Latest / The Dr. Psych Mom Show with clinical psychologist Dr. Samantha Rodman Whiten / What Depression Looks Like In Men

Transcript

What Depression Looks Like In Men · The Dr. Psych Mom Show with clinical psychologist Dr. Samantha Rodman Whiten

• 0:05
  Hi everybody and welcome to the Doctor Psych Mom Show.
• 0:08
  Today I'm going to be talking about what depression looks like
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  in men, which is an important topic because it looks different
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  than a does in women a lot of the time.
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  And a lot of times guys don't even know that they're depressed
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  when they are. And before we get to that, I
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• 0:59
  ages. It's both genders.
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  It's it's very exciting. All right.
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  Anyway, and I interact more in there.
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  So what does depression look like in men?
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  So most men are not going around crying and acting really sad.
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  Instead they act angry. Irritable.
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  Apathetic, cynical they are. They just act like they really
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  don't give a shit. Like they finally realized, and
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  this is something called depressive realism, but they
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  finally realized everything's bullshit.
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  Everything doesn't matter. So Connie might as well do
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  whatever you want. Your relationship is going to be
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  shit, you know Kids aren't going to appreciate you.
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  Work is some bullshit. And you know, why even bother?
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  Really. That's kind of a lot of how male
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  depression looks. And if you had a dad like that,
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  this can be an epiphany that he may have been depressed, right?
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  Men who have low testosterone, that can mimic depression.
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  So there's also lack of energy, right, And lack of drive, sex
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  drive and just general life drive.
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  And so the first thing to do, if you have no energy, you're
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  irritable and your wife is like kind of what's wrong with you.
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  The first thing always to do it be get your testosterone
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  checked. That's a pretty big change for a
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  lot of men, if that is too low. But there's also depression,
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  like regular depression. That is, of course, everything
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  is biologically mediated. And in future, we will know a
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  lot more about that, you know, about exactly how depression
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  manifests in the brain. We'll probably be able to scan
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  for it, you know. And now though, let's just talk
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  about what the symptoms would look like.
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  So the symptoms, there's changes in how you sleep.
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  You could be sleeping more or less, changes in how much you
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  eat. So there could be a lot of
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  weight gain or weight loss. Again, there's apathy.
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  There's lack of desire to do things that you used to want to
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  do. So while let's say you used to
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  want to go for a run, you don't want to go for a run anymore.
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  And it isn't like you're thinking, oh, I just don't want
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  to go for a run, You your brain is smart.
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  It always comes up with an excuse, a reason that makes
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  sense. Oh, my knee injury, I don't want
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  to hurt my old knee injury. That would be so stupid to
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  activate that. You know, with my luck, I'm
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  going to fall and then that's going to put me out of work.
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  So like, there's always a reason, right?
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  But remain the the point remains that you used to go for a run
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  and now you don't, you know, and instead you just kind of sit
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  around. The sitting around thing is is a
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  big indicator of depression, especially in men, because men
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  don't usually just sit around. No matter what sitcoms tell you,
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  men are usually getting up and doing shit unless they're
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  exhausted. When they're not.
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  They may be depressed. Now you could be depressed for
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  your whole life, pretty much. That's a low level of depression
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  is called dysthymia. And then when an episode of of
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  more severe depression comes upon that, it's called double
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  depression. You were, you were dysthymic or
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  this low level of apathy and cynicism kind of for your whole
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  life. And then you really have a
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  depressive episode. So that can happen to some
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  people as well. All of this, by the way, any any
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  disorder like depression, anxiety, PTSD, any of these can
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  be assessed by a psychologist or a psychiatrist, right.
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  So if you want to try medication first, go for it.
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  If you want to try therapy first, go for it.
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  What research suggests is the combination of therapy and
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  medication is the best as one can imagine, right?
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  Because sometimes if you're in therapy but you won't try any
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  medication, then you're not really giving yourself a full
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  shot at feeling better because you just cannot activate.
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  You just don't have enough dopamine or serotonin or
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  whatever's going on. Norepinephrine.
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  And this isn't just me, by the way, not understanding things.
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  We we really as a field, have very limited idea of what works.
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  You know, a lot of of these things.
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  We have no idea why certain medications work for certain
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  people or what have you, but but anyway, the point is whatever is
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  going on, you can't get over the hump biologically.
