The most common problem associated with male menopause is depression which is closely related to impotence and problems with male sexuality.  Approximately 40% of men in their 40s, 50s and 60s will experience some degree of difficulty in attaining and sustaining erections, lethargy, depression, increased irritability, and mood swings that characterize male menopause. The symptoms of depression in men are commonly not recognized for several reasons:

• The symptoms of male depression are different than the classic symptoms we think of as depression
• Men deny they have problems because they are supposed to "be strong"
• Men deny they have a problem with their sexuality and don't understand the relationship with depression
• The symptom cluster of male depression is not well known so family members, physicians, and mental health professionals fail to recognize it.

Male depression is a disease with devastating consequences.  To paraphrase from Jed Diamond's book Male Menopause

• 80% of all suicides in the US are men
• The male suicide rate at midlife is three times higher; for men over 65, seven times higher
• The history of depression makes the risk of suicide seventy-eight times greater (Sweden)
• 20 million American will experience depression sometimes in their lifetime
• 60-80% of depressed adults never get professional help
• It can take up to ten years and three health professionals to properly diagnose this disorder
• 80-90% of people seeking help get relief from their symptoms

Differences between Male and Female depression:

Men are more likely to act out their inner turmoil while women are more likely to turn their feelings inward. The following chart from Jed Diamond's book, Male Menopause, illustrates these differences.

What to Do About It?

Often we receive questions at our website from distressed women who wonder what is happening to their husbands or partners or co-workers and how they can help.

• It is important to recognize the syndrome because most men will not see it in themselves since their most basic psychological defense is denial.
• It is important to realize that most men seek help only when pressured to do so by significant people in their life.
• It is important to realize than men can be helped through a variety of approaches including
  • exercise
  • diet
  • getting in touch with their spirituality
  • individual and group psychotherapy
  • medications
  • teaching men to recreate the social supports they have lost or never had
  • teaching men to love and accept themselves for whom they are

Medications

There are a number of excellent antidepressant medications now available.  No one medication is perfect and it is very important to choose and monitor therapy carefully.

There are the following classes of medications:

Amphetamines and  MAO Inhibitors (Parnate and Nardil)--   these are dangerous and should be dispensed only by psychiatrists highly skilled in their use.   They are rarely used today.

Tricyclic Antidepressants (TCAs)-- Elavil, imipramine, trazadone, doxepin, nortriptyline etc.  These are generic and cheap but have a lot of side effects including sedation, dry mouth, urinary retention.

SSRIs (Prozac, Zoloft, Paxil, Luvox)-- the drugs of choice in the 1990s since they eliminate virtually all the side effects of the TCAs but they are not perfect.  Each medication has a slightly different profile of side effects so it may be necessary to try several different preparations to get the optimal response.  One of the most common side effects of Prozac and Zoloft is sexual dysfunction.  Reported incidence of impotence can be as high as 30%.  Obviously these medications would be a very poor choice for a male in mid-life crisis who is obsessing about inadequate sexual performance.  Another disadvantage is that these agents are expensive. Caution should be used mixing these agents with weight reduction pills, agents used in smoking cessation (Zyban--buproprion), tryptophan and St. John's Wort marketed in health food stores, and other serotonin-like agents

Other drugs include Wellbutrin (buproprion), Effexor, and Serzone.   These effect the brain through other biochemical pathways.

Table 2  Reported vs. Placebo Incidence of Sexual Dysfunction Associated with Various Antidepressants  (PDR, 2001)   

At this time, there is no one best agent for the pharmacological management of the unique issues associated with male depression at midlife.