Depression Men Update 1021

Why The Hell Am I Feeling This Way?
Men and The Dreaded “D” Word:

The Male Depression Syndrome
Ken Donaldson
Licensed Mental Health Counselor
Men and The Dreaded “D” Word: The Male Depression Syndrome
___________________________________________________________________

By Ken Donaldson
All Rights Reserved

© 2008 Kenilee, Inc.
Contributions from:
The National Institute of Mental Health (NIMH)
National Institutes of Health (NIH)
U.S. Department of Health and Human Services (USDHHS)
Substance Abuse and Mental Health Services Administration (SAMHSA)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
The National Institute on Drug Abuse (NIDA)
National Center for Complementary and Alternative Medicine (NCCAM)
Wikipedia
Published by Kenilee Ink, a division of Kenilee, Inc.

P.O. Box 4654, Seminole FL 33775
(727) 394-7325
No part of this publication may be reproduced or transmitted in any way by any means,
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permission from Ken Donaldson, except as provided by USA copyright laws.
Created in the United States.
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Ken Donaldson, LMHC
www.KenDonaldson.com
(727) 394-7325
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First, let’s get all the legal stuff out of the way…
DISCLAIMER AND TERMS OF USE AGREEMENT
The author/publisher of this Digital Book and the accompanying materials has used the best
efforts in preparing this Digital Book. The author/publisher makes no representation or
warranties with respect to the accuracy, applicability, fitness, or completeness of the contents of
this Digital Book. The information contained in this Digital Book is strictly for educational
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EVERY EFFORT HAS BEEN MADE TO ACCURATELY REPRESENT THIS PRODUCT AND
IT'S POTENTIAL. YOUR LEVEL OF SUCCESS IN ATTAINING THE RESULTS CLAIMED IN
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AND TECHNIQUES MENTIONED, YOUR FINANCES, KNOWLEDGE AND VARIOUS SKILLS.
SINCE THESE FACTORS DIFFER ACCORDING TO INDIVIDUALS, WE CANNOT
GUARANTEE YOUR SUCCESS. NOR ARE WE RESPONSIBLE FOR ANY OF YOUR
ACTIONS.
MANY FACTORS WILL BE IMPORTANT IN DETERMINING YOUR ACTUAL RESULTS AND

NO GUARANTEES ARE MADE THAT YOU WILL ACHIEVE RESULTS SIMILAR TO OURS
OR ANYBODY ELSES, IN FACT NO GUARANTEES ARE MADE THAT YOU WILL ACHIEVE
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This Digital Book is © copyrighted by Ken Donaldson. No part of this may be copied, or changed
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any circumstances.
This is NOT intended as a substitute for medical or mental health care. You
should always seek out professional help from a physician or psychotherapist if
you feel depressed.
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Ken Donaldson, LMHC
(727) 394-7325
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The book is dedicated to all my brothers:

The men of the world.
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Table Of Contents
Who IS Ken Donaldson?.......6
Introduction: Why Am I Writing This?.......7
So…What’s MY Story?.......12
Depression Facts, Stats and Acts:

What Makes It Different For A Man…….18
“But I Don’t Feel That Way”

Men And Their Covert Depression…….30
The Depression Connection With

The Affliction Of Addiction…….40
Okay, Now That I Got It,

What Do I Do With It?.......53
I’m A Guy…
I Don’t Need Any Medication!.......62
Aren’t There Other Options?

A Brief Overview Of Complementary
And Alternative Medicine…….72
I Don’t Need Any Help!

I Can Handle It On My Own!.......82
You Can Give Your Friends And Family

Members The Next Few Pages…….98
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Ken Donaldson, LMHC
(727) 394-7325
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Who IS Ken Donaldson?
I’ve been based in Tampa Bay, Florida offering counseling, coaching,

and educational programs since 1987. I’m a licensed mental health
counselor; board certified as an addictions professional and clinical
hypnotherapist; and certified as a master relationship coach. I am also
a graduate of the University of South Florida, the Institute for Life
Coach Training and the Relationship Coaching Institute. I’ve been
exclusively in private practice since 1993.
I am also the author of the breakthrough life and relationship success

book Marry YourSelf First! Saying “I Do” to a Life of Passion,
Power, Purpose and Prosperity. The material in this book is a result
of my clinical counseling and coaching experience with thousands of
individuals and couples. Find out more at
https://kendonaldson.com/the-marry-yourself-first-store/.
I was also one of six people who received the 2006 Tampa Bay
Health Care Hero Award.
I founded the REALationship Coaching programs that empower

people to have more successful lives, businesses and relationships by
building a powerful relationship with themselves first. All of my
workshops are designed to assist all the participants to live the most
passionate and balanced lives possible.
The Marry YourSelf First! program has assisted numerous singles in

having more successful relationships and more satisfying lives.
The Partners for Life program for couples provides the tools and
resources to help couples create more fulfilling relationships. Couples
report they have deeper intimacy and more fun as a result of utilizing
the tools from these programs.
I also offer several education and training programs for businesses and community
organizations. Visit my website at www.KenDonaldson.com to get a complete list of the topics
offered.
You may contact me directly at:
Ken Donaldson
PO Box 4654
Seminole FL 33775
(727) 394-7325
keni.lee@verizon.net
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Introduction:
Why Am I Writing This?
“One in five Americans are depressed or unhappy, and report

high levels of stress, anxiety and sadness.”
~Reuters Health, HealthCentral.com - Nov. 2000
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Ken Donaldson, LMHC
(727) 394-7325
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Hiding in my room, safe within my womb,

I touch no one and no one touches me.
I am a rock,
I am an island.
And a rock feels no pain;

And an island never cries.
Paul Simon
From song I Am a Rock
Why have I taken the time to write this? Is it because I see men every week in my
practice who struggle with depression? Is it because I know there are millions who are
also suffering unnecessarily because they don’t understand what’s going on with them
or are too resistant to seek out help? Or is it because I too have struggled with this
dreaded darkness and I know the effects firsthand both on me as a person, and as a
man?
How about All Of The Above!
For too long we have wrestled with the stigmas of mental health issues and all
the varied diagnoses. Many of us have taken on beliefs that “we’re showing our
weakness if we have to ask for help.” Nothing could be further from the truth.
It takes courage and strength to ask for help and commit to overcoming
depression. And for what it’s worth, there are, and have been, many other men who’ve
wrestled with the same demons of darkness.
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Ken Donaldson, LMHC
(727) 394-7325
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Here’s a few you’ve probably heard of:
1. Abraham Lincoln - Former President
2. Adam Ant - British Musician
3. Adam Duritz - Lead singer for the group Counting Crows
4. Billy Corgan - Musician from the band The Smashing Pumpkins
5. Billy Joel - Musician
6. Boris Yeltsin – Former Russian President
7. Brian Wilson – One of the Beach Boys
8. Buzz Aldrin – Former astronaut
9. Dick Cavett - American talk show host
10. Drew Carey - Comedian and host of The Price Is Right
11. Harrison Ford - Actor
12. Heath Ledger - Actor
13. Hugh Laurie - British actor who portrays Dr. Greg House on Fox
14. Jim Carrey - Comedian and actor
15. John Denver – Singer and songwriter
16. Kurt Cobain - Lead singer and guitarist for Nirvana
17. Mark Roget - Creator of Roget's Thesaurus
18. Mike Wallace – Newscaster
19. Owen Wilson - Actor
20. Richard Jeni - Comedian
21. Rodney Dangerfield – Actor and comedian
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Ken Donaldson, LMHC
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22. Tennessee Williams - American playwright
23. Terry Bradshaw – Former Football Hall of Fame star
24. Thomas F. Eagleton - 1972 running mate of presidential candidate

George McGovern
25. Trent Reznor - American musician from the band Nine Inch Nails
26. Vincent Van Gogh – Artist
27. Winston Churchill – Prime Minister of Great Britain
“From his mid-20s, Abraham Lincoln was recognized by

his closest friends as a person afflicted with melancholia,
called today depression, whose lowest points were so
intense that they had to take razors away from him and
even lock him up to protect Lincoln from injuring himself.
In the early 1840s, he suffered a second attack of depression
that set him permanently on a pattern of illness which left
Lincoln under the daily care of a doctor…His friends would
watch as he would sit quietly in a corner;
far, far away from the levity and good times around him.”
~ Joshua Wolf Shenk
Some of these men faced the depression and dealt with it. Some even became
spokesmen to help increase the awareness of depression, particularly with men.
And of course, you’ll also see some names of men who didn’t deal with the
depression and lost their lives to it.
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
This book was written for you…to remind you that you have a choice. And to let you
know that help is available and there are many ways to combat depression.
Left untreated, however, like any disease, it will get worse and it will take away your
life, piece by piece.
As men, we must remember that we are also human, and even though we may have
been programmed to NOT ask for help or NOT acknowledge our emotional needs; that
doesn’t make them go away.
The goal of this book is to provide you with the information you need to make
healthy choices for your mental health and wellbeing.
“Just like other illnesses, depression can be

treated so that people can live happy, active
lives.”
~Tom Bosley, Actor
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Ken Donaldson, LMHC
(727) 394-7325
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So…What’s MY Story?
“I cry a lot. My emotions are very close to my surface.