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  This is why the the admonition that people don't don't exercise
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  enough if they just exercise more.
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  I just read an article that actually said that that only
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  works in men. So like in in women they this
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  one study showed that depression in fact was not improved by
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  exercise in women, which I have a lot of clients that could tell
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  you myself as well. If you're a depressed woman and
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  you force yourself to exercise, often all you do is exercise and
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  come back dead, tired, you know, and you've expended all of your
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  energy for that day pretty much. But for men, it tends to work
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  more, but not every man is the same.
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  So the point I'm making is that sometimes you do need some
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  medication to get over the hump such that you can start
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  exercising, you can start feeling a little better
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  physiologically. You can have some of your life
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  drive back and then you can go to therapy and work on, you
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  know, whatever you want to work on in your life to to improve
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  your life. But I do not feel by the way
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  then at that that anything is bad about going on medication or
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  that it makes you weak or or anything.
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  I've never heard a person say, yeah, my my dad, he was such a
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  depressed, angry fuck, but thank God he never went on medication.
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  Boy, that was pretty strong of him.
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  Instead they say why was he so close minded?
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  I've tried Prozac. If he would have tried Prozac,
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  he could have been a different guy, you know, and and and also
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  then of course some people hear that and they say, oh, I don't
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  want to be a different person. First of all, why not, right?
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  I mean, shit is not going that well.
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  But point is, it can't really make you a different person.
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  What it does is it kind of brings you back to how you felt
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  before you were depressed. And if you've been dysthymic, it
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  brings you back to, like your best days, you know, days where
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  it all lifted for a little bit. So what do a lot of guys, by the
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  way, conclude when they're depressed and they don't know
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  that they're depressed? They conclude that their wife is
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  the problem. She's nagging, She's up my ass,
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  we don't have enough sex. And she she turns the kids
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  against me. Nobody respects me in this
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  house. She just treats me like an ATM.
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  All of this stuff. If you are thinking that your
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  wife is just literally terrible, you're probably depressed.
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  You know, it's a a human being is not going to be the cause of
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  all of another human being's problems.
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  Unless this is like a captor captive situation, right?
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  So unless this is like you with like Joe keeping the woman in
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  the basement, that you're not being kept in the basement by
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  your wife, she's just another person, right?
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  And she has her own struggle. She cannot make you clinically
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  depressed. She can exacerbate it.
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  Not she, but the marital dynamic.
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  So much like I say to women, he's not making you depressed.
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  He could be a narcissist or whatever.
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  Probably not. But he's not making you
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  depressed. And I have a whole podcast about
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  this. Does depression go away when you
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  remarry a more supportive spouse?
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  No, it doesn't. Depression is a biological
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  disorder that's highly heritable, right?
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  It's it's inherited by, you know, your gene pool.
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  Was your dad depressed? Was your mom depressed?
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  Most likely they probably weren't diagnosed because who
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  was at that stage? But if you have a tendency to be
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  depressive, then that's highly heritable and you should kind of
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  get your your butt in gear in terms of normalizing this and
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  not being judgmental about it. Because if it's heritable, then
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  that means it's heritable to your children too.
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  So when you start to see them acting depressed, you would
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  probably want to get them into some sort of treatment or at
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  least know what's going on instead of just assuming that
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  they're just being, you know, an asshole.
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  Because probably they are just depressed, the same as you.
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  If you have any children that act similar to how you feel, so
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  you're really negative and they're really negative.
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  Well, guess what? You know you you come from the
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  same gene pool, so your wife is probably not the reason that
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  you're a depressed man. Your marital issues are likely
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  exacerbating your depression because a good marriage is a
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  protective variable, although it is not a cure in any sense.
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  And a bad marriage exacerbates any mental illness, but it does
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  not 'cause it. So your wife could not sleep
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  with you. So there's plenty of guys whose
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  wife don't sleep with them, and they still get up and they take
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  a run and they do well at work and they're a good dad.
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  They just really hate their sex life, you know?
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  And you could think about this with anything else, right?
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  So, like, what if you really hated your job?
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  Would you have to be clinically depressed?
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  Or are there people that hate their job but the rest of their
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  life is pretty good? That's what it would be like if
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  you were not depressed, right? If you were not depressed, you
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  would say, all right, my sex life sucks.
