Transcript Unmasking Male Depression: Understanding and Treating

UNMASKING MALE DEPRESSION:
UNDERSTANDING AND TREATING
ADOLESCENTS AND ADULTS
Russell C. Gaede, PsyD – [email protected]
Executive Director, Life Enhancement Center
Jason H. King, PhD – [email protected]
Clinical Director, Life Enhancement Center
UVU 2013 MENTAL HEALTH SYMPOSIUM:
FOCUS ON DEPRESSION
PERSPECTIVES
2
DSM 5
• No more “Mood Disorders”
Category
• Bipolar Disorders
• Depressive Disorders
• No more “Dysthymia”
• Chronic Depressive Disorder
• Disruptive Mood Deregulation
Disorder (DMDD)
• Ages 6-18
• 3+ times per week for 12 months of
verbal rages or physical
aggression
• Underserved children who are
often misdiagnosed as having
Pediatric Bipolar NOS
• They do not show the same
characteristics of individuals with
classic bipolar disorder (ex:
episodic grandiosity/elevated
mood/manic episodes)
• Have developmentally
inappropriate and significant
difficulties
• The normal and expected
response to an event involving
significant loss (e.g,
bereavement, financial ruin,
natural disaster), including
feelings of intense sadness,
rumination about the loss,
insomnia, poor appetite and
weight loss, may resemble a
depressive episode.
• The presence of symptoms
such as feelings of
worthlessness, suicidal ideas (as
distinct from wanting to join a
deceased loved one),
psychomotor retardation, and
severe impairment of overall
function suggest the presence
of a Major Depressive Episode
in addition to the normal
response to a significant loss.
3
LIFESPAN OF MALE DEPRESSION
• 12-17 years, peer social development, parental
differentiation, and academic performance
• 18-30, the beginning of work life and college years
• 30-55, the middle years of career and family life
• 55+, and later life
4
WHY?
5
THE MASK
6
LATEST RESEARCH
7
INSIDE MALE DEPRESSION
• “And I didn’t see him as a father because he just
was totally hopelessness, withdrawn. He was
physically a person that was in the room, but there
was no conversation there; there was no
involvement. To me I really thought he didn’t care
or he just didn’t love us or didn’t love us enough.”
8
INSIDE MALE DEPRESSION
• “My son was not under treatment for
depression and he had not been
diagnosed with depression. But ironically
he did leave a suicide note. And in his
note he talked about not being happy.
And we were not aware that he was that
unhappy. I guess any death is painful but
to see this kind of death is just something I
see over and over again in my mind.
Because my daughter and my wife and I
found my son and he had shot himself.
And that’s a scene that just won’t go
away.”
9
INSIDE MALE DEPRESSION
• “I’m in the height of my career. Things ought to be
great. They ought to be wonderful. And yet, I’m
miserable. I went through that beat up period, you
know, hated myself. And so you try and fight
through it. But then by sometimes by doing that,
you just end up getting like deeper and deeper
down. Then you almost give up.”
10
INSIDE MALE DEPRESSION
• “People just felt like I was ready to snap. I
remember being a teenager and tearing apart my
room. I remember people saying, “Why are you so
angry?”
11
INSIDE MALE DEPRESSION
• “I’d always felt like I was
walking on eggshells. Was he
going to be Mr. Wonderful? Or
was he going to be a bear?
You know, I’m out of here. I
can’t take it anymore. You’re
driving me crazy. In
desperation, I was saying,
David, we’ve got to do
something. This is just out of
control.”
12
INSIDE MALE DEPRESSION
• “I think alcohol and depression go together. It got
to the point where I would look for different
substances that would take me away from the
depression.”
13
OUTSIDE MALE DEPRESSION
• Pain
• Depression may show up as physical signs like constant
headaches, stomach problems, or pain that doesn’t seem
to be from other causes or that doesn’t respond to normal
treatments.
14
OUTSIDE MALE DEPRESSION
• Risk Taking
• Sometimes depressed men will start taking risks like
dangerous sports, compulsive gambling, reckless driving,
and casual sex.
15
OUTSIDE MALE DEPRESSION
• Anger
• Anger can show itself in different ways like road rage,
having a short temper, being easily upset by criticism, and
even violence.
16
LEARNED HELPLESSNESS
• Dr. Seligman’s research
17
YOUTH EXTERNALIZATION
•
•
•
•
School
Work
Family
Friends
•
•
•
•
•
Stealing
Lying
Fighting
Destructiveness
Hostile aggression
18
FURTHER SYMPTOMS
• Feeling guilty, worthless, or
that you always fail
• Feeling restless and/or
irritable
• Having no energy
• Problems sleeping (not
sleeping or sleeping too
much)
• Feeling angry or violent
• Feeling like you can’t work
or get things done
• Using alcohol or drugs to
feel better
• Sexual inability
• Losing interest in hobbies,
work, and/or sex
• Missing work, class, or
appointments
• Not caring about anything
or feeling “blank”
• Always feeling sad or
nervous
• Changes in appetite and/or
weight
• Working too much
• Feeling alone
• Being negative about
everything
• Thinking about death or
suicide
• Having problems focusing,
remembering, or making
choices
19
FURTHER SYMPTOMS
• Blames others for problems
• Feels irritable
• Has trouble sleeping or
staying asleep
• Suspicious and guarded
• Overtly or covertly hostile
• Attacks when feeling hurt
• Overreacts, then often feels
sorry later
• Feels the world is set up to
fail him
• Restless and agitated
• Believes his problems could
be solved if only his _______
(spouse, co-worker, parent,
friend) would treat him
better)
• Loses control and anger
• May have sudden attacks of
rage
• Feelings blunted, often numb
• maintains rigid boundaries;
pushes others away
• Feels ashamed for who he is
• Frustrated if not praised
enough
• Denies weaknesses and
doubts
• Strong fear of failure needs to
be “top dog” to feel safe
• Uses alcohol, TV, sports, and
“sex” to self-medicate
• Wonders, ‘Am I being loved
enough?”
20
SHOULDER THERAPY
• Ice Age 3: Manny and Diego
21
TREATMENT: ADOLESCENTS
• Family therapy
• MDFT – developmental focus
• (1) the youth's interpersonal functioning with parents and peers
• (2) the parents' parenting practices and level of adult
functioning independent of their parenting role
• (3) parent-adolescent interactions in therapy sessions, and
• (4) communication between family members and key social
systems (e.g., school, child welfare, mental health, juvenile
justice).
• Interpersonal psychotherapy
• Role disputes
• Role transitions
• Interpersonal deficits
• Cognitive therapy
• REBT
22
TREATMENT: ADULTS
• Narrative therapy
• Externalization
• Unique outcomes
• Video example
• Solution-focused
therapy
• Males like fast results and
to solve problems
• Construct a concrete
vision of a preferred
future for themselves
• Psychotropics
• No SSRI’s
• Sexual drive, erection, and
orgasm
• Wellbutrin (DA and NE)
• Enhances sexual
functioning and libido
• SNRI’s +/• Serzone
• CBT
•
•
•
•
Behavioral activation
Cognitive restructuring
Functional analysis
Stress inoculation training
23
CONCLUSION
• Application
• Future research
• Questions
• Thank you
24