Grace Under Pressure: Changing What Male Depression Means
Men Should Admit Depression and Seek Help
By RADHA CHITALE, July 3 2009, ABC News Medical Unit, http://abcnews.go.com/Health/MensHealth/st...0116&page=1



In 2006, Paul Letourneau of Worcester, Mass., lost his parents, his home and his pet dog. And, that August, his life-long mild depression took a turn for the worse as he became suicidal.

"I said I didn't want to be alive anymore," Letourneau, 67, recalled telling his best friend.

He and his friend had gone for a walk when Letourneau confessed and pressed his friend about ways to die painlessly. His friend advised him to admit himself to a hospital.

"When I got back to the house, physically, I was shaking so much -- and emotionally. I couldn't stop," Letourneau said. "I knew I had to get help."

For many men, it takes a lot more than feeling down -- even for long stretches -- to recognize that they are depressed and then step through the doors of a hospital, therapist's office, or a friend's or relative's home to seek help. Men who are depressed may believe they have to defy certain stereotypes about what it means to be a man in order to get appropriate treatment, depression experts and patients say.

"When men get depressed, the depression can be quite severe," said Dr. Ian Cook, professor of psychiatry at the Geffen School of Medicine at UCLA and director of its Depression Program. "The challenge is getting men to acknowledge when they're depressed."

Depression affects about 15 million people in the United States, according to the National Institutes of Mental Health, and men report being depressed about half as often as women.

"It's unclear how much of this represents differences in biology and how much of this is a reporting bias," Cook said. "The stigma issues are somewhat different for men than they are for women."

The Frontier Myth

Steven Lappen of Boston, Mass., has suffered depression since he was a teenager and cites the Frontier Myth, which champions a self-sufficient, hardy lifestyle and mentality for men -- and for women, but to a lesser degree -- as the masculine ideal.

"People lionize that because they want to have that ability," Lappen, 59, said. "Men are bound by that independent, go-it-alone attitude and that asking for help is a sign of weakness. And that is just nonsense because when that sense of self reliance is no longer adequate to the task of bringing them to the Promised Land, they become at risk."

Having Depression Does Not Indicate Failure

Rather than admit to what they see as a failure to cope with life, men are more likely to abuse drugs and alcohol, isolate themselves, often by working more, and engaging in risky behavior such as gambling or having multiple sexual partners as a way to avoid confronting their illness, depression experts say.

"For the moment, it allows them to feel better and escape from the pain rather than entering the full impact of the depression," said Dr. Jonathan Alpert, psychiatrist and associate director of the Depression Clinical and Research Program at Massachusetts General Hospital. "Men are less likely to talk about lower self esteem or feeling bad about themselves. ... A man's attention is more likely to be gotten by a physical symptom than an emotional one."

The symptoms of depression most commonly seen in men may include loss of sleep or appetite, gaining or losing a significant amount of weight, headaches, irritability and a lack of concentration.

But, if no one recognizes that such symptoms mask an underlying depressed condition, the depression can go untreated for years. And, for men, depression can be lethal. While women attempt suicide more often than men, the rate of completed suicide is four times higher in men, Alpert said.

Depression Increases the Risk of Suicide

Lappen's first breakdown occurred during his first semester at college in 1969, when he became so depressed he could not get out of bed to go to class. He admitted himself to a hospital when he was faced with the choice to drop out of college or to fail all his classes. Even so, Lappen refused to take medications while in the hospital and after he was released four months later.

"I didn't want my temple contaminated by these medications," Lappen said. "All I was doing was denying the diagnosis. The pills were a reminder that something was broken in me that I couldn't fix."

Lappen's depression persisted, although he was able to complete college, and became severe again during his first semester of doctoral studies.

"I'd gotten the means and I found a remote site where no one would find me," Lappen said. "I felt my life as a creative individual was over and I would just die, at my own hands."

Converting Cowardice to Courage

Lappen confessed his intent to kill himself to the counselor he was seeing, after which he admitted himself to a hospital.

