherapy. For example, seeking help might be interpreted as incompetence and dependence (Möller-Leimkühler, 2002), and research has shown that individuals who adhere to the masculine role have negative attitudes towards using counselling services (Good & Wood, 1995). This has led some to theorise a disorder of masked depression, where the reduced affect is, for example, manifest in physical symptoms (Kielholz, 1973). Interestingly, associating masculinity with mental ill health has been important for the antisexist men's movement (e.g. the male role leads men to be violent to women) and for an antifeminist backlash (e.g. the male role damages men and privileges women), and this has been taken up in gender role theory with little recourse to empirical evidence. Regardless of whether masculine individuals are more likely to experience depression it is important to note that if they do, it seems that they will be less likely to recognise it as depression and to seek help.

The gender role theory approach to men and depression suggests that services could be redesigned to target masculine, problem-focused individuals. In addition, services could adopt practices to help men with depression challenge gender role norms, which would theoretically leave them better able to recognise and accept help for their own depression. Although gender role theory does acknowledge possible differences between men, it relies on a fundamental opposition between male and female. This risks overemphasising gender when other factors, such as class and ethnicity, may be more important. In particular, gender role theory largely focuses on women or, when focusing on men, is based on affluent White US college students, who are unlikely to reflect the diversity of men with depression.

The list of gender role characteristics shown in Table 1, predominantly from the 1970s, may seem dated and difficult to take seriously. However, the point is that if we cannot take historical gender role characteristics seriously then current gender role research may suffer the same fate. Indeed, a review (Choi & Faqua, 2003) of factor analytic studies validating the definitive gender role psychometric measure – the Bem Sex Role Inventory (BSRI; Bem, 1974) – suggests that the understanding of masculinity and femininity in gender role theory is insufficiently complex. Another difficulty with gender role theory is that it seems to conceptually confuse gender norms with an individual's behaviour, which could result in potentially unhealthy male role norms being seen as ‘normal’ things for men to do.

Hegemonic masculinity – ‘depression enacting gender’

Connell's (1987) concept of hegemonic masculinity is perhaps the most popular approach to gender in academia at present. Like gender role theory, hegemonic masculinity focuses on the social, rather than biological, aspects of gender. Gender is understood as something that is actually done by people. Thus, if men regularly do something in a certain way – such as waking early, being last to leave work, working at home in the evening – and this is accepted by both men and women it becomes a masculine feature, a masculinity. Gender is multiple, as practices may construct many ways of being a man, and historical, as these ways of being a man change. Power is particularly important: ‘hegemony’ refers to insidious processes of domination where the majority of people come to believe that particular ideas are not only natural but are for their benefit. Different masculinities must therefore compete to define what it is to be a man, and the dominant masculinity in any particular context is not simply the one that forces itself on people but the one that is so socially ingrained that it is almost impossible to imagine anything else. Hegemonic masculinity must also compete with other identities such as femininity, class and age. Consequently, masculinities are not always dominant and are instead subordinate to another identity. As hegemonic masculinity is defined in particular contexts, it can never be fixed and must instead be continually reworked as people move through their lives. Sex differences in the symptoms of depression may be evidence of underlying and common gendered practices.

Enacting depression could be part of enacting gender. Indeed, being depressed would seem to be unmasculine. In an interview-based study involving men who had been diagnosed with depression but were well enough to participate in the research, Emslie et al (2005) found that the recovery process was talked about as successfully renegotiating a masculinity. Thus, actually being depressed would constitute a failure to be masculine. Nevertheless, for a few of the men Emslie et al interviewed, the isolation and loneliness of depression were incorporated as signs of their difference (as more sensitive and intelligent) from others, which seems to suggest that actually being depressed would reaffirm their own masculinity.

As so few men are diagnosed with depression it is important also to look at depression-related practices in non-clinical samples. A focus group study that sought a diverse sample of men from both clinical and non-clinical populations looked at how they talked about seeking help for physical and mental health problems (O'Brien et al, 2005). The authors found considerable resistance to talking about mental ill health, particularly among young men, for whom masculinity appeared to require being strong and silent about emotions.

