A Look at Our Community A report by the American Journal of Psychiatry found that higher rates of depression exist among gay men than in the general population. As a result, gay men are more likely to engage in high-risk sexual behavior and to abuse alcohol and drugs with more frequency. Depression affects six million men in the United States. Although it has been noted that men are less likely to be affected by depression than women, studies suggest that men are less likely to mention it to their doctors. On the other hand, the suicide rates in men are four times higher than in women; however, women attempt suicide more often. Several large surveys suggest that psychiatric disorders are more common among gay men. There is a debate concerning whether gay men on the whole suffer from depression more than heterosexual men. The fact is that gay teenagers are more likely to suffer from depression due to the stress of “coming out,” and some struggle with discovering their sexuality, knowing that they are “different” from their peers. Adolescent gay men have higher rates of suicide. Most clinicians agree that screening for depression and anxiety in the gay community is warranted. Many adult gay men struggle with the complex issue of “coming out” and uneasiness over being different from society’s expectations. In the HIV community, mental illness is a frequent issue, most often due to the debilitating nature of the disease, but also due to the battle in coming to grips with having the virus. Reports suggest that the rates of major depression, bipolar disorder, and obsessive compulsive behavior in HIV- positive individuals can be as high as 54%. Other studies have shown that untreated depression can even increase the progression to AIDS in this population. Inadequate social support, internalized homophobia, shame over not meeting cultural standards, and cultural insensitivity are cited as some of the many reasons that gay men fall prey to depression. What Does Depression Look Like? The World Health Organization categorizes depression into typical, mild, moderate, or severe episodes. Patients with depression may suffer from low energy, decreased activity, and depressed mood. Often there is a diminished capacity for enjoyment and interests. Concentration is reduced, and there can be marked tiredness even in performing small tasks. Depressed men complain about disturbed sleep patterns in which they either sleep too much or suffer from insomnia (i.e. they are not able to sleep). Appetite is usually affected in much the same way, with patients complaining that they eat too much or too little. Usually the depressed male expresses feelings of low self-worth, lack of self-esteem, and lowered self-confidence. Men with prolonged depression describe a sense of worthlessness and associated guilt. Moods can vary from one day to the next and are often accompanied by “somatic” complaints, such as body aches and pains. One of the most striking complaints for gay men is a loss of sexual interest and pronounced erectile dysfunction. The three major depressive disorders include: 1. Major depression 2. Dysthymia 3. Bipolar disorder Signs and symptoms to look for that might lead you to believe that you or someone you know is depressed include: 1. Constant fatigue 2. Insomnia or sleeping throughout the day 3. Disinterest in normal activities 4. Increased use of recreational drugs or alcohol 5. Sad or irritable mood 6. Tearfulness and feelings of despair 7. Change in appetite with either weight loss or weight gain What Does Anxiety Look Like? Anxiety may often co-exist with depression. The National Comorbidity Survey (U.S.) reports that 58% of those with major depression also suffer from episodes of anxiety. The National Institutes of Mental Health (NIMH) define generalized anxiety disorder (GAD) as chronic anxiety, exaggerated worry, and prolonged tension, even when there is little or nothing to provoke it. People with GAD are often preoccupied with their health, money, and family issues. Usually they find that even the least troublesome task can be thoroughly anxiety producing. GAD is excessive worry that persists for at least six months. Most patients recognize that their worry is unwarranted; however, they are still unable to find comfort or relax, even after discussing their fears openly. Most patients with GAD have an incredibly difficult time concentrating and suffer from erratic sleep patterns. Other common symptoms associated with anxiety include headaches, nausea, heart palpitations, and shortness of breath. In mild cases of GAD, most patients can function socially and maintain a job. In more severe cases, patients instinctively avoid situations that are considered anxiety provoking; in some instances, this can interfere with basic daily activities. Social phobias and post-traumatic stress disorder (PTSD) are other forms of anxiety. In order to make the diagnosis of GAD, symptoms must persist for longer than six months and have to include at least three of the following: • fatigue • irritability • insomnia or excessive sleep • muscle tension • restlessness • difficulty focusing Most clinicians agree that screening for depression and anxiety in the gay community is warranted. How Are Depression and Anxiety Treated? Essentially, there are chemical changes or imbalances that affect how information is transmitted in the brain. These neurotransmitters affect mood. Decreased levels of certain ones, specifically serotonin and norepinephrine, can result in depression and anxiety. Medications that target these neurotransmitters are called selective serotonin re-uptake inhibitors (SSRIs), serotonin norepinephrine re-uptake inhibitors (SNRIs), or norepinephrine/dopamine re-uptake inhibitors. SSRIs work well to alleviate symptoms of depression and anxiety, but also help restore the brain’s chemical imbalances. As a whole, the SSRIs are associated with sexual side effects, sleep disturbances, as well as weight gain. Before you begin any drug regimen your doctor should discuss not only the potential side effects but also how the medication works and any drug interactions. Most antidepressants take effect after one or two weeks but require two to four weeks for full effect. For the most part, individuals usually require antidepressants to aid them through difficult periods in their lives, like the death of a loved one, the loss of a job, or a breakup. In these cases, antidepressants are prescribed for a specific period of time, usually six months to a year. In many cases, therapy is also recommended. Traditional psychotherapy can be an essential outlet for most individuals experiencing depression or anxiety. It allows some people the ability to express their underlying fears and concerns, while for others it affords the chance to explore more deeply rooted issues. In addition to traditional one-on-one therapy, there is also group therapy. This is a form of psychotherapy in which one or several therapists treat a small group of patients. Sometimes this is essential because of the cost-effectiveness compared to one-on-one counseling. In a group, the members organize around related issues and try to resolve them as a system. This gives the members the opportunity to explore personal issues within a social context. Feelings of prolonged depression and anxiety should be brought to your healthcare provider’s attention. There are many treatment options available, and no one should have to suffer. Adaptation of an article, Depression and Anxiety, by Frank Spinelli, MD: http://www.advocate.com/Health_and_Fitness/Ask_the_Doctor/Depression/Depression_and_Anxiety/