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Treatments For
Men With Depression

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 signs of depression 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

Antidepressant Medications for Men

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

SSRIs (Prozac, Zoloft, Lexapro, Paxil, Luvox) -- are considered the drugs of choice since they eliminate virtually all the side effects of the tricyclic antidepressants 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.

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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.

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

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

Antidepressants and Sexual Dysfunction

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs - Cymbalta and Effexor) have been associated with a higher rate of sexual dysfunction (in some studies, as high as 40% of the people taking them.). In plain language, when discussing these medications, "sexual dysfunction" can mean lack of interest in sex, problems achieving and maintaining an erection and ejaculatory difficulties.

According to a 2001 University of Virginia study, specific antidepressants which were associated with significantly lower rates of sexual side-effects (7-22%) were Wellbutrin (bupropion) and Serzone (nefazodone).

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