Masculinity can be practised by both men and women, which means that women need to be included when considering depression in men. Brownhill et al (2005) conducted focus groups with a non-clinical sample of men and women and found that the important difference was not how depression was experienced but how it was expressed. Their study seems to suggest that depression is part of an inner emotional world that is contained, constrained or set free by gendered practices. The ‘big build’ (Fig. 1) is the descriptive model Brownhill et al developed to explain how masculine practices in relation to depression result in a debilitating trajectory of destructive behaviour and emotional distress. These practices start as avoidance, numbing and escaping behaviours that may escalate to violence and suicide. The point seems to be that there is no difference in the depression men and women experience but that there are important differences in how depression is ‘done’ or enacted in terms of masculinities or femininities.

From the research on depression and hegemonic masculinities, it might be suggested that the destructive behaviours such as violence in intimate relationships, substance misuse and suicide are ways of ‘doing’ depression that enact particular masculinities. Further, current mental health practices in the diagnosis and treatment of depression might be seen as enacting femininities. From the concept of hegemonic masculinity, depression in men is not masked but is often visible in abusive, aggressive and violent practices; nor are these behaviours a sign of a male form of depression: women can ‘do’ masculinity and may cope with their depression in similar ways. The point for service provision is that depression may underlie wider issues of mental health (such as substance misuse) and criminal behaviour.

Although hegemonic masculinity may offer clinicians a more nuanced view of their clinical practices and how their clients act out their difficulties, it fails to offer any specific treatment possibilities.

To date, the research on hegemonic masculinity and depression has utilised focus group and interview methods. As masculinity is understood in terms of constantly recurring practices, research needs to adopt methods that identify and study depression-related practices as they occur in real life. Studies have already looked at how masculinities are achieved through destructive behaviours such as crime (Messerschmidt, 1993) and hooliganism (Newburn & Stanko, 1994), and it would be interesting to explore them for depression.

The socialisation of developing boys

In our introduction we presented three reasons for considering men and depression: men are a numerical minority among patients with depression, and they require effective interventions; in community samples there seem to be more men with depression than are receiving treatment for it; and emotional distress in men might indicate depression. Theories of sex differences, gender roles and hegemonic masculinity can be combined in an effort to explain why men are the numerical minority patient group when so many seem to have depression. Although Kraemer (2000) argues that men may be biologically disadvantaged by a fragile X-chromosome, he claims that this disadvantage is immediately mitigated once an infant's sex is known. Boys are subject to their own biological and psychological development that cannot be separated from the cultural and historical context in which they are socialised. The advantage of taking a combined approach is that it should force us to consider the individual and social together.

In a pioneering study of schoolboys, Frosh et al (2002) found that masculinity seemed to be lived through attempts to avoid being seen as feminine or homosexual. In particular, femininity and homosexuality seemed to be associated with displays of emotions and the schools reported that if boys displayed such emotions they were subject to, and would subject others to, insidious bullying. Although usually associated with younger children, the cliché ‘big boys don't cry’ is an example of how a young boy may be denied a masculine identity because he has displayed emotion. It is important to consider what this means for men and depression in practice, as the suggestion seems to be that developing boys are socialised into emotionally inarticulate young men, unable to express depression. If adolescent girls hold the monopoly on discussions relating to emotions, then by implication boys are restricted from entering these domains. This rather stark bipolarisation of emotional-feminine and unemotional-masculine must influence men's ability to recognise their own emotional difficulties, how they express them and how they seek help to cope with them. A further suggestion is that ‘health’ more generally is seen as a feminine issue, which means that the problems of genders roles and masculinities are not limited to emotional health (White, 2006).

