Unmasking Male Depression: Understanding and Treating Adolescents and Adults

1. Russell C. Gaede, PsyD – r.gaede@lecutah.com Executive Director, Life Enhancement Center Jason H. King, PhD – j.king@lecutah.com Clinical Director, Life Enhancement Center Unmasking Male Depression: Understanding and Treating Adolescents and Adults UVU 2013 Mental Health Symposium: Focus on Depression

2. perspectives

3. DSM 5 • No more “Mood Disorders” Category • Bipolar Disorders • Depressive Disorders • No more “Dysthymia” • Chronic Depressive Disorder • Disruptive Mood Deregulation Disorder (DMDD) • Ages 6-18 • 3+ times per week for 12 months of verbal rages or physical aggression • Underserved children who are often misdiagnosed as having Pediatric Bipolar NOS • They do not show the same characteristics of individuals with classic bipolar disorder (ex: episodic grandiosity/elevated mood/manic episodes) • Have developmentally inappropriate and significant difficulties • The normal and expected response to an event involving significant loss (e.g, bereavement, financial ruin, natural disaster), including feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss, may resemble a depressive episode. • The presence of symptoms such as feelings of worthlessness, suicidal ideas (as distinct from wanting to join a deceased loved one), psychomotor retardation, and severe impairment of overall function suggest the presence of a Major Depressive Episode in addition to the normal response to a significant loss.

4. Lifespan of Male depression • 12-17 years, peer social development, parental differentiation, and academic performance • 18-30, the beginning of work life and college years • 30-55, the middle years of career and family life • 55+, and later life

5. Why?

6. The Mask

7. Latest research

8. Inside male depression • “And I didn’t see him as a father because he just was totally hopelessness, withdrawn. He was physically a person that was in the room, but there was no conversation there; there was no involvement. To me I really thought he didn’t care or he just didn’t love us or didn’t love us enough.”

9. Inside male depression • “My son was not under treatment for depression and he had not been diagnosed with depression. But ironically he did leave a suicide note. And in his note he talked about not being happy. And we were not aware that he was that unhappy. I guess any death is painful but to see this kind of death is just something I see over and over again in my mind. Because my daughter and my wife and I found my son and he had shot himself. And that’s a scene that just won’t go away.”

10. Inside male depression • “I’m in the height of my career. Things ought to be great. They ought to be wonderful. And yet, I’m miserable. I went through that beat up period, you know, hated myself. And so you try and fight through it. But then by sometimes by doing that, you just end up getting like deeper and deeper down. Then you almost give up.”

11. Inside male depression • “People just felt like I was ready to snap. I remember being a teenager and tearing apart my room. I remember people saying, “Why are you so angry?”

12. Inside male depression • “I’d always felt like I was walking on eggshells. Was he going to be Mr. Wonderful? Or was he going to be a bear? You know, I’m out of here. I can’t take it anymore. You’re driving me crazy. In desperation, I was saying, David, we’ve got to do something. This is just out of control.”

13. Inside male depression • “I think alcohol and depression go together. It got to the point where I would look for different substances that would take me away from the depression.”

14. Outside male depression • Pain • Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

15. Outside male depression • Risk Taking • Sometimes depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

16. Outside male depression • Anger • Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

17. Learned helplessness • Dr. Seligman’s research

18. Youth externalization • School • Work • Family • Friends • Stealing • Lying • Fighting • Destructiveness • Hostile aggression

19. Further symptoms • Feeling guilty, worthless, or that you always fail • Feeling restless and/or irritable • Having no energy • Problems sleeping (not sleeping or sleeping too much) • Feeling angry or violent • Feeling like you can’t work or get things done • Using alcohol or drugs to feel better • Sexual inability • Losing interest in hobbies, work, and/or sex • Missing work, class, or appointments • Not caring about anything or feeling “blank” • Always feeling sad or nervous • Changes in appetite and/or weight • Working too much • Feeling alone • Being negative about everything • Thinking about death or suicide • Having problems focusing, remembering, or making choices

20. Further symptoms • Blames others for problems • Feels irritable • Has trouble sleeping or staying asleep • Suspicious and guarded • Overtly or covertly hostile • Attacks when feeling hurt • Overreacts, then often feels sorry later • Feels the world is set up to fail him • Restless and agitated • Believes his problems could be solved if only his _______ (spouse, co-worker, parent, friend) would treat him better) • Loses control and anger • May have sudden attacks of rage • Feelings blunted, often numb • maintains rigid boundaries; pushes others away • Feels ashamed for who he is • Frustrated if not praised enough • Denies weaknesses and doubts • Strong fear of failure needs to be “top dog” to feel safe • Uses alcohol, TV, sports, and “sex” to self-medicate • Wonders, ‘Am I being loved enough?”

21. Shoulder therapy • Ice Age 3: Manny and Diego

22. Treatment: adolescents • Family therapy • MDFT – developmental focus • (1) the youth's interpersonal functioning with parents and peers • (2) the parents' parenting practices and level of adult functioning independent of their parenting role • (3) parent-adolescent interactions in therapy sessions, and • (4) communication between family members and key social systems (e.g., school, child welfare, mental health, juvenile justice). • Interpersonal psychotherapy • Role disputes • Role transitions • Interpersonal deficits • Cognitive therapy • REBT

23. Treatment: adults • Narrative therapy • Externalization • Unique outcomes • Video example • Solution-focused therapy • Males like fast results and to solve problems • Construct a concrete vision of a preferred future for themselves • CBT • Behavioral activation • Cognitive restructuring • Functional analysis • Stress inoculation training • Psychotropics • No SSRI’s • Sexual drive, erection, and orgasm • Wellbutrin (DA and NE) • Enhances sexual functioning and libido • SNRI’s +/- • Serzone

24. conclusion • Application • Future research • Questions • Thank you