Why Does Stress Cause More Depression in Men Than in Women? 

Sex and gender differences are central to our lives. We all think about them, struggle with them, and seek to better understand them. From Professor Henry Higgins in My Fair Lady who lamented “Why can’t a woman be more like a man” to Sigmund Freud who wondered “What do women really want?” to our nursery rhymes which taught us to believe that “Little girls are made of sugar and spice and everything nice,” while “Little boys are made of snakes and snails and puppy-dogs tails” to Charles Boyer who proclaimed Vive La Différence!

There is an exciting new field emerging that offers new insights into the age-old questions, “Are men and women really all that different?” In a world that still limits the lives of women in significant ways, it’s not surprising that many feminists have argued that the differences between men and women are superficial and more the result of our sexist attitudes than real differences in the ways our brains and bodies are built.

However, an emerging new field called “gender-specific medicine” recognizes that sexism still exists and must be eliminated if women and men are going to reach their full potential, but there are real differences between the sexes that need to be understood and respected.

One of the leaders in this field is Marianne J. Legato M.D. In her book, Eve’s Rib:  The New Science of Gender-Specific Medicine, she says, “Everywhere we look, the two sexes are startlingly and unexpectedly different not only in their internal function but in the way they experience illness.” Dr. Legato is a cardiologist who was one of the first clinicians to recognize that heart disease presents differently in men and women. Men feel a crushing pain in their chest, while many women experience fleeting pain in the upper abdomen or back, nausea, shortness of breath, and sweating.

Another leading researcher is David C. Page, M.D., professor of biology at the Massachusetts Institute of Technology (MIT) and director of the of the Whitehead Institute, where he has a laboratory devoted to the study of the Y-chromosome.  “There are 10 trillion cells in human body,” says Dr. Page, “and every one of them is sex specific.”

“We’ve had a unisex vision of the human genome,” says Dr. Page. “But men and women are not equal in our genome and men and women are not equal in the face of disease.” He concludes by saying, “So, all your cells know on a molecular level whether they are XX or XY,” says Dr. Page. “It is true that a great deal of the research going on today which seeks to understand the causes and treatments for disease is failing to account for this most fundamental difference between men and women. The study of disease is flawed.”

Just as we had once assumed that symptoms of heart disease didn’t differ for men and women, we’ve assumed that depression was the same in women and men and that women more susceptible to depression than men. It has generally been accepted in the mental health field that depression is about twice as common in women than in men. “The generally accepted statistic is that women are twice as likely to suffer from depression as men,” says Marianne J. Legato.  “I don’t think those findings are correct,” says Dr. Legato. “I think the signs and symptoms of depression are very different in men than in women.”

In my own research on depression I found that men often express their depression through irritability, anger, and alcohol consumption. I describe the results in my book, Male vs. Female Depression: Why Men Act Out and Women Act In. A study by Lisa A. Martin, PhD and colleagues at University of Michigan and Vanderbilt University published in the Journal of the American Medical Association (JAMA), lends credence to my earlier findings that men and women express depression through different signs and symptoms.

Shervin Assari, M.D. MPH and his colleague colleague Maryam Moghani Lankarani, Ph.D found that stressful life events are more likely to predict depression in men than in women. “In fact, men are more susceptible to the depression-inducing effects of each additional stressor over long-term periods,” they found in their research.

They also found that men are more likely to have depressive episodes following work difficulties, divorce and separation. Women, on the other hand, are more sensitive to conflict, serious illness or death happening in their close social network. In fact, research suggests that most of the stressful events that cause depression among women are related to their close social network, such as romantic and marital relationships, child-rearing and parenting.

“Men may also be vulnerable to the effects of stress because they may perceive depression as a weakness,” says Dr. Assari. “They may also define talking about emotion, and seeking help for an emotional problem, such as depression, as a weakness.”

Dr. Assari concludes that our beliefs about strength, weakness, and manliness may prevent men from getting the help they need. “These beliefs strongly shape behaviors of men who are in need of mental health care, and make men vulnerable when stress and emotional problems happen. All these result in men ignoring depression when it develops, and avoiding care when needed, not to look weak. This also partially explains why more men with depression kill themselves (particularly white men) than women with depression.”

I’ve had to deal with depression and bipolar disorder in my own life and my very survival depended on changing my beliefs and attitudes. I hope other men, and the families who love them, can support men in recognizing that our symptoms of depression may be different than women’s and stress might cause us more pain, but we can, and must, reach out when we are angry and depressed. We need not suffer alone. I look forward to your comments. Please share your thoughts below and then join me on Twitter.

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