Future: gender equality policy

The ‘Real men. Real depression’ campaign of the US National Institute for Mental Health (Rochlen et al, 2005) and the publication of the leaflet Men Behaving Sadly by the UK Royal College of Psychiatrists (2006) demonstrate the growing recognition of depression in men. However, recent changes towards proactive gender equality may mean that health services have to adapt and incorporate an explicit focus on men and depression. The UK Equality Act 2006, which came into force April 2007, places a statutory duty (termed the ‘gender duty’) on public bodies to ensure that where men and women have different needs services are planned and developed in ways that successfully meet them. If, for example, a local coroner's office were to report a rate of suicide greater in men than in women, we would presume that under the gender duty the local health services would need to do something to reduce male suicide. Nevertheless, health services currently lack the expertise required for providing solutions targeted specifically at men (Men's Health Forum, 2006), which means that they may fail to meet their obligations under the gender duty. Health service projects have been designed to meet men's health needs and it is important that we learn from these as services are developed on the basis of the different needs of men and women.

MCQs and EMI

1 A man attends your surgery and you consider him to be typical of the masculine gender role. The most productive tactic to explore the possibility that he has depression is to:

a ask how he feels about his emotional difficulties
b focus on his physical symptoms
c ask about any issues or problems he is experiencing.

2 Assuming that ‘male depression’ exists, diagnosis should be based on:

a international diagnostic criteria with both men and women
b international diagnostic criteria with women and ‘male depression’ instruments with men
c diagnostic criteria and ‘male depression’ instruments with both men and women.

3 Hegemonic masculinity is best described as:

a the taken-for-granted view of what it is to be a man in a specific context
b the norm that men aspire to
c the societal view of what it is to be a man that is forced on everyone.


Theme: clinical diagnosis


a weight loss
b disturbed sleep
c ideas or acts of self-harm or suicide
d alcohol dependence during difficult times
e loss of interest or enjoyment of physical aggression.

For each patient in the scenarios below, select from the above list the symptom that is absent from international classifications of depression:

i A 40-year-old man is cheerful and friendly when he attends your surgery. When pressed, he reports that for as long as he can remember he has had periods when he loses interest in his hobbies, eats too much and puts on weight. When asked about his strategies for dealing with these periods he reports that the only thing that helps him is drinking, otherwise things get out of control as he cannot relax.

ii A 22-year-old man attends your surgery with visible bruising to his face and knuckles. Since graduating from university, he has separated from his long-term partner and had to relocate away from friends and family to start his job. After further discussion, he reports that has been feeling low and has moments when he becomes inexplicably angry, starting fights for no reason.


1 Shown to discriminate between sexes, occurring more frequently in women.

2 Shown to discriminate between sexes, occurring more frequently in men.


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Big build': hidden depression in men


Objective: To investigate men's experience of depression.

Method: A sample of male and female teachers and students was recruited from four sites of a tertiary education institution to a series of focus groups. A grounded theory approach to qualitative data analysis was used to elucidate men's experience of depression. Content analysis was applied to the women's data to examine similarities and contrasts with the men. Standard measures of mood and dispositional optimism confirmed the non-clinical status of the group.

Results: The findings suggest that some men who are depressed can experience a trajectory of emotional distress manifest in avoidant, numbing and escape behaviours which can lead to aggression, violence and suicide. Gender differences appear not in the experience of depression per se, but in the expression of depression.

Conclusion: Emotional distress, constrained by traditional notions of masculinity, may explain why depression in men can often be hidden, overlooked, not discussed or 'acted out'. There are implications for the types of questions asked of men to detect depressive symptoms.

Young Masculinities

About this book


How do boys see themselves? Their peers? The adult world? What are their aspirations, their fears? How do they feel about their own masculinity? About style, 'race', homophobia? About football?

This book examines aspects of 'young masculinities' that have become central to contemporary social thought, paying attention to psychological issues as well as to social policy concerns. Centring on a study involving in-depth exploration, through individual and group intererviews, the authors bring to light the way boys in the early years of secondary schooling conceptualise and articulate their experiences of themselves, their peers and the adult world. The book includes discussion of boys' aspirations and anxieties, their feelings of pride and loss. As such, it offers an unusually detailed set of insights into the experiential world inhabited by these boys - how they see themselves, how girls see them, what they wish for and fear, where they feel their 'masculinity' to be advantageous and where it inhibits other potential experiences. In describing this material, the authors explore questions such as the place of violence in young people's lives, the functions of 'hardness', of homophobia and football, boys' underachievement in school, and the pervasive racialisation of masculine identity construction.