I don't want to hold anything in, so it festers and
turns into pus - a pustule of emotion that explodes
into a festering cesspool of depression.”
~Nicolas Cage, Actor
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Ken Donaldson, LMHC
(727) 394-7325
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Through the Darkness, I Do Go…
These days of night overcome my Soul

They are tearing me apart and I am left less than whole
Despondent and broken; I find no hope
I lose my vision and just don’t cope
Trudging through these days of night
I can only survive and for that I do fight
I breathe my breath one at a time
Taking small steps to ease my mind
I understand not these days of night
And why they occur and cause such fright
But humbled am I and perhaps that is why
Tears fall from heaven as inside, I do cry
I see the life that I did not so live
And now in the stillness, to me, I forgive
I can let go of the “should” of the past
It’s time to be freed of the guilt I have amassed
And in this hour of the darkest of dark
I find my feet a-shuffling, as I do embark
I embark on my journey, my journey to the Light
I now know the gift that was brought by this night
And shall I, again, return to this place
I can walk through with courage and feel not disgraced
For I am but so human and so I do have faults
But I shame not myself through any inner assault
Yes, through the darkness, yes, I do go
The Yin of the Yang, the balance of the flow
Perfect imperfection, yes, that is my life
I dance with this moment and let go of inner strife…
~Ken Donaldson
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
In 1993 I fell into a very painful depression. I was not even a year out of graduate
school with my master’s degree in counseling, and my former wife and I were headed
for divorce. When I look back at that today, I can clearly see that even though that was
the first time I truly acknowledged depression, it had been around my life for many
years.
As a teenager, I often felt lonely, alone and out of place. I would have easily met
the criteria for clinical depression. I, however, found “refuge” through drugs and alcohol.
In fact, during my high school years there were far fewer days that I wasn’t high on
something then days when I was high. I felt accepted by my alcohol and drug-using
friends, so there was some level of happiness…so I thought.
Actually, it was more like a blanket over the real problem. The drugs and alcohol
just merely allowed me to not feel all those feelings I so despised. I still felt inadequate,
self-conscious and suffered from very poor self-esteem. I stopped playing sports. I
stopped many of my creative outlets and closed myself farther and farther into the world
of depression and addiction.
I thought all was well until I got arrested for possession of drugs. Then I got
arrested again. And then even a third time. And the third time was the true clincher:
Mandatory prison time with no plea bargaining.
For the first time in my life, I was truly scared. Really scared!
My parents didn’t really have a clue about my extensive drug usage and had
even less awareness of the depression that had been haunting me. They were good
parents, but like many parents, they got busy and they didn’t think anything like this
would happen in their home with their family.
I was strongly encouraged to voluntarily get into a treatment program, and I did. I
was there for many, many weeks before I had the courage to speak up in any of the
groups. When I finally did open my mouth and say a few things, I felt a tremendous
relief. Like a lifelong burden had been lifted off my chest.
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Ken Donaldson, LMHC
(727) 394-7325
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I stayed in that program for almost two years. Miraculously, the charges were
lowered from a felony to a misdemeanor and I ended up with only a conditional
discharge: Stay out of trouble for a year and the charges would be dropped.
And I did…but not for much longer than that.
About a year and a half after I graduated from that treatment program, I was back
out drinking and drugging…and not feeling very good about myself.
This time I was introduced to cocaine: This was my instant self-esteem booster.
When I was high on coke, I felt like a million dollars. I felt like I could do anything. I
wasn’t afraid of anything.
Until I crashed, that is. And when I finally did crash, I had managed to lose my
job, most of my friends, my first true girlfriend, all my money and much of my sanity.
I fell into a deep depression for about six months. On top of everything, I had to
move back in with my mother and father, which left me feeling even worse about myself.
I felt like a true loser!
There were days I just stayed in bed. I tried to work, but I left a number of jobs
halfway through the day, or only stayed for a few days or weeks. I couldn’t focus and
the slightest little frustration would just throw me over the edge.
Somehow, I pushed myself through all that. I finally landed a decent job in retail
and soon was promoted. I started to really get into my work. There were sales contests
every week and I actually won one week. I began to feel really good about myself, as
long as sales were up. Anytime there was an off day or an off week, I felt bad again.
In looking back at that time of my life, I can see that I still didn’t feel very good
about myself, but I found a way to compensate: Become a workaholic!
In addition to my workaholic mode, I also started to date more during those
years, as well as getting into long distance running. Today I can clearly see the
addictive patterns even in the relationships I was in: I used them as an attempt to feel
good about myself and to escape, just like I had done with all the drugs, from my true
feelings.
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
In retrospect I also see the addictive patterns in the running I was doing as I ran
every day and sometimes twice a day. A friend once asked me, “What are you running
from?” I tried to ignore his question but somehow it stuck with me.
What WAS I running from?
Answer: Myself!
Yes, even though the rest of the world thought I was doing great because of my
work performance, my running and my many girlfriends, deep-down inside there was
still an emptiness.
It was in my late twenties that I had a “spiritual experience.” I came to realize that I
needed something more than just myself to function in this life. I got involved in a local
church and much like my workaholic tendencies; I dove into the world of religion with an
unbridled fervor. Before long, I was on committees, involved in teaching and
volunteering for anything I could. Ironically, I never felt like I was doing enough. I also
never really felt truly connected spiritually, although I did enjoy the community of the
church.
This is where I met my former wife and shortly after we started to date, we
announced our engagement. Nothing like being impulsive! In addition, that’s when I also
felt called to go back to school to become a psychotherapist. Needless to say, we went
through a lot of change and upheaval during the early years of our relationship. We
ended up in therapy within the first year because we would have these “irresolvable”
fights.
The marriage lasted a little over 6 years and we were in and out of therapy the
entire time. When we finally decided that it wasn’t going to work and she moved out, I
was left facing my aloneness once again.
This time all the emotions I never dealt with over my lifetime seemed to come
rushing to the surface. I was wiped out most days and did all I could just to go to work
and do my job. Needless to say, I’m sure I wasn’t very effective as a therapist.
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
All this emotional chaos and relationship breakdown really left me doubting my ability
as a therapist.
“How am I going to be able to help others when I can’t even seem to hold my
own life together?”, was a question I asked myself frequently.
Because of all my addictive tendencies, I decided to seek out some 12-step
recovery groups. I heard many people share many of the same struggles I had been
trying to deal with my entire life. I felt like what I was looking for in church I found in
those 12-step groups.
I also saw a therapist on a regular basis and tried a number of antidepressants
over the course of the next few years. This combination was helping as I began to feel
better about myself. I began to discover, for the first time in my life, who I really was. My
confidence grew and much of the self-doubt began to subside.
Since 1993 I’ve had a number of peaks and valleys, but I continue to go in a
general upward direction. I’ve been involved in a couple of men’s support groups and
continue to see therapists and coaches when the load gets too big for me.
The bottom-line is that I realize that I’ve been through quite a bit with this battle
with depression and it’s time for me to give back to other men who may be struggling
with similar issues and dynamics.
My goal is to provide information, heighten awareness and offer hope.
“You largely constructed your depression. It wasn't given

to you. Therefore, you can deconstruct it.”
~Albert Ellis, Founder of Cognitive Therapy
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Ken Donaldson, LMHC
(727) 394-7325
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Depression Facts,
Stats and Acts:
What Makes It
Different For A Man
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Ken Donaldson, LMHC
(727) 394-7325
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The Basics
Depression is a serious medical condition that affects your body, mood, and
thoughts. It affects your eating and sleeping habits. It affects how you think about
things, and your self-perception. A depressive disorder is not the same as a passing
blue mood. It is not a sign of personal weakness or a condition you just will or wish
away. People with a depressive illness cannot merely "pull themselves together" and
get better. Without treatment, symptoms can last for weeks, months, or years. The good
news is that, with appropriate treatment, you can get better. In fact, there’s a good
chance you can have full recovery.
"I can remember it started with a loss of interest in basically

everything that I liked doing. I just didn't feel like doing anything. I
just felt like giving up. Sometimes I didn't even want to get out of
bed."
~Rene Ruballo, Police Officer
Depression can strike anyone regardless of age, ethnic background,