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  Probably my marriage sucks too. Should probably get into marital
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  counselling or figure out what I want to do with that.
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  Even if I know I'm never going to divorce her, at least till
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  the kids are older, well, I can make peace with that for now,
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  and I'll just focus on everything else in my life.
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  That's what you would do if you weren't depressed or depressive.
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  So there's a difference, by the way.
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  There are some people who have a negative worldview because they
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  were raised with one, but they don't have these biological
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  markers. Their sleep is fine.
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  They get out and exercise. They don't eat too much or too
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  little. It's fairly been constant.
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  You know, they do have hobbies and activities, but they are
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  kind of close minded and negative.
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  That's the kind of stuff that's the wheelhouse of therapy.
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  That's what you can really dig your teeth into.
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  And therapy, right, is a negative worldview.
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  But once it gets to the point that you're laying in bed all
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  the time, I mean, you know, this is that that's that's where
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  medication usually comes in to help.
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  You know, because there's only, there's there's not a lot that
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  therapy can can do with somebody who is too depressed to engage
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  in therapy. And that is chicken and eggs.
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  So sometimes that's when you need the medication to come in.
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  Now, is medication a panacea? Certainly not.
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  I myself have shared that IA lot of medications have not worked
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  for me. I've not found the medication
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  for depression that's worked wholly that's not had any side
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  effects that I've stayed on for a long period of time at all.
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  But sometimes something can jog you a little bit out of an
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  episode or at the very very least you can know you tried
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  which is you know a self esteem boost.
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  I will try whatever. I will try whatever comes on the
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  market, you know, And so, like new things come on and so
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  ketamine, you know, or or whatever, you know.
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  And there's so many new new things that come on all the
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  time. Science advances constantly.
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  So you can turn into somebody who will try whatever sort of
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  medication is available for depression in addition to going
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  to therapy. And then you know that you're
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  kind of doing everything that you can, if not for yourself,
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  because when you're depressed, you often don't care.
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  You're irritable, you're negative.
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  You say fuck it. Who even cares about me?
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  Well, usually people still care about their children and the
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  role model that they're being for their children.
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  So then you are somebody who's trying to get your mental health
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  in check. You're going to therapy, you try
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  medications. And for a lot of people, they
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  work. A lot of women are more screwed
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  in this regard because there's a lot of extra hormonal issues
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  that come into into the mix. The men that I've seen go on
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  Prozac, you know, a lot of them respond, you know, they respond
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  so well that their wife is like, holy shit, he was depressed.
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  Whoa, he's smiling again. And Prozac, I'm just saying is a
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  proxy variable for any SSRI. Again, I'm not an MD you, I'm a
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  PhD. You have to go consult with a
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  psychiatrist. Usually your GP will also
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  possibly give you Prozac or or Zoloft or some SSRI or SNRI or
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  something. Wellbutrin's and SNRI.
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  So it works on dorefinephrine. The the the point here is you
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  should be working with a provider, medical provider.
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  Sometimes you have to try a bunch of things and see what
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  works for you. Dosage isn't right this that the
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  other right. So either you know no matter
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  what you're doing here, you should be doing something.
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  If you're realizing from what I'm saying that actually there
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  are also biological changes, you're tired all the time, you
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  know, you don't sleep well. Everything seems like a battle.
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  You don't enjoy things, You feel down.
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  Everything seems like it sucks. You know, you get you.
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  You've made a lot more sarcastic, snarky remarks
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  recently. You know things like that.
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  You, your wife, your kids, kind of they're walking on egg shells
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  around you. You tend to explode more.
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  You see the downsides. You haven't had a good idea for
• 13:24
  something in a while. Vacations coming up.
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  You don't really care. Oh a good way to spend money.
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  Everything looks like through a lens of grey.
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  Your wife has said that you're not fun, right?
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  Like you don't ever want to do anything fun.
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  By the way, a lot of the porn addiction can ramp up when men
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  are depressed because they're trying to self medicate with
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  dopamine. So if porn has gone from like
• 13:47
  you know a couple times a week to every night and you know
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  you're hiding that from your wife and what have you, then
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  that's also an indicator that something is awry with your
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  mental health. If drinking has ramped up, I
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  have a whole podcast on drinking and binge eating.
