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The Black Dog of

Depression: Is there a
His and Her Breed?

Read this article if:

• You’re suffering from depression

• You think you’re suffering from it
• You want to know how men and women exhibit different

“Make your own recovery the first priority in your life." Robin

Depression is a term which is bandied about far too often, but it

is a serious condition which causes untold suffering. But men
and women seem to ‘carry’ the symptoms in a different way.
Jed Diamond is carrying out research to understand the
differences between the ways men and women experience
depression, and here he explains some of his initial thoughts.

The "Black Dog" was Winston Churchill’s name for his depression,
and as is true with all metaphors, it speaks volumes. The nickname
implies both familiarity and an attempt at mastery. Those of us who
have suffered from depression know well how it can sink its fangs into
us when least expect. As we live with it and become familiar with the
ways of depression, it can also seem like an old friend, hard to live
with, but never-the-less, a friend. Both my wife and I have had to
come to terms with the Black Dog in our lives. Yet her Dog and mine
often act very differently. My Black Dog is often irritable and angry.
Hers is more likely to be preoccupied and obsessive.

What we call depression has likely been around before recorded

history and has been recognized for thousands of years. Aretaeus of
Cappadocia (circa 81-138 AD) is credited with the first clinical
description of depression. Hippocrates, the Greek physician of
antiquity, was well aware of the disease of depression and called it

Although there are many physical symptoms, depression is

considered a disorder of mood. It is also called an affective disorder
to signify that one of the key aspects is a disturbance of emotions or
feelings. Almost 20% of adults will have a mood disorder requiring
treatment during their lifetime, and about 8% of adults will have a
major depressive disorder during their lives. Depression is the
leading cause of disability and premature death among people aged
18 to 44 years, and it is expected to be the second leading cause of
disability for people of all ages by 2020.

The term depression describes a spectrum of mood disturbance

ranging from mild to severe and from transient to persistent. The
diagnosis depends on the presence of two cardinal symptoms: 1.
Persistent and pervasive low mood and 2. Loss of interest or
pleasure in usual activities. However, I believe that many men and
women experience depression in different ways.

Men and Depression:

When I would become depressed, I didn’t really have a persistent

“low mood” as much as I had an angry and irritable mood. I felt
“pissy” all the time and frustrated. It seemed like nothing would go
right for me and I was angry. Usually my anger was “acted out” and
directed at someone else. Often it was my wife. This externalizing of
pain, is characteristic of many men. Two men who came out directly
and discussed their depression are Bill Maruyama and Patrick
"When I was feeling depressed I was very reckless with my life. I
didn’t care about how I drove, I didn’t care about walking across the
street carefully, I didn’t care about dangerous parts of the city. I
wouldn’t be affected by any kinds of warnings on travel or places to
go. I didn’t care. I didn’t care whether I lived or died and so I was
going to do whatever I wanted whenever I wanted. And when you
take those kinds of chances, you have a greater likelihood of dying."
-Bill Maruyama, Lawyer.

"I’d drink and I’d just get numb. I’d get numb to try to numb my
head. I mean, we’re talking many, many beers to get to that state
where you could shut your head off, but then you wake up the next
day and it’s still there. Because you have to deal with it, it doesn’t just
go away. It isn’t a two-hour movie and then at the end it goes ‘The
End’ and you press off. I mean it’s a twenty-four hour a day movie
and you’re thinking there is no end. It’s horrible."
-Patrick McCathern, First Sergeant, U.S. Air Force, Retired

Dr. Ron Kessler, a professor of health care policy at Harvard,

describes depression in men this way. "When you study depression
among children, they don’t talk about being sad, they talk about being
angry and irritable," he said. "Children don’t have the cognitive
capacity to make sense of all their feelings. There’s a great similarity
between children and men. Men get irritable; women get sad."