socioeconomic status, or gender; however, large-scale research studies have found that
depression is about twice as common in women as in men. In the United States,
researchers estimate that in any given one-year period, depressive illnesses affect 12
percent of women (more than 12 million women) and nearly 7 percent of men (more
than six million men). But important questions remain to be answered about the causes
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Ken Donaldson, LMHC
(727) 394-7325
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underlying this gender difference. We still do not know if depression is truly less
common among men, or if men are just less likely than women to recognize,
acknowledge, and seek help for depression. Furthermore, the diagnostic criteria may
not be fully accurate and, therefore, men may be under-diagnosed or misdiagnosed.
This will be addressed further later on.
Here are some additional statistics to consider:
• 54% of people believe depression is a personal weakness.
• 80% of depressed people are not currently receiving any treatment.
• 92% of depressed African American males do not seek treatment.
• 15% of depressed people commit suicide.
• Everyone, at some time in their life, will be directly affected by depression
– their own, a loved one or friend, or a coworker or employee.
• It’s estimated that depression costs employers more than 1 billion dollars
per year in absenteeism and lost productivity (and that doesn’t include
medical or pharmaceutical bills).
In focus groups conducted by the National Institute of Mental Health (NIMH) to

assess depression awareness, men described their own symptoms of depression
without realizing that they were depressed. Notably, many were unaware that "physical"
symptoms, such as headaches, digestive disorders, and chronic pain, can be
associated with depression. In addition, men were concerned that seeing a mental
health professional or going to a mental health clinic would have a negative impact at
work if their employer or colleagues found out. They feared that being labeled with a
diagnosis of mental illness would cost them the respect of their family and friends, or
their standing in the community.
So even though the statistics show men having a far lower incidence, there are
many unanswered questions as to the true validity of those numbers due to men’s
heightened resistance to get help, their lack of insight regarding the symptoms of
depression and the possibility of inadequate or incomplete diagnostic criteria.
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Ken Donaldson, LMHC
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Over the past 20 years, biomedical research, including genetics and

neuroimaging, has helped to shed light on depression and other mental disorders
increasing our understanding of the brain, how its biochemistry can go awry, and how to
alleviate the suffering caused by mental illness. Brain imaging technologies are now
allowing scientists to see how effective treatment with medication or psychotherapy is
reflected in changes in brain activity. As research continues to reveal that depressive
disorders are real and treatable, and no greater a sign of weakness than cancer or any
other serious illness, more and more men with depression may feel empowered to seek
treatment and find improved quality of life.
Types of Depression
Just like other illnesses, such as heart disease, depression comes in different
forms. There are three common types of depressive disorders. However, within these
types, there are variations in the number of symptoms, their severity, and persistence.
Major depression (or major depressive disorder) is manifested by a combination
of symptoms (see symptoms list below) that interferes with the ability to work, study,
sleep, eat, and enjoy once pleasurable activities. A major depressive episode may
occur only once; but more commonly, several episodes may occur in a lifetime. Chronic
major depression may require a person to continue in treatment.
A less severe type of depression, dysthymia (or dysthymic disorder), involves
long-lasting, chronic symptoms that do not seriously disable, but keep one from
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Ken Donaldson, LMHC
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functioning well or feeling good. Many people with dysthymia also experience major
depressive episodes at some time in their lives.
Another type of depressive illness is bipolar disorder (or manic-depressive
illness). Bipolar disorder is characterized by cycling mood changes: severe highs
(mania) and lows (depression), often with periods of normal mood in between.
Sometimes the mood switches are dramatic and rapid, but usually they are gradual.
When in the depressed cycle, an individual can have any or all of the symptoms of
depression. When in the manic cycle, the individual may be overactive, over-talkative,
and have a great deal of energy. Mania often affects thinking, judgment, and social
behavior in ways that cause serious problems and embarrassment. For example, the
individual in a manic phase may feel elated, full of grand schemes that might range from
unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated,
may worsen to a psychotic state.
“In the midst of winter, I finally learned that there was in me an

invincible summer."
~Albert Camus
There is also another type of depressive disorder referred to as Seasonal Affective

Disorder, also ironically called SAD. Some people experience a serious mood change
when the seasons change. They may sleep too much, have little energy, and crave
sweets and starchy foods. They may also feel depressed. Though symptoms can be
severe, they usually clear up. It usually happens during the winter. A less common type
of SAD happens in the summer.
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Ken Donaldson, LMHC
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What causes SAD? Some experts think it's a lack of sunlight during winter, when the
days are shorter. In the United States, it is much more common in northern states. Light
therapy, in which patients expose themselves to a special type of light for 30 minutes
every day often helps.
Other treatments include:
• Medicines
• Changes in diet
• Learning to manage stress
• Going to a sunny climate during the cold months
“Anybody who is 25 or 30 years old has physical scars

from all sorts of things, from tuberculosis to polio.
It's the same with the mind.”
~Moses R. Kaufman
Typical Symptoms of Depression and Mania
Not everyone who is depressed or manic experiences every symptom. Some

people experience only a few; some people suffer many. The severity of symptoms
varies among individuals and also over time.
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Ken Donaldson, LMHC
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Depression
• Persistent sad, anxious, or "empty" mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in hobbies and activities that were
once enjoyable, including sex.
• Decreased energy, fatigue; feeling "slowed down."
• Difficulty concentrating, remembering, or making decisions.
• Trouble sleeping, early-morning awakening, or oversleeping.
• Changes in appetite and/or weight.
• Thoughts of death or suicide, or suicide attempts.
• Restlessness or irritability.
• Persistent physical symptoms, such as headaches, digestive disorders, and
chronic pain that do not respond to routine treatment.
"You don't have any interest in thinking about the future, because
you don't feel that there is going to be any future." ~Shawn
Colten, National Diving Champion
Mania
• Abnormal or excessive elation.
• Unusual irritability.
• Decreased need for sleep.
• Grandiose notions.
• Increased talking.
• Racing thoughts.
• Increased sexual desire.
• Markedly increased energy.
• Poor judgment and inappropriate social behavior.
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Ken Donaldson, LMHC
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Co-Occurrence of Depression with Other Illnesses
Depression can coexist with other illnesses. In such cases, it is important that the
depression and each co-occurring illness be appropriately diagnosed and treated.
Research has shown that the following anxiety disorders often accompany
depression:
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder
• Panic disorder
• Social phobia
• Generalized anxiety disorder
Depression is especially prevalent among people with PTSD, a debilitating

condition that can develop after exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened.
Traumatic events that can trigger PTSD include violent personal assaults,
such as rape or mugging, natural disasters, accidents, terrorism, and military combat.
PTSD symptoms include re-experiencing the traumatic event in the form of:
• Flashback episodes
• Memories or nightmares
• Emotional numbness
• Sleep disturbances
• Irritability
• Outbursts of anger
• Intense guilt
• Avoidance of any reminders or thoughts of the ordeal
In one NIMH-supported study, more than 40 percent of people with PTSD also
had depression when evaluated at one month and four months following the traumatic
event.
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Ken Donaldson, LMHC
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Substance use disorders (abuse or dependence) also frequently co-occur with

depressive disorders. Research has revealed that people with alcoholism are almost
twice as likely as those without alcoholism to also suffer from major depression. In
addition, more than half of people with bipolar disorder type I (with severe mania) have
a co-occurring substance use disorder.
“Alcohol temporarily blunts the effects of stress hormones. It typically

leaves you feeling worse than ever because it depresses the brain and
nervous system. One study looked at people who consumed one drink
a day. After three months abstinence, their scores on standard
depression inventories improved.” ~The Brain, "You Can Control Your
Emotional Wellness," USA WEEKEND, Jan. 3, 1999, Jim Thorton
Depression has been found to occur at a higher rate among people who
have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and
Parkinson's. Symptoms of depression are sometimes mistaken for inevitable
accompaniments to these other illnesses. However, research has shown that the co-
occurring depression can and should be treated, and that in many cases treating the
depression can also improve the outcome of the other illness.
Causes of Depression
Substantial evidence from neuroscience, genetics, and clinical investigation

shows that depressive illnesses are disorders of the brain. However, the precise causes
of these illnesses continue to be a matter of intense research.
Modern brain-imaging technologies reveal that, in depression, neural circuits
responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to
function properly, and critical neurotransmitter chemicals (primarily serotonin, dopamine
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
and noreprinephrine) that brain cells use to communicate are out of balance. Studies of
brain chemistry, including the effects of antidepressant medications, continue to further
our understanding of the biochemical processes involved in depression.
In some families, depressive disorders seem to occur generation after
generation; however, they can also occur in people with no family history of these
illnesses. Genetics research indicates that risk for depression results from the influence
of multiple genes acting together with environmental or other nongenetic factors.
“Stress, or drugs such as alcohol or cocaine, can activate a

gene that is linked to depression and other mental problems.
The result can give rise to seizures, depression, manic-depressive
episodes and a host of mental problems.” ~Robert Post, National
Institute of Health (NIH), Washington Post Health, Aug. 31, 1993
Very often, a combination of genetic, cognitive, and environmental factors is

