A mental disorder is a condition that affects a person’s thinking and shows in his or her feelings and behavior. The term “mental disorder” is misleading because it implies that a mental disorder is distinct from a physical disorder. In reality, many forms of mental illness arise from a physical cause, such as an imbalance in brain chemistry. In addition, the experience of a person with a mental disorder is no less real than the experience of a person with a physical disease, and it can be just as devastating.
Common mental disorders include mood disorders, anxiety disorders, sleep disorders, and psychotic disorders. They can cause a wide variety of symptoms, such as inappropriate anxiety, disturbances of thought and perception, and mood disturbances. These disorders are legitimate medical problems. They do not go away just by trying to shake off the symptoms, and they do not come about because the affected person has a character ﬂaw or weakness. Mental disorders can be triggered by stressful negative or positive life events, such as the loss of a job, a promotion, the birth of a child, or a divorce. Sometimes, however, they occur with no obvious cause, changing the person’s personality and affecting his or her work and relationships.
Many mental disorders go untreated in men because some men may not rec- ognize the symptoms of a mental disorder. Other men may feel ashamed or fear the social stigma of having a mental disorder and may be reluctant to seek help. Many men do not even know that help is available. In fact, only about 20 percent of people with mental disorders seek treatment. In addition, health insurance coverage for mental problems is often inadequate. This is unfortunate because medical science has made great advances in determining the causes of and appropriate treatment for many mental disorders. A wide range of effective treat-
ments for mental disorders is now readily available. If you think you may have a mental disorder, talk about the problem with your doctor. He or she can refer you to the proper mental health specialist so you can get the help you need.
Mood disorders, sometimes referred to as affective disorders, are a type of men- tal illness that affects a person’s mood. Everyone experiences occasional periods of sadness or euphoria (a strong sense of well-being), but people with a mood disorder feel these emotions more strongly than other people and for longer periods. About one in seven people is affected by a mood disorder each year. Possible causes include an inherited predisposition, an imbalance in brain chem- icals that regulate mood, and environmental factors—or a combination of all three. The most common mood disorders include depression, bipolar disorder (formerly known as manic depression), and seasonal affective disorder (SAD). In general, mood disorders are among the most treatable of all mental disorders.
It is normal to feel unhappy in response to a personal loss or stressful situation, but such feelings usually go away with the passage of time. Depression, on the other hand, can cause deep feelings of sadness or despair that can last for months or even years. Depressed men often feel overwhelmed by life and become emo- tionally and physically withdrawn.
Depression is a serious condition that can have profound effects on a man’s quality of life. Long-term bouts of depression can negatively affect your ability to function at work and in social situations. It can also severely limit your capac- ity to enjoy the basic pleasures of life—your family, your friends, your favorite activities, and your sex life. More than 18 million people experience depression in the United States every year. It can occur at any age but usually seems to ﬁrst appear between ages 25 and 45. Although men are only half as likely to have severe depression as are women, depressed men are four times as likely to commit suicide than depressed women (although women attempt suicide more frequently). In fact, men over age 55 have the highest risk of suicide among Americans. Untreated depression is the leading cause of suicide in the United States.
Symptoms of depression include persistent sadness or despair, insomnia, decreased appetite, irritability, apathy, withdrawal from social situations, loss of energy, poor self-esteem, feelings of hopelessness or helplessness, an inability to enjoy former interests, a decreased interest in sex, and suicidal thoughts. Depres- sion also can cause you to lose interest in your appearance. The tone of your voice may be dull and ﬂat and your pattern of speech monotonous. Frequent bouts of crying, often with no apparent cause, are common.
Depression is the number one risk factor for suicide. In fact, 70 percent of all people who commit suicide are depressed. Although men attempt suicide only a third as
often as do women, men are more likely to be successful in the attempt. The highest sui- cide rates are for men over age 85, but suicide also is the third leading cause of death among younger men aged 15 to 24 years. Married men are less likely to attempt or com- mit suicide than are separated, divorced, or widowed men. Facing adverse life events, such as ﬁnancial loss, can alter the chemistry in the brain, increasing the risk for suicide, espe- cially if the person already has an emotional disorder or is abusing drugs or alcohol. Risk factors for suicide include a family history of an emotional disorder, substance abuse, sui- cide, or physical or sexual abuse; a prior suicide attempt; having a gun in the home; imprisonment; impulsive behavior; and exposure to the suicidal behavior of others (espe- cially for teens or young men).
