What does it look like in men?

[2boyzmama]

My husband has struggled with depression and anxiety his whole life, he finally was diagnosed in college and started counseling and several cycles of on-again/off-again medications. His depression has seemed cyclical to me, but even in the "good" times, he's never "great", just kind of "ok".

Then we started having babies. We had 3 babies in 4 years, including one with severe behavioral issues (controlled mostly through diet now) and one with severe medical issues (numerous birth defects and a genetic syndrome with multi system involvement) and one that was "unplanned". We've also moved twice (including one overseas move), he started school again (after failing/dropping out in his early 20s), I had a major job change (from military to civilian).

So basically, our life has been haywire for quite a while. As has his depression. He's been stable on Effexor for 2.5 years, this is the longest he's been on the same med. He was seeing a psychiatrist and psychologist until he was stable on his dosage, then our family practice dr took over the script.

The last year has been pretty horrible. I knew he was feeling stressed and generally unhappy, but it wasn't until recently when I confronted him about some...behaviors...that I realized just how bad it's been. He was basically in self-destruct mode, trying to intentionally ruin his marriage and his family, like some sort of self-fulfilled prophecy "I'm not happy, my life sucks, my kids and wife would jsut be better without me, I'm going to make it quicker and easier by screwing up as much as I can" kind of thing. (he didn't say that, but it's my opinion that's what was going on)

He and I are working on our marriage, working through some of the "fixable" issues (like his feeling that I'm overbearing, my feeling that he is far from pulling his share, things like that) but meanwhile, while we work hard on forgiving, compromising, etc, I think he needs more mental health help.

Could this be a form of male post partum depression? If it is, does that change the treatment any? Is it common for someone to be stable on a med for a while, then suddenly not be? Is his body just accustomed to the dosage, is it common to need an increased dose after a while? Is that a sign of something else? I have spent a lot of time trying to understand the psychology of depression, but I am still lost on the chemical side of it, and how the meds work, what the progression of pharmaceutical treatment is. Is this something that our family practice dr can handle, or should he (if he agrees to) go back to the psychiatrist? Is there a specific "type" of psychiatrist he should go to if we suspect there's an element of post partum?

Thanks so much!

[JavaJunkie]

Originally Posted by 2boyzmama

Could this be a form of male post partum depression? If it is, does that change the treatment any? Is it common for someone to be stable on a med for a while, then suddenly not be? Is his body just accustomed to the dosage, is it common to need an increased dose after a while? Is that a sign of something else? I have spent a lot of time trying to understand the psychology of depression, but I am still lost on the chemical side of it, and how the meds work, what the progression of pharmaceutical treatment is. Is this something that our family practice dr can handle, or should he (if he agrees to) go back to the psychiatrist? Is there a specific "type" of psychiatrist he should go to if we suspect there's an element of post partum?

Thanks so much!

I can't answer the male PPD questions, but I did want to say that it is completely possible for a med to stop working/not work as effectively as it once did. Sometimes a dosage change is needed, sometimes a new med is needed. FYI, sometimes going on a smaller dose can actually help, rather than a larger dose(like if you are on the highest dose possible). But that is definitely something to talk with a doctor(preferably psychiatrist) about.

I remembered coming across an article about male PPD recently, so I just went to see if I could track it down again. Here's a link: When Dads Get Depressed

[LynnS6]

I don't think it's quite the same for men as it is for women, as they don't have the hormonal changes that go along with PPD. That being said, for people who are prone to depression, times of major stress can really trigger depressive episodes. You've had a major amount of stress in the last several years.

I remember being given a stress quiz when I was diagnosed with PPD, something like this. It tallied up the points and anything over 300 puts you at 'major risk for stress related illness'. It turns out my 'stress related illness' is anxiety and depression. I suspect your dh's might be too. My first thought is: Given all that stress, he probably needs a higher dose of meds.

I would recommend that anyone dealing with a chronic illness be seen by a specialist. I love my regular doctor. I'm also treated by a psychiatrist. These days I'm down to once yearly 'check in' visits. But the psychiatrists understand the medications so much better.

For example, when my stress increased, I needed a higher dose of medication. I'm at a pretty good place right now, but am still on a low maintenance dose. I'm trying to decide whether to go off meds, or to keep this. My psychiatrist is better at laying out the pros and cons and things to think about (e.g., I'm entering perimenopause, how will that affect my mood?)

Since a lot of his issues are related to family changes (moving, children, etc.), I would look for two people: 1. A psychiatrist who is experienced in treating men (fewer men than women get treated) and 2. A counselor who is experienced with men and family issues. He needs a counselor of his own who he feels comfortable with. Unfortunately, most psychiatrists don't do a lot of counseling.