involved in the onset of a depressive disorder. Trauma, loss of a loved one, a difficult
relationship, a financial problem, or any stressful change in life patterns, whether the
change is unwelcome or desired, can trigger a depressive episode in vulnerable
individuals. Later episodes of depression may occur without an obvious cause.
In addition, most of us men have not had the best role modeling regarding the
expression of our emotions. Plus, many of us – myself included - have also subscribed
to a “macho” attitude in which asking for help or acknowledging pain, emotional or
otherwise, is considered to be a weakness.
Many men have come from abusive homes, broken homes or alcoholic homes,
and never learned adequate coping skills to deal with the everyday challenges of life.
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Ken Donaldson, LMHC
(727) 394-7325
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Furthermore, the media portrays “the tough guy” more times than not in movies
and on TV, so if we are not careful, we are invited to subscribe to all this constant
programming.
Men who have financial difficulties or lose their jobs are also more likely than
women to exhibit signs of depression under these conditions. These findings could be
because men put more pressure on themselves to perform and they also get more of
their self esteem from their work and their financial status. Likewise, recent studies have
confirmed that the overall mental health of unemployed men is far worse than
unemployed women.
“He was clinically depressed, but only in hindsight does he recognize

the symptoms and clues. He had genetic precursors for depression
— an aunt who had been hospitalized with schizophrenia, a mother
who had had bouts of depression, a niece who was bipolar. Hipple
himself struggled with depression as a teenager but didn't realize it
until he recalled
it years later as an adult.
Suddenly, now in his late 30s, he was unable to get out of

bed for work. His energy lagged. He couldn't face the office.
The business eventually went bankrupt through his neglect.
He turned to drinking and drugs and risk-taking behavior.”
~Doug Robinson, Deseret News, Nov. 27, 2008,
“Thankful for son's years,” article about Eric Hipple,
Former NFL quarterback
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Ken Donaldson, LMHC
(727) 394-7325
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“But I Don’t Feel That Way”

Men And Their Covert
Depression
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Ken Donaldson, LMHC
(727) 394-7325
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As written earlier, researchers estimate that at least six million men in the United
States suffer from a depressive disorder every year. Research and clinical evidence
reveal that while both women and men can develop the standard symptoms of
depression, they often experience depression differently and may have different ways of
coping with the symptoms. Men may be more willing to acknowledge fatigue, irritability,
loss of interest in work or hobbies, and sleep disturbances rather than feelings of
sadness, worthlessness, and excessive guilt. Some researchers question whether the
standard definition of depression and the diagnostic tests based upon it adequately
capture the condition as it occurs in men. Therefore, men’s depression may be more
“covert” or hidden, therefore misdiagnosed, than women.
So, the question is raised as to why depression in men may be undiagnosed and
undetected. The following premises have considerable possibilities:
1. The typical symptoms of depression in men may be different from those which
are typically found in women.
2. Men don't equate certain physical symptoms, such as sexual problems, with
depression.
3. Men often resist seeking help from their immediate support network while other
males don't typically ask questions about their mental health.
"Events become more irritating, you get more frustrated about getting
things done. You feel angrier, you feel sadder.
Everything's magnified in an abnormal way."
~Paul Gottlieb, Publisher
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Ken Donaldson, LMHC
(727) 394-7325
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Regardless of the possible symptom differences, the impact and negative effects
can be devastating. For example, the NIMH estimates that productivity and work
performance can drop by as much as 30%. Furthermore, they also have found that
depression is THE main root for divorce of men in midlife (which is four times higher
than other times in their lives). Furthermore, 80% of all suicide victims are men and the
suicide rate for men in their 40s and 50s is more than three times the national average.
"When I was feeling depressed, I was very reckless with my life. I

didn't care about how I drove. I didn't care about walking across
the street carefully. I didn't care about dangerous parts of the city.
I wouldn't be affected by any kinds of warnings on travel or places
to go. I didn't care. I didn't care whether I lived or died and so I was
going to do whatever I wanted whenever I wanted. And when you
take those kinds of chances, you have a greater likelihood of dying."
~Bill Maruyama, Lawyer
Are There Gender Differences in Depression?
Men who are depressed tend to “act out” while depressed women typically “act
in.” Because of the often-huge difference of symptoms between the genders and what
may be a lack of accurate diagnostics, there can often be misdiagnosis or a missed
diagnosis.
Here’s a quick self assessment to take. No research has been done, so don’t
consider it to be a “valid” test, but it may shed some light on what you’re experiencing
right now. How many of the following do you answer “yes” to?
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Ken Donaldson, LMHC
(727) 394-7325
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The Male Depression Indicator Test
1.) I have a short temper.

2.) I feel discontent or don’t find much meaning in life.
3.) I am easily annoyed, frustrated and/or grumpy much of the time.
4.) My sex life isn’t fulfilling.
5.) I have difficulty controlling my anger.
6.) I don’t feel connected, loving or lovable in my primary relationship.
7.) I use drugs or alcohol to cope with stress.
8.) I feel disappointed by other people frequently.
9.) I don’t feel much, and I often just want to isolate myself.
10.) I don’t have much sexual desire
11.) I often blame others for my mood or feelings.
12.) I seem to always be in one conflict or another.
13.) I feel restless and I’m easily agitated.
14.) I’m compulsive at times: I act without thinking.
15.) My sleeping patterns are messed up: I oversleep or under-sleep.
16.) I have a huge fear of failure that no one else knows about.
17.) I engage in high-risk or reckless behavior.
18.) I check-out from life via the TV, computer and the Internet.
19.) I inappropriately act out sexually.
20.) I don’t feel like anyone loves me…I feel unlovable.
If you said “yes” to five or more, I’d recommend that you go talk to someone.
Furthermore, you can see how these symptoms are quite different than the typical
depressive symptoms.
Although there has not been an exhaustive study, there are a number of clear
differences in the depressive symptoms between men and women, and between what
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Ken Donaldson, LMHC
(727) 394-7325
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has been the traditional diagnostic criteria (as listed previously) and what may be
missing in the correct diagnosis of men with depression.
For example, men are more likely than women to report alcohol and drug abuse
or dependence in their lifetime; however, there is debate among researchers as to
whether substance use is a "symptom" of underlying depression in men or a co-
occurring condition that more commonly develops in men. Nevertheless, substance use
can mask depression, making it harder to recognize depression as a separate illness
that needs treatment.
The following serves as a basic and general overview of gender differences in

the symptoms of depression and should not be considered a comprehensive list:
Men’s Typical Symptoms Women’s Typical Symptoms

Blames others Blames self
Easily angered and irritable Sad, withdrawn and worthless
Suspicious and guarded Anxious and frightened
Conflict creator Conflict avoider
Hostile and rude Tries to be overly nice
Restless and easily agitated Apathetic and nervous
Compulsive Procrastinates
Under-sleeping Over-sleeping
Tries to over-control Loses control
Fears failure Doesn’t see successes
Demands respect No self respect
Medicates via drugs & alcohol Medicates via food
Control focused Feels out of control
No talk about failure or weakness Open about failure/weakness
Withdrawals via internet & TV Withdrawals from friends

High risk and reckless behaviors Avoids any risks and isolates
Sexual acting out Sexually shut down
“You don’t love me enough” “Do I love you enough?”
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
You can easily see some of the radical differences between men and women.
And because of these differences, men may “fall between the cracks” when they do
seek out professional help. Unfortunately, many professionals don’t have the awareness
and insight about these gender differences.
Instead of acknowledging their feelings, asking for help, or seeking appropriate
treatment, men may turn to alcohol or drugs when they are depressed, or become
frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men
deal with depression by throwing themselves compulsively into their work, attempting to
hide their depression from themselves, family, and friends. Other men may respond to
depression by engaging in reckless behavior, taking risks, and putting themselves in
harm's way.
More than four times as many men as women die by suicide in the United States,
even though women make more suicide attempts during their lives. In light of research
indicating that suicide is often associated with depression, the alarming suicide rate
among men may reflect the fact that men are less likely to seek treatment for
depression. Many men with depression do not obtain adequate diagnosis and treatment
that may be life saving.
"I'd drink and I'd just get numb. I'd get numb to try to numb my head. I
mean, we're talking many, many beers to get to that state where you
could shut your head off, but then you wake up the next day and it's still
there. Because you have to deal with it, it doesn't just go away. It isn't a
two-hour movie and then at the end it goes 'The End' and you press off. I
mean it's a twenty-four hour a day movie and you're thinking there is no
end. It's horrible."
~Patrick McCathern, First Sergeant, U.S. Air Force, Retired
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Ken Donaldson, LMHC
(727) 394-7325
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More research is needed to understand all aspects of depression in men,

including how men respond to stress and feelings associated with depression, how to
make men more comfortable acknowledging these feelings and getting the help they
need, and how to train physicians to better recognize and treat depression in men.
Family members, friends, and employee assistance professionals in the workplace also
can play important roles in recognizing depressive symptoms in men and helping them
get treatment.
Depression in Older Men

