how to help

Source: National Institute of Mental Health

“It affects the way you think. It affects the way you feel. It just simply invades every pore of your skin. It’s a blanket that covers everything. The act of pretending to be well was so exhausting. All I could do was shut down. At times you just say ‘It’s enough already.’”

-Steve Lappen, Writer

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

Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, or other activities.
Set realistic goals 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.
Expect your mood to improve gradually, not immediately. Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.
Postpone important decisions. 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.
Do not expect to ‘snap out of’ a depression. But do expect to feel a little better day by day.
Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
Let your family and friends help you.

How Family and Friends Can Help

The most important thing anyone can do for a man who may have depression is to help him get to a doctor for a diagnostic evaluation and treatment. First, try to talk to him about depressionhelp him understand that depression is a common illness among men and is nothing to be ashamed about. Perhaps share this booklet with him. Then encourage him to see a doctor to determine the cause of his symptoms and obtain appropriate treatment.

Occasionally, you may need to make an appointment for the depressed person and accompany him to the doctor. Once he is in treatment, you may continue to help by encouraging him to stay with treatment until symptoms begin to lift (several weeks) or to seek different treatment if no improvement occurs. This may also mean monitoring whether he is taking prescribed medication and/or attending therapy sessions. Encourage him to be honest with the doctor about his use of alcohol and prescription or recreational drugs, and to follow the doctor’s orders about the use of these substances while on antidepressant medication.

The second most important thing is to offer emotional support to the depressed person. This involves understanding, patience, affection, and encouragement. Engage him in conversation and listen carefully. Do not disparage the feelings he may express, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person’s doctor. In an emergency, call 911. Invite him for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push him to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of laziness or of faking illness, or expect him ‘to snap out of it.’ Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring him that, with time and help, he will feel better.

Where to Get Help

If unsure where to go for help, talk to people you trust who have experience in mental health, for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding scale fee clinic treatment options. Otherwise, check the Yellow Pages under “mental health,” “health,” “social services,” “suicide prevention,” “crisis intervention services,” “hotlines,” “hospitals,” or “physicians,” for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Religious leaders/counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University or medical school affiliated programs
State hospital outpatient clinics
Social service agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies

Within the Federal government, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a “Services Locator” for mental health and substance abuse treatment programs and resources nationwide. Visit their Web site at http://www.mentalhealth.samhsa.gov/databases/ or call 1 800 789 2647 (toll free).

Conclusion

A man can experience depression in many different ways. He may be grumpy or irritable, or have lost his sense of humor. He might drink too much or abuse drugs. It may be that he physically or verbally abuses his wife and his kids. He might work all the time, or compulsively seek thrills in high risk behavior. Or, he may seem isolated, withdrawn, and no longer interested in the people or activities he used to enjoy.

Perhaps this man sounds like you. If so, it is important to understand that there is a brain disorder called depression that may be underlying these feelings and behaviors. It’s real: scientists have developed sensitive imaging devices that enable us to see depression in the brain. And it’s treatable: more than 80 percent of those suffering from depression respond to existing treatments, and new ones are continually becoming available and helping more people. Talk to a healthcare provider about how you are feeling, and ask for help.

Or perhaps this man sound like someone you care about. Try to talk to him, or to someone who has a chance of getting through to him. Help him to understand that depression is a common illness among men and is nothing to be ashamed about. Encourage him to see a doctor and get an evaluation for depression.

For most men with depression, life doesn’t have to be so dark and hopeless. Life is hard enough as it is; and treating depression can free up vital resources to cope with life’s challenges effectively. When a man is depressed, he’s not the only one who suffers. His depression also darkens the lives of his family, his friends, virtually everyone close to him. Getting him into treatment can send ripples of healing and hope into all of those lives.

Depression is a real illness; it is treatable; and men can have it. It takes courage to ask for help, but help can make all the difference.

“And pretty soon you start having good thoughts about yourself and that you’re not worthless and you kind of turn your head over your shoulder and look back at that, that rutted, muddy, dirt road that you just traveled and now you’re on some smooth asphalt and go, ‘Wow, what a trip. Still got a ways to go, but I wouldn’t want to go down that road again.’”

