Depression in older men

Posted by Agatha Cheng

Depression is on the increase in the UK, in particular among men, but what are the causes and what are the symptoms? studies have estimated that between 5% and 10% of the population are affected at any time by depression to the extent that it has an adverse impact on their lifestyle. The lifetime prevalence rate is between 1 in 4 and 1 in 6 of the entire population. A number of factors are thought to be responsible, not least of which is the current level of stress in the workplace and the pace at which we live our lives today. It is an indisputable fact that stress and depression go hand in hand.

Amongst the key symptoms of depression are a loss of interest in life and surroundings, a loss of libido and a tendency to become introverted and isolated from family and friends. Relationship difficulties may then arise between the sufferer and his partner. In addition to all his other problems, the male with depression often experiences erectile dysfunction. This condition carries an even greater taboo than depression and is something no male will readily admit to. Because of the problem, the man may avoid close contact with his partner and what was previously a close and loving relationship begins to disintegrate. The partner may, quite reasonably, become suspicious that she has a rival for her partner's attentions. Alternatively, she may conclude that she is no longer attractive or desirable, or that she has failed as a wife. Such factors merely serve to undermine the relationship further and with the husband failing to appreciate what is happening, the downward spiral of the relationship may result in its total disintegration.

Conversely, erectile dysfunction can lead to depression, anxiety, loss of self-esteem, hopelessness and loss of confidence. The combination of depression with erectile dysfunction destroys the male macho image completely. This has important psychological implications for men. Sexual dysfunction is the most avoided topic between doctor and patient. Progress has been made in recent years but men are still notoriously bad at expressing their feelings and doctors, often by their very manner, phraseology or body language, suggest to patients that they are uncomfortable discussing this subject. All too frequently, a male patient with depression or sexual dysfunction will, under pressure from their partner, consult the GP but fail to address the true symptoms. As a result, the patient leaves the surgery with a wholly inappropriate treatment for their condition. This represents a huge waste of resources. Unfortunately men are sometimes correctly diagnosed and prescribed a course of antidepressants but are not informed that they may suffer erectile difficulties as a result of the medication.

Often the legacy of sexual dysfunction remains in the form of lack of sexual confidence. Sex has been likened to riding a bicycle. Once learnt, it is never forgotten. Yet this has all to do with confidence in one's ability. What if that confidence has been destroyed? If one continually falls off the bicycle, the natural inclination will be to give up cycling. The same is true with erectile dysfunction. It has much to do with psychological confidence that will have been shattered by recent experiences. Hence, there is the very real danger that the patient will not be fully recovered and that erectile dysfunction will persist, leading to loss of confidence, low self-esteem and a sense of worthlessness. This will most likely encourage the return of depression with the inherent risk that it will be more severe than previously.

The interaction between depression and sexual problems is an area that requires more research, more education and more publicity. We urgently need to develop a sympathetic, understanding and non-judgemental society where such matters can be discussed openly and frankly. The answer lies in publicising just how common both conditions are and creating an environment where it is all right to talk about either condition in the same way one does today about the common cold or arthritis. At the end of the day, they are recognised and legitimate medical conditions that merit treatment with the most modern and effective medicines available.

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