Young Masculinities will be invaluable to researchers in psychology, sociology, gender and youth studies, as well as to those devising social policy on boys and young men.

Male Gender Role Conflict, Depression, and Help Seeking: Do College Men Face Double Jeopardy?


To investigate the previously untested hypothesis that college men with higher levels of male gender role conflict (MGRC) experience both increased risk of depression and more negative attitudes toward seeking counseling services, this study used latent variable modeling to examine these relations. Two components of MGRC were identified: restriction-related MGRC, which predicted 25% of the variance in help-seeking attitudes, and achievement-relatedMGRC, which predicted 21% of the variance in depression. It is suggested that outreach programs designed to increase college men's willingness to use counseling services attempt to counter the option-limiting aspects of male gender roles, whereas counseling with depressed college men incorporate an examination of their perceptions of success and achievement.

The fragile male

The human male is, on most measures, more vulnerable than the female. Part of the explanation is the biological fragility of the male fetus, which is little understood and not widely known. A typical attitude to boys is that they are, or must be made, more resilient than girls. This adds “social insult to biological injury.” Culture and class make a difference to the health and survival of boys. The data presented here have implications for the clinical management of male patients as well as for the upbringing of boys.

Summary points

  • The disadvantages of the male are usually seen as socially mediated
  • Even from conception, before social effects come into play, males are more vulnerable than females
  • Social attitudes about the resilience of boys compound the biological deficit
  • Male mortality is greater than female mortality throughout life
  • The causes are a mixture of biological and social pressures: we need to be aware of both in order to promote better development and health for boys and men

Downhill from conception to birth

At conception there are more male than female embryos. This may be because the spermatozoa carrying the Y chromosome swim faster than those carrying X. The male's pole position is, however, immediately challenged. External maternal stress around the time of conception is associated with a reduction in the male to female sex ratio, suggesting that the male embryo is more vulnerable than the female.1 From this point on it is downhill all the way. The male fetus is at greater risk of death or damage from almost all the obstetric catastrophes that can happen before birth.2 Perinatal brain damage,3 cerebral palsy,4 congenital deformities of the genitalia and limbs, premature birth, and stillbirth are commoner in boys,5

Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression


Consultation rates and help-seeking patterns in men are consistently lower than in women, especially in the case of emotional problems and depressive symptoms. Empirical evidence shows that low treatment rates for men cannot be explained by better health, but must be attributed to a discrepancy between perception of need and help-seeking behavior. It is argued that social norms of traditional masculinity make help-seeking more difficult because of the inhibition of emotional expressiveness influencing symptom perception of depression. Other medical and social factors which produce further barriers to help-seeking are also examined. Lines of future research are proposed to investigate the links between changing masculinity and its impact on expressiveness and on the occurence and presentation of depressive symptoms in men.

The gender gap in suicide and premature death or: why are men so vulnerable?


Suicide and premature death due to coronary heart disease, violence, accidents, drug or alcohol abuse are strikingly male phenomena, particularly in the young and middle-aged groups. Rates of offending behaviour, conduct disorders, suicide and depression are even rising, and give evidence to a high gender-related vulnerability of young men. In explaining this vulnerability, the gender perspective offers an analytical tool to integrate structural and cultural factors. It is shown that traditional masculinity is a key risk factor for male vulnerability promoting maladaptive coping strategies such as emotional unexpressiveness, reluctance to seek help, or alcohol abuse. This basic male disposition is shown to increase psychosocial stress due to different societal conditions: to changes in male gender-role, to postmodern individualism and to rapid social change in Eastern Europe and Russia. Relying on empirical data and theoretical explanations, a gender model of male vulnerability is proposed. It is concluded that the gender gap in suicide and premature death can most likely be explained by perceived reduction in social role opportunities leading to social exclusion.