"I had a realization that there was still a significant life force in me that did not want to cash out," Lappen said. "I thought I still had some talent and wanted to give myself a chance. But there are still times when I regret not following through."

While there are no studies to confirm whether the reported rates of depression in men are rising, clinicians say they have seen an increase, many of which are in the context of job losses.

"Losing a job is something anyone can understand, which makes it more acceptable to talk about it," Cook said. "It opens the door for people to learn about depression and to get help and that kind of direction can be a good thing."

Awareness and acceptance can go a long way to removing the stigma of male depression, but the illness is still viewed by many as a character flaw.

"How do you convert weakness to courage? You have to use the language of courage," Lappen said. "Asking for help means you are a social being and you're looking to fortify yourself. ... Convince [the depressed] person that asking for help is not weakness but is a sign of strength."

Gene Clues to Schizophrenia Risk
BBC News, July 2 2009, http://news.bbc.co.uk/2/hi/health/8128005.stm

Scientists have identified thousands of tiny genetic variations which together could account for more than a third of the inherited risk of schizophrenia.

They also showed the condition is genetically similar to bipolar disorder also known as manic depression.

The findings came from work by three separate teams, who analysed DNA from thousands of people.

The studies - the biggest ever into the genetics of schizophrenia - appear in the journal Nature.

“ We fully expect that future work will assemble them into meaningful pathways that will teach us about the biology of schizophrenia ”
Dr Pamela Sklar Massachusetts General Hospital

The findings suggest that schizophrenia is much more complex than previously thought, and can arise not only from rare genetic variants, but common ones as well.

It is hoped the work could lead to new diagnostic tests and treatments for the condition.

Schizophrenia is a common form of mental illness, affecting up to 1% of adults worldwide.

Symptoms tend to appear in late adolescence or early adulthood, and can include delusions, hallucinations, paranoia, and depression.

The cause of schizophrenia remains unclear, but it is thought that up to 90% of cases may be inherited.

Research linking the condition to specific genes was published last year, but it is thought they accounted for only a few cases.

Potentially, the findings of the latest studies could be much more significant.

The researchers say that individually many of the genetic variations they have identified play only a tiny role in raising the risk of passing schizophrenia down the generations.

Cumulative Effect

However, Dr Shaun Purcell, from Harvard University, who co-led one of the three teams, said: "Cumulatively, they play a major role, accounting for at least one-third - and probably much more - of disease risk."

The researchers stress that more work is needed to establish exactly how the genetic variants translate into schizophrenia.

But researcher Dr Pamela Sklar, of Massachusetts General Hospital, said: "We fully expect that future work will assemble them into meaningful pathways that will teach us about the biology of schizophrenia."

All three studies highlight genes found on Chromosome 6 in area known as the Major Histocompatibility Complex, which plays a role in the immune system, and in controlling when other genes are switched on and off.

The researchers believe this might help explain why environmental factors also seem to affect risk for schizophrenia.

For example, there is evidence that children whose mothers contract flu while pregnant have a higher risk.

Bipolar Disorder

In total the researchers identified 30,000 tiny genetic variants more common in people with schizophrenia.

A similar pattern was found in people with bipolar disorder - indicating a previously unrecognised overlap between the two conditions.

Dr Thomas Insel, of the US National Institute of Mental Health, said: "These new results recommend a fresh look at our diagnostic categories.

"If some of the same genetic risks underlie schizophrenia and bipolar disorder, perhaps these disorders originate from some common vulnerability in brain development."

The three research teams, who shared their data, were the International Schizophrenia Consortium, the Molecular Genetics of Schizophrenia consortium and SGENE.

In total, they analysed genetic data from 8,014 people with schizophrenia, comparing them to samples from 19,090 people who did not have the condition.

Paul Corry, of the mental health charity Rethink, said: "This exciting research brings us one step closer to understanding the causes of schizophrenia, but we are still a long way from a full explanation.

"Most of the genetic contribution to this illness is still unknown and it is crucial to realise that genes are only part of the picture - environmental and social factors, such as drug use or trauma, can exacerbate or even trigger schizophrenia."