Depression and Suicide in Men What You Need to Know

Depression and Suicide in Men

The statistics of mental health disorders are alarming. In 2015, 300 million cases of depression were registered worldwide. Unfortunately, depression is also strongly linked to suicide, acts of self-harm and even crimes during episodes of acute psychosis.  It is estimated that around 800,000 people commit suicide every year (WHO, 2017).

Suicide: Why Men?

Males are more at risk of committing suicide than women, study finds. A study with over 5,000 participants concluded that there was a statistically significant link between serious suicide acts and the male gender (Freeman et al., 2017).

Signs and Symptoms of Depression

The clinical presentation of depression can vary from person to person. The usual symptoms reported by patients are:

• Feelings of sadness and guilt
• Social withdrawal
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Suicidal thoughts or thoughts of self-harm

Sometimes depression can present with psychotic symptoms, which clinicians refer to as psychotic depression. Symptoms of psychotic depression include:

• Hallucinations
• Delusions

How Do Clinicians Diagnose Depression?

Clinicians use either the ICD-10 or DSM-V criteria to confirm a diagnosis.

Important Tests Your Doctor Will Request

• Thyroid Function Tests
• Liver Function Tests
• Renal Function Tests
  
  

Management

The current treatment regimen according to the severity of depression:

• Mild depression: Psychological interventions like sleep hygiene, problem-solving techniques and Cognitive Behavioral Therapy (CBT)
• Moderate depression: First line antidepressants (usually a Selective Serotonin Reuptake inhibitor, SSRI) in combination with Cognitive Behavioral Therapy
• Severe depression: Adding or changing the class of antidepressants. Severe depression can also be associated with psychotic symptoms. Thus, antipsychotics are usually added.

Tips to Cope with Depression

• Be Active

Keeping yourself active throughout the day can prevent you from ruminating. When your body is engaged physically, all your focus is brought to what you are doing at the current moment. Besides, exercise has been clinically proven to release the body’s happiness boosters known as endorphins.

• The National Institute for Health and Care Excellence (NICE) recommends 3 sessions of at least 45 minutes of exercise daily.

• Try Relaxation Techniques
  Several studies have proved that relaxation techniques confer significant benefits in the treatment of depression. The techniques that showed the greatest positive effects include:
  • Progressive muscle relaxation training
  • Music intervention
  • Yoga

(Klainin-Yobas et al., 2015).

• Practice Good Sleep Hygiene

Good sleep hygiene is of utmost importance to optimize the quality of your sleep. Sleep optimization strategies include:

• Creating a proper environment for sleep. Put all your electronic gadgets away, keep your bedroom tidy, comfortable and block out noise.
  • Sleeping at the same time every day to regulate your circadian rhythm.
  • Avoiding stimulants like coffee or energy drinks in the evening.
  • Sleeping in a dark room. Melatonin, also known as the sleep hormone, is released in response to darkness.

Novel Promising Findings on Depression:

• Esketamine nasal spray can effectively treat severe resistant depression within a few hours, study reports.

A novel treatment based on a paper published in 2006 was recently approved by the FDA (U.S. Food and Drug Administration, 2020). This ketamine-based nasal spray is a major breakthrough in the treatment of resistant depression (Shouan and Grover, 2018). While most antidepressants target serotonin, norepinephrine and dopamine, ketamine targets glutamate receptors. Glutamate might have been the missing piece of this puzzle the whole time. Esketamine is a fast-acting drug and thus, can lower the symptoms of depression within a few hours only as compared to the routinely used antidepressants which can take over 2 weeks to months to start working (Healthline, 2020).

• Researchers have identified specific genes associated with lack of motivation.

A specific circuit is affected in depressive patients suffering from amotivation, researchers say.  An experiment carried out by the researchers at the University of California has identified specific genes in the lateral habenula coding for the symptom of amotivation in depression.  While this finding may still be in its infancy, it might in the future open the doors to novel antidepressants that are tailor-made to treat specific symptoms and thus, lead to a revolutionary patient-focused depression therapy rather than the current guesswork strategy (Cerniauskas et al., 2019).

References:

1. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
   Available at: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1
2. Freeman, A., Mergl, R., Kohls, E., Székely, A., Gusmao, R., Arensman, E., Koburger, N., Hegerl, U. and Rummel-Kluge, C. (2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17(1).
   Available at: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1398-8
3. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders.
   Available at: https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
4. Klainin-Yobas, P., Oo, W., Suzanne Yew, P. and Lau, Y. (2015). Effects of relaxation interventions on depression and anxiety among older adults: a systematic review. Aging & Mental Health, 19(12), pp.1043-1055.
   Available at: https://www.ncbi.nlm.nih.gov/pubmed/25574576
5. Nice. (2020). Depression in adults: recognition and management
   Available at: https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742638037
6. U.S. Food and Drug Administration. (2020). FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic. [online] Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified
7. Shouan, A. and Grover, S. (2018). Adjunctive Intranasal Esketamine in Treatment-Resistant Depression. JAMA Psychiatry, 75(6), p.654.
   Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534172/
8. Healthline. (2020). Depression Treatment With Nasal Spray. [online]
   Available at: https://www.healthline.com/health-news/fda-approves-new-nasal-spray-for-depression
9. Cerniauskas, I., Winterer, J., de Jong, J., Lukacsovich, D., Yang, H., Khan, F., Peck, J., Obayashi, S., Lilascharoen, V., Lim, B., Földy, C. and Lammel, S. (2019). Chronic Stress Induces Activity, Synaptic, and Transcriptional Remodeling of the Lateral Habenula Associated with Deficits in Motivated Behaviors. Neuron, 104(5), pp.899-915.e8.
   Available at: https://europepmc.org/article/med/31672263

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Caution: Content on this site is for entertainment purposes and is not intended to substitute for advice given by a licensed health-care professional.  You should not use this information as self-diagnosis or for treating a health problem.  Contact your health-care provider immediately if you suspect that you have a medical problem.

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