Not so long ago, I had to approach a friend to discuss what appeared to me to be a battle with depression. It was clear to me that this debilitating disorder was affecting both him and the people around him, and that some type of loving intervention was needed. But wow, was this a nerve-wracking conversation to have. And I’m a therapist!
Part of the difficulty was that my friend’s symptoms were more about impatience, irritability, and anger than the behaviors we typically associate with depression, such as crying, moping, and an inability to get started with any task, because everything seems so daunting. And this is often a reason why depression in men can be more difficult to identify than depression in women. Depressed women tend to “act in” (sleeping too much, crying, overeating, drinking too much, failing to fully function, etc.), while depressed men tend to “act out” with unpleasant behaviors. So a depressed woman might be more likely to look and act depressed, while a depressed man might just seem like he’s being a jerk.
Yes, plenty of men do get depressed with tears and an inability to function, and plenty of women express anger and rage when they’re depressed, but as a general rule, depressed women are more obvious about what they’re feeling, while men just seem unhappy and angry. And that’s what I was experiencing with my friend—a great guy for many years who slowly but steadily became incredibly unpleasant over the course of a year. I know this individual well and felt certain that he was acting out not because he’s a jerk, but because he was depressed, so I decided to share this with him. But still, this was not an easy thing to do.
- What if I’m wrong and he really isn’t depressed?
- What if he gets angry with me for my “accusation”?
- What if trying to intervene costs me an important friendship?
And then I worried the opposite:
- What if I’m right, and I don’t say something, and he never gets help?
- What if he desperately needs to know that someone cares enough to say something?
- What if I don’t intervene, and I lose an important friendship to suicide?
So yeah, when a person in your life is showing signs of depression, you’ve got a tough decision to make. Do you take the seemingly easy path and hope things will run their course, or do you step up and try to help? The answer, if you’re wondering, is that you absolutely must step up and help.
In many respects, intervening with depression is like intervening with an addiction. First and foremost, you should know that depressed people, especially men, can be deeply in denial about their problem and the negative impact it’s having on them and the people around them. They may actually have no conscious knowledge that they look and act depressed. And even if they are consciously aware, they may craft a web of lies that they tell themselves (and others) about why they seem to be struggling. Often, they blame other people, especially those closest to them, for their ongoing bad mood.
This, of course, can make attempts to help them difficult at best. But there are ways to intervene successfully.
Know What You Are Dealing With
First and foremost, you must understand the nature of depression, including the signs and symptoms. As stated above, depression can manifest differently in men and women. In general, however, the warning signs are as follows:
- Expressing a negative or a hopeless outlook.
- Losing interest in previously enjoyable hobbies and activities.
- Social and emotional isolation.
- Sleeping too much or too little.
- Eating too much or too little or poorly (junk food).
- Expressing shame, guilt, and feelings of worthlessness.
- Talking about death or suicide (even in passing).
- Sudden bursts of irritability, agitation, anger, rage, etc.
- Blaming others for personal problems.
- Feeling trapped.
- Unexplained pain and/or physical malaise.
- Feeling like a burden.
- Increased use of alcohol, drugs, or a compulsive behavior (porn, sex, gambling, spending, etc.)
- Extreme mood swings.
If you see more than one or two of these warning signs on a consistent basis in a man you care about, you need to initiate a conversation about depression. If you’re uncomfortable having this conversation one-on-one, speak with his family and friends and ask them to assist.
You can’t help a struggling man if you don’t speak up. If you stay silent, the depression will continue, perhaps indefinitely, or until he eventually commits suicide. So you must initiate a conversation, however difficult and anxiety-inducing that might be.
The best way to go about this is to use the “addiction intervention” model of telling him that you love him and care about him, and that you are worried for his safety and well-being. Next, you can say that you think he is suffering from depression. Then you should list the signs of depression that you have seen him exhibit. If you’re worried about suicide, be direct. Ask him, “Are you thinking about killing yourself?”
Be prepared for any response—anger, fear, crying, resignation, desperation, and just about any other emotion you can think of. Whatever the response, be willing to sit there and let him get it out. Listen with patience and compassion. Make sure he knows you care and want to help. Do not leave until you feel certain he is not a danger to himself or anyone else.
Most of all, you need to let him know that help is available, so he doesn’t have to always feel this way. Ideally, you will steer him to both a medical doctor and a certified psychotherapist who specializes in depression and related issues. Clergy members can also help, as can friends, family, and support groups for men dealing with depression.
If he is willing to listen, you can educate him about treatments for depression, which include:
- Individual therapy, where he can explore thoughts, feelings, and behaviors, and develop coping skills to help manage depression.
- Group therapy, with the same basic goals as individual therapy, but with added support from others who are also fighting depression.
- Medications (antidepressants and mood stabilizers) can help a depressed individual manage the symptoms (though they don’t “cure” depression).
- Support groups for men with depression provide confidential spaces for depressed men to share openly and honestly and to support one another.
- Eating healthier, developing healthy sleep habits, and exercising regularly are helpful in combatting depression.
If a depressed man says that he is suicidal, you need to immediately call 911 or take him to the nearest emergency room. You can also reach out to the National Suicide Prevention Lifeline. The site offers a free, 24-hour suicide prevention hotline, which can be reached at 1-800-273-8255. This is a nationwide service. The website offers a wide variety of resources.
To help a depressed man locate a therapist in his area, connect him to the Psychology Today Therapy Directory.
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Resources you can share with a depressed man include:
American Foundation for Suicide Prevention: This site provides information on finding support for people at risk of suicide.
American Psychological Association: This site offers, among other things, the latest information about depression, anxiety, and related conditions.
American Psychiatric Association: This is the professional organization for psychiatrists, with links to resources about mental health problems, information about medications, and more.
Anxiety and Depression Association of America: This site offers facts about depression and its symptoms, plus information on finding treatment, getting support, and more.
Brain and Behavior Research Foundation: This site offers, among other things, information about depression, anxiety, and related conditions.
Crisis Text Line: Anyone in an immediate mental health crisis can text a specialist with this service, 24/7/365. Text HOME to 741741 to speak to a trained crisis counselor.
Depression and Bipolar Support Alliance: This is a self-help organization for depression, anxiety, and bipolar disorder.
Drug News: Information about prescription medications, warnings about products, patient stories, and possible side effects.
Mental Health America: This is a mental health nonprofit with information about various disorders and a large list of resources.
National Association of Mental Illness: Provides education and support about mental health disorders, including depression.
National Center for Complementary and Integrative Health: Provides information about medications and alternative and holistic therapies, including herbs and supplements.
National Institute of Mental Health: The largest mental health organization in the world, NIMH offers detailed information on depression and related disorders.
For specific information about healthfully helping a troubled man, I recommend my book, Prodependence: Moving Beyond Codependency. It's written primarily for family members of addicts, but the principles apply equally to depression.