‘It's caveman stuff, but that is to a certain extent how guys still operate’: men's accounts of masculinity and help seeking


It is often assumed that men are reluctant to seek medical care. However, despite growing interest in masculinity and men's health, few studies have focussed on men's experiences of consultation in relation to their constructions of masculinity. Those that have are largely based on men with diseases of the male body (testicular and prostate cancer) or those which have been stereotyped as male (coronary heart disease). This paper presents discussions and experiences of help seeking and its relation to, and implications for, the practice of masculinity amongst a diversity of men in Scotland, as articulated in focus group discussions. The discussions did indeed suggest a widespread endorsement of a ‘hegemonic’ view that men ‘should’ be reluctant to seek help, particularly amongst younger men. However, they also included instances which questioned or went against this apparent reluctance to seek help. These were themselves linked with masculinity: help seeking was more quickly embraced when it was perceived as a means to preserve or restore another, more valued, enactment of masculinity (e.g. working as a fire-fighter, or maintaining sexual performance or function). Few other studies have emphasised how men negotiate deviations from the hegemonic view of help-seeking.

A Strong Connection to Your Therapist Improves the Results of Your Treatment for Depression

Having a therapist who you can really connect to can make a big difference in your therapy for depression.

Lately, you've been feeling down and depressed. While you've certainly felt this way before, you've never felt so fatigued that you feel weighed down. Feeling worthless and hopeless, you decide to see a therapist in the hopes of getting help. You tell a friend, who suggests that you call their therapist. According to your friend, this is the best therapist in the world. Thankful for the referral, you call and make an appointment. However, after several appointments, you just don't feel as though you and your therapist have connected. But because your friend simply loves this therapist, you wonder if trying out a different therapist is the right thing to do. Maybe the lack of connectedness is just in your head. Or maybe it's just the depression getting in the way of connecting with your therapist.

Make a Real Connection

While it's certainly true that symptoms of depression can interfere with connecting with others1, it's important to not just dismiss the lack of connection, particularly if it's your first experience with therapy. In fact, a large body of research indicates that the therapeutic alliance, or the extent to which you feel connected to your therapist, is one of the primary mechanisms leading to change in depressive symptoms across several types of psychotherapy.2, 3 Additionally, research indicates that the therapeutic alliance is particularly important to the outcome for those who have had a history of fewer depressive episodes.4

In a new study conducted from the University of Pennsylvania, Brown University, VU University Amsterdam, and Akrin Mental Health Care, a team of researchers examined the effect of the therapeutic alliance on the relations between the number of prior depressive episodes and treatment outcome between two types of therapy: cognitive behavior therapy (CBT) and psychodynamic therapy.5 In the study, individuals meeting criteria for depression completed surveys about their alliance with their therapist and their depressive symptoms over the course of 16 sessions of either CBT or psychodynamic therapy.

The results of the study indicated that, although the number of prior depressive episodes did not affect treatment outcome of either treatment, having a strong therapeutic alliance predicted positive treatment outcomes. Additionally, although having a strong therapeutic alliance was an important factor in both treatments, how important the alliance was differed based on the type of therapy and number of prior episodes. Specifically, for those individuals undergoing psychodynamic therapy, the alliance had a large effect on treatment outcome, regardless of the number of prior depressive episodes. In contrast, for those undergoing CBT, having a strong therapeutic alliance had a larger effect on treatment outcome in those with a history of fewer prior depressive episodes. Depending on the treatment and the number of prior depressive episodes, having a strong therapeutic alliance was an important mechanism of change in depressive symptoms.

The results of this study point to the importance of considering not only a therapist match to areas of expertise and type of therapy, but also to your interpersonal fit and feeling of connectedness. While it may be frustrating and time-consuming to shop around for a therapist, finding someone that you feel connected to may increase the likelihood of reducing your symptoms of depression.


