Dads and depression

Stephen Bradford’s depression began with nothing more than a vague feeling of inner heaviness. Outwardly, his life was the picture of success: A chartered accountant, he had a high-powered job as vice-president of a large company in the heart of Toronto’s financial district, making a six-figure salary with stock options. He had a strong marriage to a woman who was an accomplished artist; he had a sweet-tempered, healthy young son, along with a host of friends, interests and hobbies. “But I started to get this heavy feeling inside,” Stephen says. And being the strong, steady man he is, he did everything he could to hide it from his family and colleagues.

Alcohol helped to numb the sensation, so Stephen started going for a drink occasionally after work. Gradually he got into binge drinking one or two nights a week, coming home staggering and remorseful. He knew that his wife, June, was deeply troubled by the uncharacteristic behaviour of the man she’d known since they were young adolescents. But Stephen couldn’t seem to do anything more than sincerely apologize, and keep drinking. When the alcohol was no longer enough, he added a hit of cocaine once or twice a week. “I would go out and use at night, and then come into work the next morning with the same suit and shirt on because I hadn’t gone home,” he recalls.

June, horrified by what was happening to her husband, insisted he go to rehab. Stephen agreed, and he successfully kicked the addictions. But now, deprived of his mood-altering substances, he was left with only the horrible weight inside, which kept growing heavier, until one day he was simply incapable of getting out of bed. He says, “It was like the drugs and alcohol had got me so far and then, not having them, everything fell apart. I just couldn’t hang on anymore.” Stephen fell into a pit of depression that would engulf his life for 10 long years.

It’s a tragic paradox that while a depressed man often feels isolated and alone, in truth he has plenty of company: millions of other men, also suffering alone. Depression in men is a staggeringly common illness, but it’s rarely talked about, resulting in what has become a silent epidemic of desolation. “About 10 percent of all men will have major depression sometime in their life,” says Allan Young, a physician and psychiatrist who holds the Leading Edge Endowment Fund (LEEF) Chair in Depression Research at the University of British Columbia in Vancouver. That figure includes those who have clinical depression, as well as those with bipolar disorder, which can include long periods of depression. Even that number may be low: A new Ipsos Reid poll of more than 4,000 working Canadians reported last November that one in four either had been diagnosed with depression (18 percent) or believe they have the illness (a further eight percent).

From time to time we hear of famous men who have struggled with depression — Canadian senator Roméo Dallaire, former Ontario lieutenant-governor James Bartleman, musician Eric Clapton, comedians Drew Carey and Jim Carrey and, recently, actor Owen Wilson, who attempted suicide last August. But too often, we fail to see depression in our own communities, neighbourhoods and families. Young calls it the “iceberg” effect, since the men who have come forward with depression represent only a tiny fraction of those who have the disorder: “Not all men will recognize the symptoms, not all who do will go to the doctor, not all doctors will pick up on it and of the ones who do, not all men will be treated. So most depression is under-recognized and under-diagnosed.”

One reason is denial: biologically and culturally, men are supposed to be strong, and depression is a perceived weakness that could jeopardize a man’s social standing and entire career, especially in macho professions such as police work, the military, firefighting or, as with Stephen Bradford, the corporate elite. But there’s a bigger reason that the illness is under-reported in men. Male depression can manifest itself quite differently from female depression. Both entail low mood, unresponsiveness and loss of pleasure. But while a depressed woman may withdraw into a corner and cry, a man suffering from major depression or bipolar disorder is more prone to anger attacks, impulsivity, extreme irritability and anti-social behaviour, including alcohol or drug abuse, workaholism, spousal and child abuse, gambling and promiscuity.

While researchers have clearly established that a mother’s depression can have deep and long-lasting effects on her children, science is just beginning to explore the impact of a father’s depression. A 2007 study from the University of Colorado found that infants of fathers reporting depression showed significantly poorer learning in a face recognition experiment than infants of healthy fathers. British research from a large 2005 University of Oxford study found that paternal depression was associated with adverse emotional and behavioural outcomes in kids by the time they reach age 3½. Looking at older children, the Oregon Research Institute reported in 2005 that a father’s depression was associated with higher stress levels in kids, decreased feelings of social competence and, alarmingly, higher risk of suicide in adolescents.

Depressed men themselves are also at a chillingly high risk of suicide. The Public Health Agency of Canada reports that while more women report being depressed than men, men are four times more likely than women to kill themselves.

During his 10 years on the couch, in bed and in hospital, Stephen Bradford felt he’d lost just about everything. He’d lost his health. He’d gone through his retirement savings. He’d lost his career, a point driven home when a courier van pulled up to the house and unceremoniously dropped off the contents of his office. He’d lost contact with his colleagues; of the 400 employees at his company, only one ever spoke to him about his condition. He’d lost most of his friends, who simply didn’t know what to say or do.

But Stephen didn’t lose his family. June says that although their lives were a nightmare for several years, she never considered abandoning Stephen. “I just knew I was going to be in there for the long haul,” she says. While taking on the role of Stephen’s caregiver, she also became virtually a single parent to their son, caring for all his daily needs, supervising his homework and chauffeuring him to rep hockey. She took over the family finances from her accountant husband, who was no longer up to the task. An accomplished artist and illustrator, she started working full-time and became the family’s sole breadwinner.

After years of addictions, rehab and hospitalizations, Stephen finally received a diagnosis of bipolar disorder. He likely inherited a predisposition from his mother, who suffered from depression, and the trigger for his breakdown may have been a delayed reaction to his parents’ tragic deaths a few years earlier: his father’s from cancer, his mother’s immediately afterward from suicide.