A suicide attempt—or even talking about suicide—should never be dismissed as a mere attention-getting ploy. Attempted suicide is always a cry for help from a person who is usually battling some type of emotional disorder, such as depression, or a substance abuse problem. Most people with depression or substance abuse can be treated success- fully and go on to lead healthy lives. If someone you know begins talking about or threat- ening to commit suicide, take the person seriously and try to get him or her to see a doctor, or call a suicide hot line. A suicide attempt is often preceded by certain telltale warning signs, such as:
• talking about suicide or death, even jokingly
• difﬁculty dealing with the loss of a loved one or some other adverse life event
• withdrawal from friends and activities
• hoarding of pills or purchase of a gun
• abuse of drugs or alcohol
• giving away prized possessions
• a previous suicide attempt
• writing notes or poems about death
• changes in eating or sleeping habits
• neglect of personal appearance
The best way to prevent a suicide attempt is to get professional help for an emotional disorder or substance-abuse problem. Recognition of depression in older men can go a long way toward preventing suicide, especially if they are living alone. Limiting access to guns, especially in combination with treatment of an emotional disorder, also is an effec- tive way to prevent suicide attempts in high-risk men. If someone you know is in imme- diate danger, call 911 or your local emergency number.
Some people have a recurrent but less severe form of depression, called dys- thymia. Dysthymia is diagnosed when a depressed mood persists for at least 2 years and is accompanied by at least two other symptoms of depression. People with this milder form of depression are susceptible to periodic episodes of major depression.
Doctors think that a number of factors may combine to cause depression. A deﬁcit in certain brain chemicals—particularly serotonin and norepinephrine— seems to cause the anxiety, irritability, and fatigue often experienced in the dis- order. A family history of depression also can increase your chances of having the disorder. Certain environmental factors—such as exposure to violence or emotional or physical abuse—also seem to have a role. People who have low self-esteem or a pessimistic outlook seem to be more susceptible to depression than those who are more self-conﬁdent and optimistic.
The good news is that depression responds very well to treatment, even in people who have had the disorder for many years. Up to 90 percent of depressed people who receive treatment experience a reversal of their symptoms. If you have symptoms of depression, your primary care doctor probably will refer you to a psychiatrist (a doctor who specializes in treating mental disorders) for treat- ment. Before he or she prescribes any form of treatment, the psychiatrist will request that your primary care doctor perform a complete physical examination. If these evaluations reveal no physical cause for your symptoms, your psychia- trist will then conduct a psychological evaluation.
Doctors usually treat depression with antidepressant medication, often com- bined with psychotherapy or psychological counseling. The purpose of drug treat- ment is to correct any imbalance in brain chemistry. The most common drugs prescribed to treat depression are selective serotonin reuptake inhibitors (such as ﬂuoxetine, ﬂuvoxamine, and paroxetine) and tricyclic antidepressants (such as amitriptyline, desipramine, and nortriptyline). These drugs are not tranquilizers or sedatives and are not addictive. Antidepressant medications can improve the symptoms of depression in 4 to 6 weeks, although the person needs to continue taking them for at least 5 months (usually longer) after symptoms improve.
Psychotherapy may be recommended for an individual or a family, or in a group setting with other people who are experiencing depression. Individual psychotherapy takes place in the ofﬁce of a psychiatrist or psychologist, in reg- ularly scheduled 30- to 45-minute sessions. The goal of psychotherapy is to relieve the person’s distressing symptoms so that he or she can resume a normal routine. There are different types of psychotherapy. One type involves helping the person understand unconscious and unresolved conﬂicts. Another empha- sizes changing negative patterns of thinking. A third attempts to replace ineffec- tive behaviors with more positive constructive behaviors. Ask your therapist which type he or she recommends and why. Treatment can last several weeks, months, or years, depending on the severity of the depression.
In extreme cases of severe depression, a psychiatrist may admit the person to the psychiatric unit of a hospital for full, 24-hour care. The doctor will develop a treatment plan, which will be carried out by a team of mental health profes- sionals that includes the psychiatrist, psychiatric nurses, a clinical psycholo- gist, a social worker, rehabilitation therapists, and an addiction counselor, if needed. The treatment plan usually includes individual, group, or family ther- apy, along with medication. The person usually remains hospitalized for about
6 to 12 days.
Bipolar disorder, in which periods of deep depression alternate with episodes of euphoria or mania, affects about 1 percent of Americans. The disorder’s wide mood swings continue indeﬁnitely, interrupted by periods of remission or nor- mal mood. The depressed phase produces typical symptoms of depression, such as sadness or despair, loss of interest in favorite activities, fatigue, and thoughts of suicide (see page 346). During the manic phase, affected people experience persistently elevated mood and energy, delusions of grandeur, feelings of invin- cibility, unrealistically high self-esteem, agitated movement, talkativeness, abra- sive and rapid speech, racing thoughts and distractibility, poor judgment, poor impulse control, and a decreased need for sleep. Some people in the manic phase also go on unrestrained buying sprees or have impulsive, indiscreet sexual encounters. Extreme mania can lead to delirium (mental confusion) or paranoia (excessive or irrational suspiciousness). Manic states can last for days, weeks, or months and may begin gradually or suddenly. They are followed by a period of normal mood or by an episode of depression. Initial episodes of mania fre- quently occur between ages 15 and 25.
