What Depression Looks Like In Men with PTSD

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Lisa Zamosky discusses why there are more than 5 million men in the U.S. experiencing depression each year. These are staggering figures and are overrepresented amongst those suffering from Trauma, Complex PTSD and PTSD related conditions.

Clinical depression—in women or men—can cause sadness and a loss of interest in once pleasurable activities. But depression can sometimes manifest in different ways in different people.

“While the symptoms used to diagnose depression are the same regardless of gender, often the chief complaint can be different among men and women,” says Ian A. Cook, MD, the Miller Family professor of psychiatry at the University of California–Los Angeles.

Here are 12 signs of depression in men with PTSD.

Fatigue

People who are depressed undergo a series of physical and emotional changes. They can experience fatigue, as well as psychomotor retardation, or a slowing down of physical movements, speech, and thought processes.

According to Josh Klapow, PhD, a clinical psychologist with the University of Alabama at Birmingham’s School of Public Health, men are more likely than women to report fatigue and other physical symptoms of depression as their chief complaints.

Sleeping too much or too little

Sleep problems—such as insomnia, waking up very early in the morning, or excessive sleeping—are common depression symptoms.

“[Some people] sleep 12 hours a day and still feel exhausted or toss and turn and wake up every two hours,” says Dr. Cook.

Like fatigue, sleep troubles are one of the main symptoms that depressed men may discuss with their doctor, experts say.

Stomachache or a backache

Health problems such as constipation or diarrhea, as well as headaches and back pain, are common in people who are depressed.

But men often don’t realize that chronic pain and digestive disorders go hand in hand with depression, according to focus groups conducted by the National Institute of Mental Health. Norman Sussman, MD, a professor of psychiatry at the NYU Langone Medical Center, says people who are depressed do genuinely feel bad physically.

“It is a medical disorder,” says Dr. Sussman.

Irritability

Instead of seeming down, men who are depressed often show signs of irritability. “If they talk about an emotional component, it could be sadness with irritability,” says Dr. Cook.

In addition, says Klapow, negative thoughts are a common aspect of depression. “Men will report feeling irritable because they are having negative thoughts constantly,” he says.

Difficulty concentrating

Psychomotor retardation can slow down a man’s ability to process information, thereby impairing concentration on work or other tasks.

“Depression fills one with negative thoughts, almost like an intrusion,” Klapow says. “You’re slowed down and constantly thinking about negative things in your world. As a result, it makes it very difficult to focus on anything.”

“I describe depression as a form of reversible brain failure, Dr. Sussman says. “When you’re depressed, it’s like your CPU [central processing unit] isn’t working properly.”

Anger or hostility

Some men manifest depression by being hostile, angry, or aggressive, says. Dr. Sussman. “A man who realizes something is wrong may need to compensate by demonstrating that he is still strong or capable,” he says.

Anger and hostility are different than irritability. “Anger tends to be a stronger emotion,” Klapow says. “Irritability is a crankiness.”

Dr. Sussman says he’s also seen men become hostile when they have withdrawn as a result of their depression and feel under pressure by friends or family to rejoin society.

Stress

“Men might be more likely to report symptoms of depression as stress. It’s not that they have more stress; it’s that it’s more socially acceptable to report it,” Klapow says.

According to Dr. Cook, stress and depression can also travel a two-way street. “It’s accurate to say that feeling stressed can be an indicator of having clinical depression but also be part of the cause,” he says.

Research has shown that prolonged exposure to stress can lead to changes both in the body and brain, which can, in turn, lead to depression.

Anxiety

Research has shown a strong link between anxiety disorders and depression.

Men may be no more likely than women to experience anxiety—in fact, anxiety disorders are about twice as prevalent in women—but it’s often easier for men to talk about feeling anxious rather than sad, Dr. Cook says.

Men may discuss concerns about work and whether the loss of a job will impede their ability to provide for themselves and their family. “It may be easier to put words to worries and fears,” Dr. Cook says.

Substance abuse

Substance abuse frequently accompanies depression. Research has shown that alcoholics are almost twice as likely to suffer from major depression as people without a drinking problem.

“It can happen for both men and women, but using drugs or alcohol to mask uncomfortable feelings is a strategy many men will employ instead of seeking health care,” says Dr. Cook.

“There’s a cultural bias of, ‘I should be able to fix this myself and so I’ll use what chemicals I have available to me to do that,'” Dr. Cook says.

Sexual dysfunction

Depression is a common reason for loss of desire and erectile dysfunction (ED), and it’s one symptom that men are inclined not to report. “Performance problems can come from depression and make depression worse,” Dr. Cook says.

However, ED can be the result of other medical conditions or medications (including antidepressants), and ED by itself does not signal depression.

“My strong recommendation…is that you can’t go after one symptom; it’s a group of symptoms,” Klapow says.

Indecision

“I can’t count the number of people who have said, ‘I had money in the bank but the phone got shut off because I couldn’t bring myself to [pay the bill] or decide what to do and when.’ It gets overwhelming,” Dr. Cook says.

Some people naturally have a hard time making decisions, so an inability to make choices is usually worrisome only if it’s a new behavior.

“It’s an information-processing issue,” and depression slows down your ability to decide, Klapow says.

Suicidal thoughts

Women are more likely to attempt suicide, but men are more than four times as likely to die if they do attempt suicide. One reason is that men tend to choose more lethal methods. “They more often use firearms and kill themselves the first time they try,” Dr. Cook says.

Older men are at highest risk for suicide, and doctors may miss depression symptoms in this group. In fact, more than 70% of older suicide victims saw their primary care physician within the month of their death.

Depression is not a normal part of aging in men or women.

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