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Men And Depression: Time For More Targeted Treatment

Depression in men is a complex challenge that requires much more research from the clinical research community and more creative thinking from policy-makers. Improving the detection, diagnosis and treatment of depression in men is a worthy ambition.
Maureen Drennan

It's well documented that men are less likely than women to seek help for mental health problems and that they are several times more likely to die by suicide. So far, there have been some excellent and insightful contributions in this HuffPost UK Building Modern Men series, not least from guest editor Andy Murray. It is abundantly clear that we need more discussion, more research and more creative thinking on male mental health. This is an urgent issue for public health, every bit as important as the global challenges of obesity, cancer and heart disease.

I'm a male psychiatrist who has been engaged with clinical research on depressive disorders for the last ten years. In my view, any discussion of 'men and depression' needs to consider a number of key points about the nature of depression.

Depression is a very broad clinical term and depressive syndromes are genetically and clinically heterogeneous. In other words: they come in all shapes and sizes and different types of depression need different approaches. This may seem obvious, but it is regrettably sometimes not the case in our increasingly under-resourced NHS mental health services.

Although there's no evidence that male depression is distinct from female depression, it's unrealistic to think that men and women will respond to the same treatments. A young man with depression living in a socially deprived community will need a very different approach to diagnosis and treatment compared to an elderly woman who's depressed due to bereavement and multiple age-related medical problems. These two individuals may both meet the diagnostic criteria for clinical depression but the factors causing and perpetuating their symptoms are obviously very different.

In modern healthcare we're about to enter a 'precision medicine' revolution. President Obama recently announced the multi-billion dollar Precision Medicine Initiative, which will use advances in our understanding of genetics and medication response to deliver 'the right treatment to the right person at the right time'. With cancer, it's now possible to look at the genetic make-up of certain tumours and select a treatment which more directly targets the cancer sub-type. The cancer world has accepted that one size does not fit all - now we need a precision medicine approach for mental health. The complex and specific challenges of depression in men are a good illustration of this - let's understand more fully the causes of different kinds of depression in men and women, young and old, rich and poor, from different ethnic backgrounds - and then develop more precise and more targeted treatments.

Future mental health services need to be funded so they can train and keep hold of talented individuals to deliver interventions in a flexible, multidisciplinary, person-centred way. To give one brief example, clinical psychology training in the UK is dominated by female trainees, out-numbering male counterparts four to one. Female clinical psychologists are highly effective therapists, but are we trying to attract more men into clinical psychology training? We don't know if men with depression do better with a male or with a female therapist, but I think it's a valid question that needs to be addressed.

Starting an open and frank public conversation about the stigma which prevents men with depression seeking help is vitally important and is a necessary first step.

Depression is a disorder which in general responds well to treatment (often a combination of medication with a talking therapy such as cognitive behavioural therapy) and for most people the prognosis is favourable.

But depression in men is a complex challenge that requires much more research from the clinical research community and more creative thinking from policy-makers. Improving the detection, diagnosis and treatment of depression in men is a worthy ambition - it will impact not only on individuals but also on the future lives of millions of partners, children, friends and colleagues around the world.

HuffPost UK is running a month-long focus around men to highlight the pressures they face around identity and to raise awareness of the epidemic of suicide. To address some of the issues at hand, Building Modern Men presents a snapshot of life for men, the difficulty in expressing emotion, the challenges of speaking out, as well as kick starting conversations around male body image, LGBT identity, male friendship and mental health.

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