Depression in men differs from depression in women in a number of significant and subtle ways.  Biological factors long recognized as important in women also play a role in the onset and treatment course for Major Depressive Disorder (MDD) in men.

Neuroimagery studies have analyzed volumetric changes in the brain, bioassay findings on tryptophan metabolism, and genetic research examining 5HT transporter genes and CREB-1 polymorphisms. They have revealed  gender differences  which  may  be associated with risk for or protection from MDD. Age related decline in testosterone has also been associated with increased risk for MDD for men.

A number of psychosocial factors also influence MDD in men.

  • Men tend to be more hesitant to seek treatment and, therefore, fewer men with MDD may be diagnosed and treated.
  • Stressful life events such as job loss, financial problems, and separation or divorce may precipitate MDD in men.
  • When men do go for help, they often report fewer symptoms. Some researchers have noted increased likelihood of men to show alexithymia (inability to verbalize emotional experiences).
  • Their presenting symptoms are frequently from the typical or ”pure” subset of depressive symptoms.

A recent large study of depression (STAR*D) showed a statistically significant difference in age of onset with men averaging 26.5 years vs. women at 24.3 years. Men have been found to have 4 times the risk of completed suicide as women.  Risk factors associated with male suicide include alcohol and substance abuse, older age (men over 85 have 12x risk of suicide), and a choice of more lethal methods.

Depression in men is complicated by a higher rate of premorbid or concurrent psychiatric illness (69.3% vs. 57.5% for women).  Comorbid alcohol or substance abuse is far more common in men than women, and each masks and complicates successful MDD treatment.

The unique aspects of depression in men may often be overlooked but the condition is no less debilitating and may have far greater lethality.