Understanding that Stephen’s problem was a medical illness, not a moral weakness, brought some relief to both him and June, but by then his illness was so advanced, a quick turnaround wasn’t possible. He saw several top psychiatrists and tried many different medications. Nothing changed until the day a psychiatrist left Stephen a message saying, “I can’t see you anymore. I’ve done all I can.”

Stephen, who was hospitalized at the time, felt angry — “which was the best thing that could have happened,” he says today. “It was a turning point. That doctor couldn’t help me, but I realized I could do a lot of things to help myself.” With a new sense of empowerment, he got his clothes from the locker, walked out of the hospital and made the conscious decision to be in charge of his own recovery. He found another psychiatrist and became an informed patient, learning about the medications he was taking. A former fitness buff, he forced himself to start taking short walks. He pushed himself to go to his son’s hockey games. He got back in touch with his spirituality. Baby steps — but in the right direction. He says, “The more moments I had of feeling better, the more I could build on that. And I started thinking, ‘This is working.’”

Learning about the illness is powerful therapy, says Young, perhaps especially for men who may be accustomed to taking charge of a problem in order to fix it. While many depressed people can’t simply “decide” to get better, adopting a fighter’s attitude may make a significant difference to those for whom medication alone is not enough. But a spouse’s support is also crucial. “Your loved one is in a war for his life,” says Karen Liberman, executive director of the Mood Disorders Association of Ontario, “and he needs all the warriors he can get on his side.”

Stephen and his family won the war, and he credits June for her part in his recovery — especially for carrying the hope when he was unable to. “Most people wouldn’t have stuck by me,” he says, “but she was just amazing. She was able to separate the issues from the person and to hang on to the person she loved.” Today Stephen is healthier than he’s been in years. He has a meaningful job he enjoys, at the Krasman Centre in Richmond Hill, Ont., a drop-in resource centre for survivors of mental illness and their families. Although he missed some of his teenage son’s early years, he’s become a very involved dad and the two have a close, loving relationship.

June insists she’s no saint. While she’s proud that she stayed strong throughout Stephen’s long illness, she wishes she’d reached out for support earlier, instead of pretending that everything was fine behind closed doors. “Mental illness is nothing to be ashamed of,” she says now. “If your husband got sick with something else, you would tell your friends and your family, and people would be supporting you and calling, so this isn’t any different.”

Stephen agrees that social support — even an occasional call from a friend to simply say, “I’m thinking about you” — would likely have speeded his recovery. While medication continues to be essential for him, he feels that his family was equally important in fuelling his own determination to get well.

Stephen’s message for men suffering with depression and for the women who love them? “Don’t give up too soon. There’s light at the end of the tunnel.”

Depressive disorders often have a genetic component in both men and women. But while female depression may have hormonal, cultural or social triggers, male depression is more likely sparked by a stressful event. This could be emotional, such as a death or marriage breakup. Men aged 20 to 64 who are divorced or separated are six times more likely to report an episode of depression than men who stay married, according to a 2007 Statistics Canada report.

But the trauma could also be physical. In a 2007 survey of 2,552 retired professional football players, the more concussions they’d had, the more likely they were to be diagnosed with depression, according to the University of North Carolina. While the old model of depression focused on an under-production of the feel-good brain chemicals such as serotonin, the newest research is looking at an overproduction of the feel-bad stress chemicals, such as cortisol, which can damage nerve cells. Thirty to 40 percent of people with common illnesses, such as diabetes, heart disease or cancer, also have depression.

There’s also ongoing research into the role of testosterone, which modulates brain chemistry. “We’ve found that the lower the levels of bioavailable testosterone, the greater the levels of depressive symptoms,” says psychiatrist Roger McIntyre, head of the Mood Disorders Psychopharmacology Unit at Toronto’s University Health Network.

There are generally two treatment options, which ideally go together: medication, of which there are dozens of types, and therapy, such as cognitive behavioural and interpersonal. The Mood Disorders Association of Ontario says that 80 to 90 percent of all depressed people respond to treatment and nearly all depressed people who receive treatment see at least some relief from their symptoms. Treatment can also prevent recurrences.

Your support could play a major role in your partner’s diagnosis and recovery. Remember that the sooner he gets help, the better the chances of recovery.

• If you suspect he has depression, choose a calm, relaxed moment to broach the subject. For example: “I’m concerned about you because you haven’t seemed yourself over the past few weeks.”

• Ask him if he’s feeling depressed or if he’s still enjoying things as much as usual. “Simple questions like that pick up many people’s depression,” says Allan Young, a physician and psychiatrist who holds the Leading Edge Endowment Fund (LEEF) Chair in Depression Research at the University of British Columbia in Vancouver

• Suggest he do a quick, confidential online screening test from the Mood Disorders Association of Ontario at checkupfromtheneckup.ca.

• Encourage him to get a doctor’s diagnosis. “The important thing is that he tell the doctor he thinks he may be depressed,” says Young.

• Support him in getting to medical appointments and complying with treatment, as you would with any illness.

• Tell your children about their dad’s illness in the same way you’d tell them if he had diabetes or cancer. Obviously, it depends on maturity level: You might say to a three-year-old, “Daddy’s sick, and he’ll be spending a lot of time at home till he gets better,” but to a 10-year-old you might say, “Dad’s been diagnosed with depression. He’s talked to the doctor and he’s taking medication, and he might need some extra love and support till he gets well.” Tell other family members and friends what’s happening, so you can enlist their support.

• Stay positive. Eighty percent of people who receive proper treatment for depression show improvement within four to six weeks.