Men must cope with several kinds of stress as they age. If they have been the
primary wage earners for their families and have identified heavily with their jobs, they
may feel stress upon retirement, loss of an important role, loss of self-esteem that can
lead to depression. Similarly, the loss of friends and family and the onset of other health
problems can trigger depression.
Depression is not a normal part of aging. Depression is an illness that can be
effectively treated, thereby decreasing unnecessary suffering, improving the chances for
recovery from other illnesses, and prolonging productive life. However, health care
professionals may miss depressive symptoms in older patients.
“Americans, 65 and older account for about 13 percent

of the population but almost 20% of all suicides. The national
rate is 11 suicides for every 100,000 people. This is higher
than any other age group, and the attempts are strikingly lethal:
one out of four succeeds compared to one out of 200 for
young adults. The graying baby boomers are already more
prone to suicide than other generations.”
~Factors behind elderly suicide rate examined, Washington,

The Daily Progress newspaper, Charlottesville, Virginia, July 23, 2002
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Older adults may be reluctant to discuss feelings of sadness or grief, or loss of

interest in pleasurable activities. They may complain primarily of physical
symptoms. It may be difficult to discern a co-occurring depressive disorder in patients
who present with other illnesses, such as heart disease, stroke, or cancer, which may
cause depressive symptoms or may be treated with medications that have side effects
that cause depression. If a depressive illness is diagnosed, treatment with appropriate
medication and/or brief psychotherapy can help older adults manage both diseases,
thus enhancing survival and quality of life.
However, identifying and treating depression in older adults is critical.
There is a common misperception that suicide rates are highest among the
young, but it is older white males who suffer the highest rate. Over 70 percent of older
suicide victims visit their primary care physician within the month of their death; many
have a depressive illness that goes undetected during these visits. This fact has led to
research efforts to determine how to best improve physicians' abilities to detect and
treat depression in older adults.
Approximately 80 percent of older adults with depression improve when they
receive treatment with antidepressant medication, psychotherapy, or a combination of
both. In addition, research has shown that a combination of psychotherapy and
antidepressant medication is highly effective for reducing recurrences of depression
among older adults. Psychotherapy alone has been shown to prolong periods of good
health free from depression and is particularly useful for older patients who cannot or
will not take medication. Improved recognition and treatment of depression in later life
will make those years more enjoyable and fulfilling for the depressed elderly person,
and his family and caregivers.
"I wouldn't feel rested at all. I'd always feel tired. I could get
from an hour's sleep to eight hours sleep, and I would always
feel tired."
~Rene Ruballo, Police Officer
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Suicide
Sometimes depression can cause people to feel like putting themselves in harm's
way or killing themselves. Although the majority of people with depression do not die by
suicide, having depression does increase suicide risk compared to people without
depression.
So, here’s the deal, if you’re thinking about suicide, get help immediately:
• Call your doctor's office.
• Call 911 for emergency services.
• Go to the emergency room of the nearest hospital.
• Ask a family member or friend to take you to the hospital or call your doctor.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-
800-273-TALK (1-800-273-8255) to be connected to a trained counselor at the
suicide crisis center nearest you.
"You are pushed to the point of considering suicide, because living

becomes very painful. You are looking for a way out.
You're looking for a way to eliminate this terrible psychic pain. And I
remember, I never really tried to commit suicide, but
I came awful close, because I used to play matador with
buses. You know, I would walk out into the traffic of New York City, with
no reference to traffic lights, red or green, almost
hoping that I would get knocked down."
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Ken Donaldson, LMHC
(727) 394-7325
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The Depression Connection With

The Affliction Of Addiction
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Ken Donaldson, LMHC
(727) 394-7325
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What’s the first thing you think of when you hear the word “addiction”? “Addiction”
typically brings up many different images and often strong emotions. But if you have a
strong emotional reaction to that word, what is it that you’re really reacting to? Too often
the comparison is to the cliché of the wino passed out in the street or the heroin junkie
begging for money. Those cases are actually few and far between. The truth is that
most people who struggle with addictive behavior blend right in with society.
Furthermore, if the addiction is exposed, too often the underlying depression stays
hidden. If you’re having a strong reaction, I invite you to look at the man in the mirror.
Defining Addiction
First, let’s identify what all is addictive. There are four primary categories with a
few examples in each area:
1.) Substance addiction: Drugs, alcohol and food.

2.) Activity addiction: Shopping, spending, working, video games, internet,
exercising and gambling.
3.) People addiction: Codependent relationships and sexual liaisons.
4.) Emotional addiction: Thrill seeking, “adrenaline junkies” and
rage-aholics.
As you can see, the classic drug and alcohol addiction which most people
stereotype with the word addiction is only a small portion of the big addiction picture.
So, the next obvious question is: What separates addictive behavior from normal
behavior?
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Ken Donaldson, LMHC
(727) 394-7325
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Here are the basic criteria which determine if a behavior is addictive:
• Denial of a problem despite negative consequences and/or losses.

• Continued engagement of the behavior despite repeated negative
consequences.
• Increased tolerance resulting in an increasingly need of more and more of
the behavior.
• A “craving” or a strong need to engage in the behavior despite the
negative consequences.
• Loss of control over the behavior.
• Increased losses and problems in any of the primary areas of one’s life:
Social, emotional, physical, vocational, financial, spiritual, family
• Physical dependence or withdrawal symptoms when the behavior is
stopped.
Physical dependence, which is often thought to be a determining factor of

addiction, is not that important because many of the most addicting and dangerous
addictive behaviors, including many drugs (Crack cocaine and methamphetamine are
clear examples), do not even produce very severe physical symptoms upon withdrawal.
What does matter tremendously is whether or not the addictive behavior causes
what we now know to be the essence of addiction: Uncontrollable and unpredictable,
compulsive seeking and use or engagement, even in the face of negative health and
social consequences.
Essence of Addiction
Compulsive and unpredictable behaviors are the essence of addiction. For the
person struggling with addiction, there is no motivation more powerful than the
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Ken Donaldson, LMHC
(727) 394-7325
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addiction. Eventually, the addict’s entire life becomes centered on the addictive
behavior. At that point, virtually nothing seems to outweigh the addiction as a motivator.
People have committed all kinds of crimes and even abandoned their children
because of addiction.
The following will provide you with a more in-depth overview of three of the more
common addictive behaviors in men: Alcohol, gambling, sex and Internet.
Alcohol
Here’s a short quiz for you to take if you think alcohol may be an issue for you:
• Do you drink alone or when you feel angry or sad?

• Does your drinking ever make you late for work?
• Does your drinking worry your family or friends?
• Do you ever drink after telling yourself you won't?
• Do you ever forget what you did while drinking?
• Do you get headaches or have a hang over after drinking?
• Does a “bad day” make you want to drink?
• Do you hide your drinking from others?
Often times people drink when they encounter some or all of the following:
• Feeling tense and nervous

• Being tired all the time
• Having sleep problems
• Crying often or easily
• Wanting to be alone most of the time
• Feeling numb
• Being angry or irritable
• Having problems concentrating and remembering things
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
If you see any patterns here of your own behavior, it’s time to think twice. If you’re
already struggling with depression, alcohol will only make it worse. Likewise, continued
drinking often times results in an onset of depression.
Gambling
Gambling addiction, also known as compulsive gambling, is referred to as a type of

impulse-control disorder. Compulsive gamblers can’t control the impulse to gamble,
even when they know their gambling is hurting themselves or their loved ones.
Gambling is all they can think about and all they want to do, no matter the
consequences. Compulsive gamblers keep gambling whether they’re up or down, broke
or flush, happy or depressed. Even when they know the odds are against them, even
when they can’t afford to lose, people with a gambling addiction can’t “stay off the bet.”
Gamblers can have a problem, however, without being totally out of control. Long
before an addiction has fully developed, gambling can have a negative impact. Problem
gambling is any gambling behavior that disrupts your life. If you’re preoccupied with
gambling, spending more and more time and money on it, chasing losses, or gambling
despite serious consequences, you have a gambling problem. There are two types of
compulsive or problem gamblers:
• Action gamblers are addicted to the thrill of risk-taking. Gambling itself is

