Over at ironshrink.com, my Q&A blog, Sean asked what he can do to prevent another seasonal mood change this fall. Having suffered through low mood during recent winters, he surmised that he has developed Seasonal Affective Disorder. The condition usually brings hopelessness, feelings of worthlessness, and other typical depressive symptoms.
But Sean wasn't endorsing that variety of symptom. Instead, he reported becoming uncharacteristically "irritable, fractious, melancholy, and generally about as pleasant as a plowed-up snake from about mid-November until at least mid-May." While he reported mild sadness, his main complaint was grouchiness.
Mood problems don't always resemble stereotypical depression, especially in men. That may be why women are diagnosed with depression at about twice the rate. Sarah Romans and Rose Clarkson (2008) found that while crying is a diagnostic criteria in most depression inventories, men tend not to cry when they are depressed. Because of that, depression inventories appear to be less able to detect male depression. (Men also tend to underreport depression. When we factor out these two considerations, rates of depression are about equal between the genders.)
So what do men do when they get depressed? Many of them become irritable or angry. Lisa Ann Martin (2010) found that depressed men report higher rates of anger attacks, substance use, risk-taking behavior, and that they tend more than women to cope with their depression through destructive outlets.
The Diagnostic and Statistical Manual of Mental Disorders gives relatively short shrift to nonstandard symptoms of depression. Some researchers have argued for the inclusion of specific subtypes of depression, including Agitated Depression (Schenk 2009) and Irritable-Hostile Depression (Benazzi & Akiskal 2005).
While a lack of research makes it difficult to pinpoint the prevalence of irritability, it's been my clinical experience that depressed men are prone to it. Whether it's brought about by seasonal mood changes, hormonal changes, as a by-product of alcohol use, or any other source of depression, men are simply likelier than women to manifest their pain by way of a rough and contentious exterior.
Unfortunately, irritability is deceiving. We can lose sight of the fact that someone who is acting like a knucklehead might actually be suffering, and it's tough to be empathetic when we're on the defensive against churlish behavior.
For that reason, depressed men are frequently misdiagnosed, for example with anger-management problems. A clinician has to be on his or her toes to identify and treat the real issue.
The good news is that there are ample behavioral interventions that can make life more pleasant for all concerned. Failing that, one can always turn to medication. You can go here to read my recommendations for Sean's seasonal mood problems.
I'd like to close on a personal note to fellow men: Life is too short to spend our precious time in pain and treating our loved ones poorly. There's no excuse for it when there are solutions to the problem. If you need help, do the right thing and get it. You will be glad you did.
Benazzi, F. & Akiskal, H. (2005). Irritable-hostile depression: further validation as a bipolar depressive mixed state. Journal of Affective Disorders, 84, 197-207.
Martin, L.A. (2010). Challenging depression criteria: An exploration of men's experiences of depression. Dissertation Abstracts International: Section B: The Sciences and Engineering, 71(5-B), 3004.
Romans, S.E., & Clarkson, R.F. (2008). Crying as a gendered indicator of depression. Journal of Nervous and Mental Disease, 196(3), 237-243.
Schenk, C.D. (2009). Mixed Depression: The importance of rediscovering subtypes of mixed mood states. American Journal of Psychiatry, 166, 127-130.
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Dr. Smith is a psychologist in Denver, Colorado and the author of The User's Guide to the Human Mind: Why Our Brains Make Us Unhappy, Anxious, and Neurotic and What We Can Do about It. You can read the introduction and find other goodies at guidetothemind.com.