1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

2. Arnow, B. A., Steidtmann, D., Blasey, C., Manber, R., Constantino, M. J., Klein, D. N., … Fisher, A. J. (2013). The relationship between the working alliance and treatment outcome in two distinct psychotherapies for chronic depression. Journal of Consulting and Clinical Psychology, 81, 627-638. Doi: 10.1037/a0031530

3. Ulvenes, P.G., Berggraf, L., Hoffart, A., Stiles, T. C., Svartberg, M., McCullough, L., & Wampold, B. E. (2012). Different processes for different therapies: Therapist actions, therapeutic bond, and outcome. Psychotherapy, 49, 291-302. doi: 10.1037/a0027895

4. Lorenzo-Luaces, L., DeRubeis, R. J., & Webb, C. A. (2014). Client characteristics as moderators of the relation between the working alliance and outcome in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 82, 368-373. Doi: 10.1037/a0035994.

5. Lorenzo-Luaces, L., Driessen, E., DeRubeis, R. J., Van, H. L., Keefe, J. R., Hendriksen, M., & Dekker, J. (2017). Moderation of the alliance-outcome association by prior depressive episodes: differential effects in cognitive-behavioral therapy and short-term psychodynamic supportive psychotherapy. Behavior Therapy, 48(5), 581-595.

Dreaming of Deleting Depression?

If you’ve ever endured a broken heart, you understand the desperate desire to end the mental anguish, at any cost. A broken heart is temporary, but mental illness is often chronic, and the desire to purge that experience from the brain can be persistent and overwhelming. It’s not possible yet, but, as some neurotechnology experts discuss in an intriguing episode of The Future of X: Health, one day we could have a neural implant inside our brains that anticipates, and eliminates, depression symptoms before they take hold. LISTEN NOW

Can Depression Be Detected With a Blood Test? 3/21/22

When you're ill, your doctor may run a battery of tests to help figure out what's causing you to feel unwell. In the case of common infections, a simple blood test can make the diagnosis and guide your doctor in prescribing the right treatment.

When you have symptoms of mental illness, however, diagnosis and treatment can be a far more complex process. Promising research is being done, but we don't yet have a simple blood test that can diagnose depression.

Initial Steps

If you have symptoms of depression and go to your doctor, the process of getting the correct diagnosis and finding a treatment that works for you may take several steps and require the expertise of more than one type of healthcare provider.

To begin, your regular doctor will ask you about your symptoms, look for observable signs of your overall health, and refer to your past medical history. They will also ask about your family's health history, including mental health.

Your doctor can use blood tests to rule out medical conditions that may cause symptoms of depression or even be an underlying cause of the condition.

Depending on the results of the blood tests, the next step may be getting a referral to another type of doctor, such as a psychiatrist or another mental health provider.

Professionals trained in mental health can confirm a diagnosis of depression by differentiating it from other psychiatric conditions, such as bipolar disorder, anxiety disorders, and obsessive-compulsive disorder (OCD).

Once a diagnosis is made, your provider can use all of this information, as well as findings from your primary care doctor, to inform the creation of a treatment plan.

Possible Blood Tests

After your appointment with your primary care physician, they may order one or more blood tests that can be used to rule out other health conditions that can cause symptoms of depression such as fatigue, low mood, and weight changes.

Complete Blood Count (CBC)

A CBC looks at the various types of cells found in blood and counts how many there are. The test can be used to check for anemia or infection, both of which can lead to fatigue.1?

Thyroid Function Panel

Thyroid tests check the blood for levels of hormones produced by the thyroid gland. If the thyroid gland is under- or overactive, mood symptoms can result.2?

Creatinine and Blood Urea Nitrogen (BUN)

Creatinine and BUN levels reflect how well the kidneys are working. Not only can kidney disease lead to symptoms similar to depression, but it’s also important for doctors to know if kidney function is impaired before prescribing an antidepressant.3? When the kidneys aren’t working well, they may not be able to metabolize certain medications properly.