their “drug.” They usually gamble with others, since part of the rush is beating
the house or other gamblers. Action gamblers usually prefer games of skill,
such as card games, craps, and sports betting. They may also play the stock
market.
• Escape gamblers gamble to escape emotional pain, worries, and loneliness.
Rather than gambling to feel a rush, they gamble to feel numb. Escape
gamblers prefer more isolated activities such as slot machines, bingo, and
online poker. They also prefer games that don’t require much thought, so they
can “zone out.”
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Ken Donaldson, LMHC
(727) 394-7325
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So, “problem gambling” includes all gambling behavior patterns that compromise,
disrupt or damage personal, family or vocational pursuits. The essential features are
increasing preoccupation with gambling, a need to bet more money more frequently,
restlessness or irritability when attempting to stop, "chasing" losses, and loss of
control manifested by continuation of the gambling behavior in spite of mounting,
serious, negative consequences. In extreme cases, problem gambling can result in
financial ruin, legal problems, loss of career and family, or even suicide.
Needless to say, you can see how someone who’s struggling with depression
might easily turn to gambling as both a way to escape from their inner turmoil and to
create a high to try to compensate for the same.
The bottom-line is that gambling, like all other addictive behaviors, will only add
to one’s depressed state.
“By gaming we lose both our time and treasure - two things most precious
to the life of man.”
~Owen Felltham
Sexual Addiction
The idea that sex can be an addiction may be new to you. The term "addiction",
as previously outlined, describes any form of self-destructive behavior that one is
unable to stop despite known and predictable adverse consequences. For some people,
sexual behavior fits that description. It involves frequent self-destructive or high-risk
activity that is not emotionally fulfilling, that one is ashamed of, and that one is unable to
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
stop despite it causing repeated problems in the areas of marriage, social relationships,
health, employment, finances, or the law.
You might ask how sex can be an addiction when it is doing what comes
naturally and does not involve abuse of a psychoactive substance like drugs or alcohol,
or any other of the more notable addictive behaviors. Recent advances in
neurochemistry suggest that we carry within us our own source of addictive chemicals
and sexual activity releases many of those natural substances.
When pleasure centers in the human brain are stimulated, chemicals called
endorphins are released into the blood stream. Endorphins are believed to be
associated with the mood changes that follow sexual release. Any chemical that causes
mood changes can be addictive, with repeated exposure altering brain chemistry to the
point that more of the chemical is "required" in order to feel "normal."
For example, experiments have shown that the level of endorphins in the blood
increases dramatically after several ejaculations. Experimental rats habituated to
endorphins will go through much pain in order to obtain more. In rats, the addiction to
endorphins is even stronger than the addiction to morphine or heroin.
Therefore, sexual “acting out”, which can easily turn into addictive behavior, is a
common denominator with people who are depressed, especially men. Because of the
extreme health risks involved, as well as the destruction sexual addiction can cause in
families, some extra focus will be placed on this.
"Sex Addicts Anonymous is a fellowship of men and women who share

their experience, strength and hope with each other so they may overcome
their sexual addiction and help others recover from sexual addiction and
dependency."
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Ken Donaldson, LMHC
(727) 394-7325
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Indicators of Sexual Addiction
The sex addict uses sex as a quick fix, or as a form of medication for anxiety,
pain, loneliness, stress, or sleep. Sex addicts often refer to sex as their "pain reliever" or
"tension reliever.”
Other indicators that sexual behavior may be out of control include:
• An obsession with sex that dominates one's life

• Sexual fantasies that interfere with work performance
• So much time devoted to planning sexual activity that it interferes with
other activities
• Strong feelings of shame about one's sexual behavior
• A feeling of powerlessness or inability to stop despite predictable adverse
consequences
• Inability to make a commitment to a loving relationship
• Extreme dependence upon a relationship as a basis for feelings of self-
worth
• Little emotional satisfaction gained from the sex act
Compulsive or addictive sexual behavior may take various forms, including what
many regard as "normal" behavior. The type of sexual activity and even the frequency
or number of partners are not of great significance in diagnosing this problem. Some
individuals have a naturally stronger sex drive than others, and the range of human
sexual activity is so broad that it is difficult to define "normal" sexual behavior. What is
significant is a pattern of self-destructive or high-risk sexual behavior that is unfulfilling
and that a person is unable to stop.
The first major study of sexual addiction was published by Patrick Carnes in
1991. It was based on questionnaires filled out by 752 males and 180 females
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Ken Donaldson, LMHC
(727) 394-7325
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diagnosed as sex addicts, most of them admitted for treatment in the in-patient Sexual
Dependency Unit of a hospital in Minnesota. The others had at least three years of
participation in one of the 12-step programs for recovery from sexual addition. Of the
sex addicts in this survey, 63% were heterosexual, 18% homosexual, 11% bisexual,
and 8% were unsure of their sexual preference.
The sexual addicts who responded to Carnes' questionnaire were typically

unable to form close friendships. Their feelings of shame and unworthiness made them
unable to accept real intimacy. They were certain they would be rejected if others only
knew what they were "really" like, so they found a myriad of obsessive ways to turn
away a potential friend or loving partner. Despite a large number of superficial sexual
contacts, they suffered from loneliness, and many developed a sense of leading two
lives--one sexual, the other centered around their occupation or other "normal" activity.
In Carnes' survey, 97% responded that their sexual activity led to loss of self-
esteem. Other reported emotional costs were strong feelings of guilt or shame, 96%;
strong feelings of isolation and loneliness, 94%; feelings of extreme hopelessness or
despair, 91%; acting against personal values and beliefs, 90%; feeling like two people,
88%; emotional exhaustion, 83%; strong fears about own future, 82%; and emotional
instability, 78%.
Carnes found that 42% of sex addicts in his sample also had a problem with
either alcohol or drug dependency and 38% had eating disorders.
Consequences of Sexual Addiction
Out-of-control sexuality may have serious adverse consequences. In the Carnes

survey of individuals in treatment, 38% of the men and 45% of the women contracted
venereal diseases; 64% reported that they continued their sexual behavior despite the
risk of disease or infection. Of the women, 70% routinely risked unwanted pregnancy by
not using birth control, and 42% reported having unwanted pregnancies.
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Ken Donaldson, LMHC
(727) 394-7325
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Many patients had pursued their sexual activities to the point of exhaustion (59%)
or even physical injury requiring medical treatment (38%). 58% pursued activities for
which they felt they could be arrested and 19% actually were arrested. Sleep disorders
were reported by 65%; they usually resulted from stress or shame connected with the
sexual activity.
Of the survey respondents, 56% experienced severe financial difficulty because

of their sexual activity. Loss of job productivity was reported by 80%, and 11% were
actually demoted as a result. Many of these problems are, of course, encountered by
persons whose sexuality is not out of control, but the percentages are much lower.
It’s easy to see, again, how easy it would be to use sex as a way to escape from
depression, but obviously this would be like throwing gas on the fire of depression.
Internet Addiction
Computers, video games, and the internet have become entrenched features of
our daily lives. While originally designed for work purposes, computers are now a major
source of fun and entertainment for many people. While most integrate computer use
into their lives in a balanced, healthy manner, for others, time spent on the computer is
out of balance and has displaced friends, family, and an honest day's work.
“Why is it drug addicts and computer aficionados are both

called users?”
~Clifford Stoll
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Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
For someone who’s struggling with depression, the internet, computers and video
games can all be sources to attempt to escape from the inner pain and strife.
There are five specific sub-types of internet addiction:

• Cyber-sexual addiction -- compulsive use of adult websites
• Cyber-relational addiction -- over-involvement in online activities, including online
dating sites
• Net compulsion -- obsessive online gambling, shopping, or online trading
• Information addiction -- compulsive web surfing or database searches
• Computer addiction -- obsessive computer-game playing
Internet addiction is a rapidly growing problem in the workplace. Most companies
and organizations have strict policies about their employees' online activities, especially
regarding "objectionable" sites that contain pornographic material or facilitate online
gambling. Companies and organizations reinforce their policies by using tracking
software to identify computer users that visit inappropriate sites. Knowing this, why
would someone risk his or her job, reputation, and marriage by engaging in this kind of
activity at work?
“Some services available over the Internet have unique psychological

properties which induce dissociation, time distortion, and instant
gratification, with about 6% of
individuals experiencing some significant impact on their
lives. Sex, gaming, gambling, and shopping online can
produce a mood-altering effect.”
~ David Greenfield, Ph.D. of the Center for Internet Behavior
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Most people who engage in forbidden online activity at work do so for a variety of
reasons, including:
• They cannot do it at home; the behavior may have already caused problems in
their primary relationships.
• These online activities are part of a larger infidelity problem.
• They feel independent and over-confident that they will not be caught and suffer
any consequences while in the privacy of their own offices.
• They use "their" computers after hours and feel that since they are "off the clock"
that going to forbidden sites is acceptable.
• There may be an air of permissiveness in a particular work group that fosters
more curiosity and more risk-taking behavior. Their computers at work are faster
than the ones they have at home.
• They are depressed or bored and feel that these activities give them a "lift."
The same symptoms for internet addiction apply as they do for other types of
addiction: preoccupation with use; repeated, unsuccessful efforts to control, cut back or
stop internet use; loss of control and being online more than originally intended;
increased use over time; and jeopardized or risked loss of significant relationships, job,
or career opportunities because of internet use.
Final Note About Addictive Behavior
Recognition of self-destructive addictive behavior has spawned the rapid growth of

nationwide self-help organizations for persons trying to recover from addictive behavior.
These 12-step recovery programs are patterned after Alcoholics Anonymous. There is
more information about these programs in a chapter in the resources section.
If you see yourself with any of this addictive behavior and you’re already struggling
with depression, now is the time to take action before you go any further down.
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Okay, Now That I Got It,