Women and Depression:

When my wife would get depressed she would seem distracted and
sad. When I’d ask her what was going on, she would describe a
myriad of thoughts that would be going through her head. I couldn’t
believe how much she chewed on real and imagined shortcomings.
She would go over and over ways she felt she had not been a good
mother or wife or daughter. Although she is multi-talented and good
at what she does, she would become preoccupied with all the ways
she would fall short of her goals. Where most people would look at
her many talents as an asset, when she became depressed she
would see them as inadequacies. She believed that she hadn’t done
anything important and had only skimmed the surface of her
Psychologist Susan Nolen-Hoeksema interviewed 1,328 adults (631
males, 697 females) ages 25–75. Participants were asked how
depressed they felt, and what they found themselves doing when
their mood was low. Specifically, they were given a test to measure
their tendency to “ruminate,” or stew about how bad they felt and
what they were doing to deserve to feel this bad. Participants also
were asked about problems they had experienced as a result of
alcohol dependence or abuse, including losing a job or an important
relationship. In addition, they were asked about the extent to which
they drank to cope with negative feelings, to help themselves feel
better and to deal with stress.

“I have found that women’s tendency to ruminate more than men is

tied to their lack of power and the stresses that come with this lack of
power in society,” says Nolen-Hoeksema. “In addition, women’s
stronger emotional ties to others, compared to men’s, may contribute
to their tendency to ruminate.”

When Depressed, Women Think Too Much, Men Drink Too Much
(But Not Always)

Nolen-Hoeksema found that while women tend to over-think and

ruminate when they are depressed, men tend to “act out” their pain.
They often drink to escape their feelings of hopelessness and
helplessness. “But some men are ruminators and some women drink
to cope,” she adds, “and for both men and women, rumination and
drinking to cope are related.” In other words, people who do one are
at increased risk of doing the other.

While alcohol may temporarily do an effective job of dampening

rumination for men, Nolen-Hoeksema suggests that it seems to fuel
rumination in women. Instead of quelling women’s worries, using
alcohol to cope with distress just gives them one more thing to worry
about, she speculates.
The Depressed Brain in Men and Women: The Experiment That
Made Me Go WOW!

One of the most interesting and intriguing experiments on gender

differences in depression was conducted by J. Douglas Bremner,
M.D., director of mental health research at the Atlanta Veterans
Administration Medical Center and author of the book, Does Stress
Damage the Brain? He gathered a group of former depression
patients. With their permission, he gave them a beverage that was
spiked with an amino acid that blocks the brain’s ability to absorb
serotonin, the neurotransmitter that allows us to feel upbeat and

What I found fascinating were the gender specific differences in the

way men and women reacted to the potion that blocked the effects of
the serotonin. Typical of the males was John, a middle-aged
businessman who had fully recovered from a bout of depression,
thanks to a combination of psychotherapy and Prozac. Within
minutes of drinking the brew, however, "He wanted to escape to a bar
across the street," recalls Bremner. "He didn’t express sadness … he
didn’t really express anything. He just wanted to go to Larry’s

Contrast John’s response with that of female subjects like Sue, a

mother of two in her mid-thirties. After taking the cocktail, "She began
to cry and express her sadness over the loss of her father two years
ago," recalls Bremner. "She was overwhelmed by her emotions."

Although most depressed men tend to “act out” their unhappiness

through anger or alcohol, around 10% are prone to “acting in.” They
think, ruminate, and feel sad. Most depressed women tend to “act in”
their unhappiness, about 10% of them use the more traditional male
style of acting out. I’ve found some men and women who go back
and forth between both styles.

If you’ve been depressed what has been your pattern? If you’ve lived
with someone who has been depressed, how did they express their
depression? I’m currently conducting research to better understand
the differences between the ways men and women experience
depression. If you’d like to participate or would like more information
about this important area of gender-specific medicine, drop me a note
at Jed@MenAlive.com

Jed Diamond is the author of Male Menopause and The Irritable

Male Syndrome.
www.MenAlive.com and www.TheIrritableMale.com.

Jed Diamond, Ph.D. has been a health-care professional for the last
45 years. He is the author of 9 books, including Looking for Love in
All the Wrong Places, Male Menopause, The Irritable Male
Syndrome, and Mr. Mean: Saving Your Relationship from the
Irritable Male Syndrome . He offers counseling to men, women, and
couples in his office in California or by phone with people throughout
the U.S. and around the world. To receive a Free E-book on Men’s
Health and a free subscription to Jed’s e-newsletter go to
www.MenAlive.com. If you enjoy my articles, please subscribe. I
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