Liver Function Panel

If the liver is inflamed or damaged, there are often changes that are detectable with a simple blood test. Liver disease can cause symptoms similar to depression, such as lethargy. If a person’s liver isn’t working well, it can also indicate alcohol misuse, which can co-occur with or cause depression.4?

Like with the kidneys, it’s also important to know how well the liver is working before prescribing medications, as the organ’s ability to metabolize drugs properly can influence how they work.

Fasting Blood Glucose

The amount of sugar in your blood after an overnight fast can be used to detect diabetes. While the exact link is unclear, depression and diabetes often occur together. Several studies have also indicated that people with diabetes have an increased risk of developing depression.5? Your doctor may also check your blood glucose levels before prescribing you a medication to treat depression.


Cholesterol is not known to be specifically linked with depression, but your levels do affect your overall health. Blood tests can detect if you have high cholesterol levels, which increases your risk for health problems associated with plaque buildup in your arteries. Your doctor might want to check your cholesterol before prescribing certain antidepressants, which may affect your levels.

Calcium and Magnesium Levels

While it’s rare, having calcium and/or magnesium levels that are too high or too low can cause psychiatric illness.6?

Folate and Vitamin B12 Levels

Low levels of folate (vitamin B9) or vitamin B12 can indicate a condition called pernicious anemia, which often causes symptoms of depression.7? In some cases, fatigue and lethargy may set in even before tests show a deficiency.

What Tests Results Mean

When the results of your blood work come back, there may be a clear “next step” for you to take. For example, if you have low levels of vitamin B12, your doctor may recommend you start taking a vitamin supplement or receive injections.

If you are diagnosed with a medical condition such as hypothyroidism or diabetes, you may find your depression symptoms start to get better as soon as you begin treatment for the underlying condition. They may even resolve once the condition is managed.

When blood tests indicate you have high cholesterol, your doctor may recommend making some lifestyle changes. You may find that adjusting your diet and getting regular exercise help ease your depression symptoms, too.

The results of your blood tests may prompt your doctor to ask you about your alcohol and drug use as well. If you are using substances or dealing with addiction, it's crucial that you are honest with your doctor. Getting support and treatment for addiction is part of addressing depression.

For your safety, as well as the efficacy of treatment, your doctor needs to know if you are using drugs or alcohol, as it may influence the medications they prescribe.

When All the Tests Are Normal

If all the blood tests your doctor orders come back normal, they will likely feel much more confident that your depression is not being caused by an underlying medical condition. Once another cause has been ruled out, the focus can be turned toward finding the most effective treatment.

Your doctor may start by prescribing an antidepressant for you to try, referring you to a therapist within the healthcare system or community, or both. They may refer you to a psychiatrist for a more thorough assessment or to prescribe medication.

Treatment for depression can be as complex as the condition itself. What works well for one person may not work at all for someone else. You may also need to use more than one treatment, such as psychotherapy and antidepressants, at the same time.

You may need to modify your depression treatment or start something completely new. For example, as you get older, changes in your life and your body can influence how well certain treatments work for you.

Depression Tests of the Future

While they are not yet in common use by most health care providers, in the realm of psychological research there is much interest in the potential of biomarkers to help diagnose depression and other psychiatric conditions.8?

There are many factors that determine whether someone develops depression in their lifetime, including genetics and environment.

Research also continues to show how the brain and the body are inextricably connected; the health of one influences the health of the other.

Some studies have been looking for a potential connection between levels of inflammation in the body and depression.9? Others are investigating how the gut microbiome might influence mental health.10?

A study published in 2013 explored the possibility of a connection between elevated cortisol levels in young adults (particularly males) and depression. In 2015, a study at UC San Diego proposed changes in a specific gene linked to the X chromosome may contribute to mental illness in women.11?

One day, we may be able to screen a person’s genetic information, measure the levels of inflammatory markers in their blood, and look for changes in the structure of their brain to determine their risk for depression, diagnose the condition, and find the most effective treatment—but we’re not there yet.12?

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database.


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