MARK NICHOLS February 22 1999


MARK NICHOLS February 22 1999

Coming to grips with depression


Men are often unwilling to seek help when the black moods strike


Dick Smyth was 62 when the black dogs of depression came to tear him apart. His work as a radio and television broadcaster was “incredibly, unbelievably” stressful. It was the spring of 1995, and Smyth was on vacation, visiting Venice with his wife, Marilyn. “I had always wanted to see Venice, that magic wonderful city,” he says. “So there we were and I was saying Who cares? So what?’ That’s when I knew something was wrong.” Smyth went to his GP, who prescribed sleeping pills. That wasn’t the solution. Smyth, then living in Toronto, remembers saying to himself that autumn: “Look, you’ve got a good job, you’ve been married over 40 years, you have three wonderful daughters, a lovely place in Muskoka, opportunities to travel. You have an enviable lifestyle, Dick, so why do you wake up every morning trying to figure out how to kill yourself?” By Christmas, his depression, still undiagnosed, had chased him into a deep hole. “It was like a scene from a bad opera,” he now recalls. “Here I was with

a kitchen knife at my wrist, trying to get enough courage to make the cut. I broke down completely.”

Smyth is unfortunately typical of many men with depression who do not persist in getting the help they need, and end up in a crisis. There is a 30to 40-per-cent higher incidence of reported depression among women than men, according to Dr. Edgardo Pérez, chief of medical staff at the Homewood Health Centre, a private addiction and psychiatric services facility in Guelph, Ont. But specialists such as Dr. Stan Kutcher, head of psychiatry at Dalhousie University in Halifax, say the condition can be particularly worrisome in men because of their unwillingness to reach out for help. One in 10 men will have a major depressive episode requiring treatment, according to the selfhelp organization the Mood Disorders Association of Ontario and Toronto, but only one in 10 of those actually get the help they need. And with the numbers rising, the prognosis is unsettling. Kutcher cites World Health Organization forecasts that by the year 2020, “depression will be the most prevalent disease we have in the world.” Suicidal thoughts are never to be taken

lightly, but that is especially so among men. ‘When men try to kill themselves, chances are higher than with women that they will succeed,” says Pérez. In 1996, according to Statistics Canada, 3,093 men and 848 women committed suicide. Figures from the Clarke Institute of Psychiatry in Toronto show that depression and suicide are strongly linked: fully 80 per cent of suicides are carried out by people who have depressive illness.

Luckily for Smyth, he realized, even as he held a knife to his artery, that he was sick and needed help. His decision to call a doctor was a turning point, the beginning of a slow climb out of the black hole. He has been taking the antidepressant Zoloft for three years, but now wants to see if he can get along without it. “If need be, I’ll go back on it,” he says, “but I’m hoping to get rid of it.”

Many experts point to persistent societal stereotypes to explain the reluctance of men to admit they are depressed. “Boys are raised to be workers, to achieve and be successful,” says Dr. Jerry Arthur-Wong, a registered clinical counsellor and program director of the B.C. Men’s Resource Centre in Vancouver. “Anything short of that is considered shameful.” The centre receives about 900 calls a year from troubled men, whom he sees as

victims of overly high expectations from society—what he calls the “sturdy oak” syndrome. ‘Too many men are their own worst enemies,” says Arthur-Wong. “They avoid anything that is perceived as feminine, such as admitting internal discomfort.” Arthur-Wong’s work gives him a ringside view of the pressures on men in the ’90s. “I see mental health problems stemming from failures of various sorts,” he says, “at work, in relationships and from the fear of aging.” Divorce is a major contributor to the problems he treats. “It can be very devastating for men not to get access to their children,” he says. “I see people start to drink, take drugs and commit suicide.” While it is often said that depression is much more common among women than men, ArthurWong suspects many men’s cases simply go unreported. “I think the figures would be much closer if men came forward,” he says. “They may be depressed but don’t know it, or it’s hidden by use of alcohol to numb themselves to pain or failure or shame.” Another way many men mask their depression, says Homewood’s Pérez, is to work obsessively. “Men tend to cover up by becoming reclusive or more involved at work.” Thanks to ubiquitous cell phones, laptop computers and e-mail, even home is no longer the healing space it used to be. “Men use the computer to substitute for what’s missing in their lives,” says Pérez. “The computer provides pseudotherapy but in the long run it is worse. They are isolated and don’t have a chance to be questioned about whether they are doing OK. We’re beginning to see more of that in men.” Despite a widespread tendency to dismiss depression as a simple lack of willpower, it is in fact a disease caused by a chemical imbalance in the brain. And it tends to run in families. According to Pérez, having a parent who suffered from it doubles a person’s chances of becoming depressed—having both parents triples the odds. He calculates that six per cent of the population suffers from major depression at any given time, and 40 per cent of the known victims are male. Once depression has reared its head, the risk of recurrence is high—50 per cent after one episode, 70 per cent after two and 90 per cent after three.

The numbers of cases are rising, perhaps because depression is coming out of the closet. In 1988, mental problems including depression represented about 11 per cent of Mutual Life of Canada’s long-term disability claims. Now, says Sue Mark, director of disability services at the firm’s head office in Waterloo, Ont., they “make up about a quarter.” And although most mental claimants are women, the men’s portion is growing. In

1996, 29 per cent of claimants were men; in

1997, that number rose to 34 per cent and last year it reached 36 per cent. But Dalhousie’s Kutcher is skeptical of people who cite unprecedented levels of stress in the modern world as the cause of the increasing incidence

of depression. “Every generation thinks it’s special,” he says. “But look at people under extreme circumstances of stress like war. The vast majority never get depressed.”

For those who do, chances are good that it is treatable. About 70 per cent of sufferers will respond to antidepressants such as selective serotonin reuptake inhibitors or SSRIs (Paxil, Zoloft and Prozac), tricyclic antidepressants or TCAs (Impramine and Elavil), and monoamine oxidase inhibitors or MAOs (Nardil), or a combination of medications, says Pérez. Those drugs often take three weeks or more to effectively alter the brain chemistry. Newer antidepressants, such as Serzone, produce fewer of the sexual problems and other side-effects that many men may fear. And a natural medication, St John’s Wort, says Pérez, is “up to 50-per-cent” effective for mild to moderate depression. As well, psychotherapy counselling can help deal with underlying issues such as mari’ tal, family, occupational and social issues.

In severe, urgent cases of depression, a newer version of the old “shock treatment” is used. Dr. Gary Hasey, clinical director of the mood disorders program at the Hamilton Psychiatric Hospital in Hamilton, calls electroconvulsive therapy—which uses a machine to pass an electrical current through the brain— “the single most powerful treatment for de-

pression.” Recent studies have found ECT to be 65to 75-per-cent effective. But there is a down side—its side-effects may include headaches, muscle pain and memory loss.

As for Dick Smyth, he is now semi-retired, doing daily commentaries on Toronto radio station CFRB. He lives with his wife, Marilyn, in Bracebridge, in Ontario’s cottage country. Smyth says he talks openly about his ordeal because he hopes it will encourage other men to seek help. “All it is,” he says, “is a chemical imbalance in the brain. There is no shame in it whatsoever.” □