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  People try to use those things to self medicate, obviously.
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  So if you're eating and drinking has ramped up, that's also not a
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  good sign. Any sort of addictive behavior,
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  gambling, gaming, whatever. So anyway, oh, and also a very
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  big one is you don't give a shit about people you don't want to
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  see. Any friends.
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  A friend is in town, you really could care and everything kinds
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  of seems stupid. Maybe work.
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  You still go to work because you have to provide, but that seems
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  stupid too. And friends for sure seems
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  stupid. So your wife says, I don't know,
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  why don't you join the gym? And you're like what?
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  To spend money on something else?
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  Maybe I could. If you didn't shop at the mall
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  so much, and that's like the end of that conversation.
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  So there's a lot of conversations that that you
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  perceive that you end, then that's like a bad sign.
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  You know, like your wife starts a conversation, you end the
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  conversation, your kid starts a conversation, you end the
• 14:53
  conversation. Nobody at work, you know, really
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  gets the full brunt of somebody being depressed.
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  But even they don't necessarily seem to think that you're that
• 15:00
  much fun to work with. So if this can be an epiphany,
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  then reach out, see a therapist, see a psychiatrist, see both.
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  If you go to a therapist, they can tell you if you seem
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  depressed, right? And they could say, yeah, let's
• 15:14
  work on things and eventually maybe you'll you'll try
• 15:16
  medication too. I'll refer you to somebody.
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  Some people get better without medication.
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  Those are generally people that don't have as severe intractable
• 15:25
  depression. So if you're just feeling like
• 15:28
  this for a few weeks and you think that you just kind of need
• 15:31
  to talk to somebody and get your head on straight, you're feeling
• 15:34
  disillusioned and demoralized about, let's say, work or your
• 15:37
  relationship or aging or whatever, then yes, therapy can
• 15:42
  certainly help. But it's certainly not like
• 15:43
  everybody that I see is also on an antidepressant.
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  But I always like to lead pretty strong with If you have to do
• 15:49
  that, it is no personal failing and it would be pretty smart to
• 15:54
  try to use all the tools at your disposal, right?
• 15:59
  And just the one thing is that there are sexual side effects to
• 16:02
  SSRIs, but sometimes those could be good, because if you ever
• 16:06
  suffer from premature ejaculation, what it does is it
• 16:09
  increases the latency to orgasm for many people.
• 16:12
  So it's not necessarily a bad thing for some.
• 16:15
  But anywho, I hope that you found this instructive.
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  If you're a woman listening and this sounds a lot like your
• 16:20
  husband, and he won't go to therapy, get him into couples
• 16:22
  therapy, which you should be able to do because that's that.
• 16:25
  That's literally your relationship.
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  I mean, people say I can't get my partner into couples
• 16:29
  counseling. I have multiple podcasts how to
• 16:31
  convince your partner to go to couples counseling.
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  But it comes down to I'm in this relationship, I'm not happy.
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  I scheduled something on Tuesday.
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  We're going because if somebody wants to stay married, they
• 16:40
  cannot just say no to something like that.
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  Then once you're in couples therapy, then the therapist will
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  see that he's depressed, if he's depressed and may recommend some
• 16:49
  individual counseling. So it's kind of like a backdoor
• 16:51
  way to get a husband into individual counseling or to get
• 16:54
  him to try some medication or what have you to get him into
• 16:57
  couples counseling. And then you, you know, you play
• 17:01
  ball, you endorse, you know your own problems but say, but I do
• 17:05
  think he's depressed, but I do think he's depressed.
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  Eventually somebody's going to listen.
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  You know, he's going to listen. They're going to listen.
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  Somebody's going to listen. All right.
• 17:13
  I hope you guys found this interesting.
• 17:15
  And it is. A large percent of people that
• 17:17
  come into therapy, obviously, you know, as working with
• 17:21
  negative thoughts and feelings are pretty much, you know,
• 17:24
  tantamount to a a great, a great large percentage of what we deal
• 17:29
  with as therapists. So reach out always to me or my
• 17:31
  team at Best Life Behavioral Health if you do not know who to
• 17:34
  reach out to for therapy or coaching and I will talk to
• 17:39
  everybody soon. Have a great day.