What Do I Do With It?
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"Your tendency is just to wait it out, you know, let it get better.
You don't want to go to the doctor. You don't want to admit to
how bad you're really feeling."
The first step to getting appropriate treatment for depression is a physical

examination by a physician. Certain medications as well as some medical conditions
such as a viral infection, thyroid disorder, or low testosterone level can cause the same
symptoms as depression, and your physician should rule out these possibilities through
examination, interview, and lab tests. If no such cause of the depressive symptoms is
found, the physician should refer you to a mental health counselor, psychologist or a
psychiatrist.
Just to set the record straight and because there seems to be some confusion
around these different titles, a psychiatrist is a medical doctor who specializes in the
treatment of mental health issues and mental health counselors and psychologists
provide psychotherapy or counseling.
Andropause, a rather new medical term, addresses the impact of low levels of
testosterone in middle aged and older men. This can sometimes mimic depression.
Some of the primary symptoms include:
Loss of libido and potency Inability to concentrate
Nervousness, worry and anxiety Fatigue
Depression and irritability Insomnia
Impaired memory Indecisiveness
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Ken Donaldson, LMHC
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Men And The Dreaded “D” Word: The Male Depression Syndrome
Having your hormone levels checked, which isn’t always standard protocol, may
be something to look into if you have some of these symptoms.
A good diagnostic evaluation will include a complete history of symptoms: i.e.,
when they started, how long they have lasted, their severity, and whether the patient
had them before and, if so, if the symptoms were treated and what treatment was given.
The doctor should ask about alcohol and drug use, and if you’ve had any thoughts
about death or suicide. Further, a history should include questions about whether other
family members have had a depressive illness and, if treated, what treatments they may
have received and if they were effective. Last, a diagnostic evaluation should include a
mental status examination to determine if speech, thought patterns, or memory has
been affected, as sometimes happens with depressive disorders.
Treatment choice will depend on the diagnosis, severity of symptoms and
preference. There are a variety of treatments, including medications and short-term
psychotherapies (i.e., "talk" therapies) that have proven effective for depressive
disorders. In general, severe depressive illnesses, particularly those that are recurrent,
will often require a combination of treatments for the best outcome.
“Alcohol has been found to lower serotonin and norepinephrine levels.”
~"Food and Mood," Natural Medicine Chest, Let's Live magazine, Jan.
2000
© 2008 Ken Donaldson

Your PersonalPsychotherapies
Empowerment Coach
Page 55
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Several forms of psychotherapy, including some short-term (10-20 weeks) therapies,

can help people with depressive disorders. Two of the short-term psychotherapies that
research has shown to be effective for depression are cognitive-behavioral therapy
(CBT) and interpersonal therapy (IPT).
Psychotherapy is offered by a variety of licensed mental health providers,
including (a few) psychiatrists, psychologists, social workers, and mental health
counselors.
Cognitive behavioral therapy (or cognitive behavior therapy, CBT) is a

psychotherapeutic approach that aims to influence problematic and dysfunctional
emotions, behaviors and cognitions through a goal-oriented, systematic procedure.
Cognitive-behavioral therapists help patients change the negative thinking and behavior
patterns that contribute to, or result from, depression. Through verbal exchange with the
therapist, as well as "homework" assignments between therapy sessions, CBT helps
patients understand their depression and resolve problems related to it.
CBT treatments have received empirical support for efficient treatment of a

variety of clinical and non-clinical problems, including mood disorders, anxiety
disorders, personality disorders, eating disorders, substance abuse disorders, and
psychotic disorders.[2] It is often brief and time-limited. It is used in individual therapy as
well as group settings, and the techniques are also commonly adapted for self-help
applications. Some CBT therapies are more oriented towards predominately cognitive
interventions while some are more behaviorally oriented. In cognitive oriented therapies,
the objective is typically to identify and monitor thoughts, assumptions, beliefs and
behaviors that are related and accompanied to debilitating negative emotions and to
identify those which are dysfunctional, inaccurate, or simply unhelpful. This is done in
an effort to replace or transcend them with more realistic and useful ones.
CBT was primarily developed through a merging of behavior therapy with

cognitive therapy. While rooted in rather different theories, these two traditions found
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common ground in focusing on the "here and now" and symptom removal. Many CBT
treatment programs for specific disorders have been developed and evaluated for
efficacy and effectiveness; the health-care trend of evidence-based treatment, where
specific treatments for specific symptom-based diagnoses are recommended, has
favored CBT over other approaches. In the United Kingdom, the National Institute for
Health and Clinical Excellence recommends CBT as the treatment of choice for a
number of mental health difficulties, including post-traumatic stress disorder, obsessive
compulsive disorder (OCD), bulimia nervosa and clinical depression.
The particular therapeutic techniques vary within the different approaches of CBT
according to the particular kind of problem issues, but commonly may include keeping a
diary of significant events and associated feelings, thoughts and behaviors; questioning
and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and
unrealistic; gradually facing activities which may have been avoided; and trying out new
ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are
also commonly included. Cognitive behavioral therapy is often also used in conjunction
with mood stabilizing medications to treat conditions like bipolar disorder.
Going through cognitive behavioral therapy generally is not an overnight process

for clients. Even after clients have learned to recognize when and where their mental
processes go awry it can, in some cases, take considerable time and effort to replace a
dysfunctional cognitive-affective-behavioral process or habit with a more reasonable
and adaptive one.
One theory of depression is Aaron Beck's cognitive theory of depression. His

theory states that depressed people think the way they do because their thinking is
biased towards negative interpretations. According to this theory, depressed people
acquire a negative schema of the world in childhood and adolescence as an effect of
stressful life events. When the person with such schemata encounters a situation that in
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some way resembles the conditions in which the original schema was learned, the
negative schemata of the person are activated.
Beck also described a negative cognitive triad, made up of the negative

schemata and cognitive biases of the person; Beck theorized that depressed individuals
make negative evaluations of themselves, the world, and the future. Depressed people,
according to this theory, have views such as "I never do a good job," and "things will
never get better." A negative schema helps give rise to the cognitive bias, and the
cognitive bias helps fuel the negative schema. This is the negative triad. Also, Beck
proposed that depressed people often have the following cognitive biases: arbitrary
inference, selective abstraction, over-generalization, magnification and minimization.
These cognitive biases are quick to make negative, generalized, and personal
inferences of the self, thus fueling the negative schema.
For treatment of depression, a large-scale study in 2004 showed substantially

higher results of response and remission (73% for combined therapy vs. 48% for either
CBT or a particular discontinued antidepressant alone) when a form of cognitive
behavior therapy and that particular discontinued anti-depressant drug were combined
than when either modality was used alone.
"It affects the way you think. It affects the way you feel. It just simply
invades every pore of your skin. It's a blanket that covers everything.
The act of pretending to be well was so exhausting.
All I could do was shut down. At times you just say, 'It's enough
already.'"
Steve Lappen, Writer
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Interpersonal therapists help patients work through disturbed personal

relationships that may be contributing to or worsening their depression.
In the initial stages of IPT, therapeutic goals typically include diagnosis,

completing the requisite inventories, identifying the client's major problem areas, and
creating a treatment contract.
In the intermediate stages of IPT, the client and therapist, focusing on the
present, work on the major problem areas identified. Four major problem areas are
commonplace in IPT. The first is grief, and clients typically present with delayed or
distorted grief reactions. Treatment aims include facilitating the grieving process, the
client's acceptance of difficult emotions, and their replacement of lost relationships.
The second major problem area is role dispute, in which a client is experiencing
nonreciprocal expectations about a relationship with someone else. Here, treatment
focuses on understanding the nature of the dispute, the current communication
difficulties, and works to modify the client's communication strategies while remaining in
accord with their core values.
A third major problem area is role transition, in which an individual is in the

process of giving up an old role and taking on a new one. In this case, treatment
attempts to facilitate the client's giving up of the old role, expressing emotions about this
loss, and acquiring skills and support in the new role they must take on.
A final problem area commonly broached with IPT is interpersonal deficits.