-Patrick McCathern, First Sergeant, U.S. Air Force, Retired

For Further Information

National Institute of Mental Health
Public Information and Communications Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892 9663
Toll Free: 1 866 227 NIMH ( 6464)
Phone: 1 301 443 4513
FAX: 1 301 443 4279
TTY: 1 301 443 8431
TTY toll-free: 1-866-415-8051
Web site: http://www.nimh.nih.gov
E mail: nimhinfo@nih.gov

For information about the Real Men Real Depression (RMRD) campaign, e-mail menanddepression@mail.nih.gov or visit the RMRD Web site at http://www.menanddepression.nimh.nih.gov.

This publication is also available in Spanish.

Visit the NIMH Website at http://www.nimh.nih.gov/ for information that supplements this publication.

For information on organizations and related resources for depressive disorders, go to MedLinePlus®, a service of the U.S. National Library of Medicine and the National Institutes of Health, at the following site:
http://www.nlm.nih.gov/medlineplus/depression.html.

References

Blehar MD, Oren DA. Gender differences in depression. Medscape Women’s Health, 1997; 2(2):3. Revised from: Women’s increased vulnerability to mood disorders: integrating psychobiology and epidemiology. Depression, 1995; 3:3 12.
Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubin Stiper M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK. Cross national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 1996; 276: 293 9.
Narrow WE. One year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished table.
Sackeim HA. Commentary: Functional brain circuits in major depression and remission. Archives of General Psychiatry, 2001; 58(7): 649 50.
Regier DA, Rae DS, Narrow WE, Kaelber CT, Schatzberg AF. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry, 1998; 173(Suppl. 34): 24 8.
Depression Guideline Panel. Clinical practice guideline, number 5. Depression in primary care: volume 1. Detection and diagnosis. AHCPR Pub. No. 93 0551. Rockville: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, 1993.
Shalev AY, Freedman S, Perry T, Brandes D, Sahar T, Orr SP, Pitman RK. Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 1998; 155(5): 630 7.
Strakowski SM, DelBello MP. The co occurrence of bipolar and substance use disorders. Clinical Psychology Review, 2000; 20(2): 191 206.
NIMH Fact Sheets on Depression and Other Illnesses. June 2002.
http://www.nimh.nih.gov/publicat/cooccurmenu.cfm
Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.
Lewinsohn PM, Hoberman HH, Rosenbaum M. A prospective study of risk factors for unipolar depression. Journal of Abnormal Psychology, 1988; 97(3): 251 64.
Pollack W. Mourning, melancholia, and masculinity: recognizing and treating depression in men. In: Pollack W, Levant R, eds. New Psychotherapy for Men. New York: Wiley, 1998; 147 66.
Cochran SV, Rabinowitz FE. Men and depression: clinical and empirical perspectives. San Diego: Academic Press, 2000.
Robins L, Regier D. Psychiatric disorders in America. New York: Free Press, 1991.
Kochanek KD, Murphy SL, Anderson, RN, Scott, C. Deaths: final data for 2002. National Vital Statistics Reports; 53(5). Hyattsville, MD: National Center for Health Statistics, 2004.
Moscicki EK. Epidemiology of suicide. In: Jacobs D, ed. The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey Bass, 1999; 40 71.
Moscicki EK. Epidemiology of completed and attempted suicide: toward a framework for prevention. Clinical Neuroscience Research, 2001; 1: 310 23.
Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce MI, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life: consensus statement update. Journal of the American Medical Association, 1997; 278(14): 1186 90.
Gallo JJ, Rabins PV. Depression without sadness: alternative presentations of depression in late life. American Family Physician, 1999; 60(3): 820 6.
Conwell Y. Suicide in later life: a review and recommendations for prevention. Suicide and Life Threatening Behavior, 2001; 31(Suppl): 32 47.
Bruce ML, Pearson JL. Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Dialogues in Clinical Neuroscience, 1999; 1(2): 100 12.
Little JT, Reynolds CF III, Dew MA, Frank E, Begley AE, Miller MD, Cornes C, Mazumdar S, Perel JM, Kupfer DJ. How common is resistance to treatment in recurrent, nonpsychotic geriatric depression? American Journal of Psychiatry, 1998; 155(8): 1035 8.