Bipolar disorder affects an equal number of men and women. It tends to run in families; up to 90 percent of those affected have a relative with either bipolar disorder or depression. The illness also has been linked to both an imbalance in brain chemistry and a deﬁciency in the production of certain hormones (sub- stances produced by the body that control key bodily functions). The severe mood swings characteristic of the disorder can seriously affect a person’s life, upsetting personal relationships and disrupting routines at work. Although everyday occurrences can trigger a manic episode, dates that have signiﬁcant meaning for the person, such as the anniversary of a parent’s death, are espe- cially likely to trigger one.
Like depression (see page 345), bipolar disorder is readily treatable, but because the affected person feels so elated and invincible, he or she may dismiss the need for treatment or refuse to comply with prescribed treatment. Medica- tions that are most commonly used to treat bipolar disorder include mood stabi- lizers (such as lithium), antidepressants (such as ﬂuoxetine or bupropion), and antipsychotic drugs (such as haloperidol), often in combination. The hallmark
mood stabilizer for bipolar disorder is lithium carbonate, a naturally occurring mineral salt. Lithium controls the manic phase of bipolar disorder by affecting the central nervous system’s control over emotion. Its effectiveness depends on the amount of the drug in the bloodstream, so lithium must be taken exactly as prescribed. A blood test can be performed to ensure a therapeutic level. For peo- ple who do not respond well to lithium, doctors may use other mood stabilizers, such as divalproex sodium or carbamazepine. Most mood stabilizers produce side effects, including weight gain, thirst, hand tremors, and muscle weakness.
Doctors may prescribe antidepressants during the depressive phase of bipolar disorder, but they usually instruct the person to resume taking a mood stabilizer once the depressive phase has ended. Antipsychotic drugs are used predomi- nantly for people whose manic phase has escalated into a psychotic episode (loss of awareness of reality).
Psychotherapy, also called talk therapy, can boost the effectiveness of the drugs used to treat bipolar disorder by helping those with the illness learn how to become more aware of their symptoms, deal with stressful life events, and com- ply with drug treatment. This kind of therapy works best when the therapist is experienced in treating bipolar disorder. Because families also are affected by the disorder, family members may be offered counseling to help strengthen rela- tionships that have been strained by the illness. People with very severe cases of bipolar disorder may need hospitalization or, in extreme cases, electroconvul- sive therapy, in which a current of electricity is passed through the brain to induce seizures. This treatment may be highly effective within a few weeks (usu- ally three treatments per week). Memory loss may occur, but the memory returns within a few months.
Seasonal Affective Disorder
Seasonal affective disorder (SAD) is a type of mood disorder that brings on depression when the seasons change. The most common type of SAD is known as winter depression, which usually starts in the late fall or early winter and ends in spring. Many people without SAD feel “blue” and more fatigued when the days get shorter. However, people with winter depression experience true depression, along with symptoms that are not typical of a depressive disorder, including excessive sleeping, increased appetite, a craving for high-carbohydrate foods, irritability, and weight gain. A smaller number of people experience another form of the disorder known as summer depression, which usually begins in late spring or early summer. Signs of summer depression include the more typical depressive symptoms of decreased appetite, weight loss, and sleepless- ness. The cause of summer depression is not known. Both forms of SAD seem to recur at the same time each year. SAD can occur along with a bipolar disorder (see previous page) or depression (see page 345). Women are affected by SAD four times as often as men.
Doctors think that winter depression may be brought on by the reduction in the amount of sunlight that occurs during the winter months. A good argument for this theory is that SAD is more common in people living in the northern lat- itudes than in those living farther south. In addition, artiﬁcial, bright-light ther- apy, also known as phototherapy, is very effective in treating winter depression. In a typical phototherapy session, people with the disorder sit in front of a desk- top light box or wear a light visor, initially for 10 to 15 minutes per day, increas- ing to 30 to 45 minutes per day. Beneﬁts may not be seen for several days to several weeks. It is important to continue phototherapy until spring, when the person can obtain increased natural light from the sun. Phototherapy appears to have few side effects, although some people may experience headaches, fatigue, irritability, and insomnia if they take light therapy too late in the day. These side effects can be reduced by sitting farther from the light source or by decreasing the length of the phototherapy sessions.
Tanning beds are not recommended for the treatment of winter depression because they emit high levels of ultraviolet rays, which are harmful to the eyes and the skin. Phototherapy is often combined with drug therapy or psychother- apy to treat winter depression. The drug of choice for this type of SAD is called a monoamine oxidase inhibitor (such as isocarboxazid or phenelzine).
Doctors treat summer depression differently than the winter form of SAD. Summer depression responds better to the antidepressants usually prescribed for nonseasonal depression (see page 345).