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“Before you diagnose yourself with depression or low self-esteem…”

| By: Dr Robert Stevens

“…first make sure that you are not, in fact, just surrounded by assholes.” ~ William Gibson

I love this quote, it’s funny yet incisive.  Whilst on first impression it simply pokes fun at this narcissistic, self-important civilised society we live in, where self is more important than the collective, where it’s more important to receive than it is to give, where entitlement proceeds hard work and earning your position in life, ‘entitled takers’ I like to call them. It also raises awareness of mental health without it sounding like a personal failure.  Low self-esteem and self-deprecation are not to be accepted.  You must indeed make sure you are not surrounded by assholes!

Depression in men is common yet under-diagnosed.  The risk of suicide is higher in men than it is in women. Men aged 45-49 are most at risk of suicide at 26.5 per 100,000 in 2014.(1)

Effectively diagnosing and treating depression is difficult in General Practice.  Sure, there are accredited and validated tools like the PHQ9 questionnaire that attempts to quantify a qualitative condition.  Your GP must take a full history, explore your ideas, concerns and expectations; exclude red flags including suicidal risk.  They will need to examine you, make sure there is not a physical cause for your depression, order appropriate investigations, formulate a management plan, have you agree with said management plan, check your understanding and concordance, organise appropriate follow up and ensure there is appropriate safety-netting in place.  All this in ten minutes.

So how do we go about treating low mood and mild depression in General Practice?  Simple, offer you talking therapies. Hopefully, you’ll choose the online cognitive behavioural therapy course as the waiting list for actually seeing a human being face-to-face is long.  Your GP may even give you an antidepressant, most likely a Selective Serotonin Re-uptake Inhibitor (SSRI), to bump up the Serotonin hormone (the happiness hormone) in the brain.  I’m intentionally being flippant, playing devil’s advocate as it is almost impossible to do all this with the necessary compassion, empathy and understanding that is required.  This is one of the many reasons your doctor is running behind, this takes more than ten minutes.

So, what can you do?  How can you help yourself? The first step is to understand that mental illness is a disease that should be treated like any other disease.  Asking and accepting help is not a sign of weakness, it is actually a sign of strength, that will set you on the path of discovery that you are not in fact alone.  We need to be mindful that there’s an important difference between sharing and losing control.  Masculinity and machismo are characteristics that can be foe as well as friend.

It is important to maintain a healthy lifestyle, eat healthily and engage in regular physical exercise to help stave off mental illness. In fact, adopting these facets of life are important in treating the disease.  Low mood, loss of energy, alongside sexual dysfunction are the commonest presenting complaints of men I see here at the Men’s Health Clinic.  They’ve been offered and declined toxic anti-depressants.

Through trawling the internet and listening to similar stories from other men, they’ve put their pieces into the same jigsaw and discovered they have Testosterone Deficiency Syndrome.  Correcting their testosterone has given them a new lease of life.  Checking testosterone is an important part of the work-up in men presenting to the doctor with low mood and depression.  Testosterone is pivotal to men’s health, an optimal testosterone is an important part of the jigsaw that is life.