Reynolds CF III, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. Journal of the American Medical Association, 1999; 281(1): 39 45.
Klerman GL, Weissman M. Increasing rates of depression. Journal of the American Medical Association, 1989; 261: 2229 35.
Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, Greenwald S, Klier CM, Ryan ND, Dahl RE, Wickramaratne P. Depressed adolescents grown up. Journal of the American Medical Association, 1999; 281(18): 1701 13.
Shaffer D, Fisher P, Dulcan MK, Davies M, Piacentini J, Schwab Stone ME, Lahey BB, Bourdon K, Jensen PS, Bird HR, Canino G, Regier DA. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American Academy of Child and Adolescent Psychiatry, 1996; 35(7): 865 77.
Angold A, Worthman CW. Puberty onset of gender differences in rates of depression: a developmental, epidemiologic and neuroendocrine perspective. Journal of Affective Disorders, 1993; 29: 145 58.
Angold A, Costello EJ. Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. American Journal of Psychiatry, 1993; 150(12): 1779 91.
Kovacs M. Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care, 1997; 20(1): 36 44.
Birmaher B, Brent DA, Benson RS. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. American Academy of Child and Adolescent Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry, 1998; 37(11): 1234 8.
Ryan ND, Puig Antich J, Ambrosini P, Rabinovich H, Robinson D, Nelson B, Iyengar S, Twomey J. The clinical picture of major depression in children and adolescents. Archives of General Psychiatry, 1987; 44(10): 854 61.
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. Fluoxetine, cognitive behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 2004; 292(7): 807 20.
McClellan J, Werry J. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. American Academy of Child and Adolescent Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(Suppl 10): 157S 76S.
Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M. Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 1996; 53(4): 339 48.
Shaffer D, Craft L. Methods of adolescent suicide prevention. Journal of Clinical Psychiatry, 1999; 60(Suppl 2): 70 4; discussion 75 6, 113 6.
Kochanek KD, Murphy SL, Anderson, RN, Scott, C. Deaths: final data for 2002. National Vital Statistics Reports; 53(5). Hyattsville, MD: National Center for Health Statistics, 2004.
Ferguson JM. SSRI antidepression medications: adverse effects and tolerability. Primary April 12, 2005Care Companion Journal of Clinical Psychiatry. 2001; 3: 22 27.
Clayton AH, Warnock JK, Kornstein SG, Pinkerton R, Sheldon Keller, McGaravey EL.A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. Journal of Clinical Psychiatry, 2004; 65(1): 62 67.
Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S. Treatment of antidepressant associated sexual dysfunction with sildenafil: a randomized controlled trial. Journal of the American Medical Association, 2003; 289(1): 56 64.
U.S. Department of Health and Human Services. Mental health: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. http://www.surgeongeneral.gov/library/mentalhealth/home.html
Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, Greenberg RM, Crowe RR, Cooper TB, Prudic J. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. Journal of the American Medical Association, 2001; 285(10): 1299 307.
Rami, L; Bernardo, M; Boget, T; Ferrer, J;Portella, M; Gil Verona, J; Salamero, M. Cognitive status of psychiatric patients under maintenance electroconvulsive therapy: a one year longitudinal study. The Journal of Neuropsychiatry Clinical Neurosciences, 2004; 16: 465 71.
Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John’s wort) in major depressive disorder: a randomized, controlled trial. Journal of the American Medical Association, 2002; 287(14): 1807 14.

The following staff of the NIMH Public Information and Communications Branch were contributing writers and editors of this booklet: Rayford Kytle, Margaret Strock, Melissa Spearing, Clarissa Wittenberg, Daisy Whittemore, Ruth Dubois, Lisa D. Alberts, Jennifer K. Loukissas, and James Petersen. Scientific review was provided by Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D., of NIMH.

NIH Publication No. 05-4972
Revised 2005