Clients presenting interpersonal deficits commonly engage in an analysis of their
communication patterns, participate in role playing exercises with the therapist, and
work to reduce their overall isolation, if applicable.
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In the termination stages of IPT, the therapist works to consolidate the client's
gains, discuss areas which still require work, talk about relapse prevention, and process
any emotions related to termination of therapy.
The American Psychiatric Association Practice Guidelines indicated that among

psychotherapeutic approaches, cognitive behavioral therapy and interpersonal
psychotherapy had the best-documented efficacy for treatment of major depressive
disorder.
There are numerous other therapeutic approaches for the treatment of

depression. One other effective approach would include using hypnotherapy to assist in
lessening the severity of the depressed state, while also addressing unresolved issues
from the past.
Hypnotherapy is often applied in order to modify a subject's behavior, emotional

content, and attitudes, as well as a wide range of conditions including dysfunctional
habits, anxiety, stress-related illness, pain management, and personal development.
Rapid Resolution Therapy™ is painless and complete. Patients

are not required to relive the past or feel the pain from traumatic events.
The ongoing influences that painful past events have on emotions,
thoughts and behaviors are eliminated; whether the traumatic
experiences are remembered or repressed. Unconscious conflicts
blocking desired change are resolved. Self destructive behavior
disappears. The mind is clear. There is emotional freedom.
~Dr. Jason Quintal, www.drquintal.com
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Ken Donaldson, LMHC
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For many people, especially those with moderate to severe depression, a

combination of antidepressant medication and psychotherapy is the preferred approach
to treatment. Few psychiatrists offer both types of intervention. Therefore, two mental
health professionals, such as a mental health counselor and a psychiatrist, may
collaborate in the treatment of a person with depression; for example, a psychiatrist or
other physician, such as a family doctor, may prescribe medication while a nonmedical
therapist provides ongoing psychotherapy.
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I’m A Guy…
I Don’t Need Any Medication!
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There may come a point when medication is the best alternative for you to improve.
I know that most people, especially men, don’t really like the idea of having to be on a
medication. I understand that and have been there myself. However, you have to ask
yourself how badly you want to feel better. If the pain has not subsided and your
symptoms are worsening, then I suggest you go see your doctor and be evaluated.
Fortunately, there are several types of medications used to treat depression.

These include newer antidepressant medications - chiefly the selective serotonin
reuptake inhibitors (SSRIs) - and older ones, the tricyclics and the monoamine oxidase
inhibitors (MAOIs). The SSRIs (and other newer medications that affect
neurotransmitters such as dopamine or norepinephrine) generally have fewer side
effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before
finding the most effective medication or combination of medications for the patient.
Sometimes the dosage must be increased to be effective. Although some improvements
may be seen in the first couple of weeks, antidepressant medications must be taken
regularly for three to four weeks (in some cases, as many as eight weeks) before the full
therapeutic effect occurs.
I don’t want to overwhelm you with too much scientific information, but I do want
to provide you with a good overview of the most common medications currently used. I
know that I can’t even pronounce many of the names of these, but, again, I’d rather
have you be over-informed than under-informed.
Types of Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are a family of

antidepressants considered to be the current standard of drug treatment. It is thought
that one cause of depression is an inadequate amount of serotonin, a chemical used in
the brain to transmit signals between neurons. SSRIs are said to work by preventing the
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reuptake of serotonin (also known as 5-hydroxytryptamine, or 5-HT) by the pre-synaptic

neuron, thus maintaining higher levels of 5-HT in the synapse.
This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil, Seroxat),

escitalopram (Lexapro, Esipram), citalopram (Celexa), sertraline (Zoloft), and
fluvoxamine (Luvox). These antidepressants typically have fewer adverse events and
side effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry
mouth, nervousness, anxiety, insomnia, decreased appetite, and decreased ability to
function sexually may occur. Some side effects may decrease as a person adjusts to
the drug, but other side effects may be persistent. Though safer than first generation
antidepressants, SSRIs may not work on as many patients as previous classes of
antidepressants, suggesting the role of norepinephrine in depression is still important.
Recent randomized controlled trials published in the Archives of General

Psychiatry showed that up to one-third of the effect of SSRI Treatment can be seen in
the first week. These early effects have also been shown to have a secondary effect of
increasing the absolute reduction in Hamilton Rating Scale for Depression (HRSD)
scores by 50%.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine

(Effexor), milnacipram and duloxetine (Cymbalta) are a newer form of antidepressant
that work on both norepinephrine and 5-HT. They typically have similar side effects to
the SSRIs, although there may be a withdrawal syndrome on discontinuation that may
necessitate dosage tapering.
Noradrenergic and specific serotonergic antidepressants (NASSAs) form a newer

class of antidepressants which purportedly work to increase norepinephrine
(noradrenaline) and serotonin neurotransmission by blocking presynaptic alpha-2
adrenergic receptors while at the same time minimizing serotonin-related side effects by
blocking certain serotonin receptors. The only example of this class in clinical use is
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mirtazapine (Avanza, Zispin, Remeron). Mianserin also has similar mechanism of

action. Side effects may include drowsiness, increased appetite, and weight gain.
Norepinephrine (noradrenaline) reuptake inhibitors (NRIs) such as

reboxetine (Edronax) act via norepinephrine (also known as noradrenaline). NRIs are
thought to have a positive effect on concentration and motivation in particular.
Norepinephrine-dopamine reuptake inhibitors such as bupropion (Wellbutrin,

Zyban) inhibit the neuronal reuptake of dopamine and norepinephrine (noradrenaline).
Tricyclic antidepressants are the oldest class of antidepressant drugs and

include such medications as amitriptyline and desipramine. Tricyclics block the reuptake
of certain neurotransmitters such as norepinephrine (noradrenaline) and serotonin.
They are used less commonly now due to the development of more selective and safer
drugs. Side effects include increased heart rate, drowsiness, dry mouth, constipation,
urinary retention, blurred vision, dizziness, confusion, and sexual dysfunction. Toxicity
occurs at approximately ten times normal dosages; these drugs are often lethal in
overdoses, as they may cause a fatal arrhythmia. However, tricyclic antidepressants are
still used because of their effectiveness, especially in severe cases of major depression.
Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) may be

used if other antidepressant medications are ineffective. Because there are potentially
fatal interactions between this class of medication and certain foods (particularly those
containing Tyramine), red wine, as well as certain drugs, classic MAOIs are rarely
prescribed anymore. MAOIs work by blocking the enzyme monoamine oxidase which
breaks down the neurotransmitters dopamine, serotonin, and norepinephrine
(noradrenaline). MAOIs can be as effective as tricyclic antidepressants, although they
can have a higher incidence of dangerous side effects (as a result of inhibition of
cytochrome P450 in the liver). A new generation of MAOIs has been introduced;
moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase (RIMA).
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A RIMA acts in a more short-lived and selective manner and does not require a special
diet. Additionally, (selegiline) marketed as Emsam in a transdermal form is not a classic
MAOI in that at moderate dosages it does not require any dietary restrictions. One of
the side effects is weight gain and could be extreme.
Some antidepressants have been found to work more effectively in some

patients when used in combination with another drug. Such "augmenter" drugs include
tryptophan (Tryptan) and buspirone (Buspar).
Tranquillizers and sedatives, typically the benzodiazepines, may be prescribed

to ease anxiety and promote sleep. Because of their high potential for fostering
dependence, these medications are intended only for short-term or occasional
use. Often these medications are abused addressing either the symptoms of
depression or the side effects for other medication. Quetiapine fumarate (Seroquel) is
designed primarily to treat schizophrenia and bipolar disorder, but a frequently reported
side-effect is drowsiness very much like the side effects that Benadryl
(diphenhydramine) has.
Psychostimulants are sometimes added to an antidepressant regimen if the

patient suffers from anhedonia, hypersomnia and/or excessive eating as well as low
motivation. These symptoms which are common in atypical depression can be quickly
resolved with the addition of low to moderate dosages of amphetamine or
methylphenidate (brand names Adderall and Ritalin, respectively) as these chemicals
enhance motivation and social behavior, as well as suppress appetite and sleep. These
chemicals are also known to restore sex drive. Extreme caution must be used however
with certain populations. Stimulants are known to trigger manic episodes in people
suffering from bipolar disorder. Close supervision of those with substance abuse
disorders is urged. Emotionally unstable patients should avoid stimulants, as they
exacerbate mood shifting.
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Lithium remains the standard treatment for bipolar disorder and is often used in
conjunction with other medications, depending on whether mania or depression is being
treated. Lithium's potential side effects include thirst, tremors, light-headedness, and
nausea or diarrhea. Some of the anticonvulsants, such as carbamazepine (Tegretol),

sodium valprate (Epilim), and lamotrigine (Lamictal), are also used as mood stabilizers,
particularly in bipolar disorder.
Whew! Okay, hopefully that covered more than enough ground about the
scientific aspects of the medications for treating depression. However, there’s a bit more
information you need to know about medications before we look at the other forms of
treatment.
“Depressed people think they know themselves, but maybe they only
know depression.”
~Mark Epstein
People on antidepressants are often tempted to stop medication too soon. They
may feel better and think they no longer need the medication, or they may think it isn't
helping at all. It is important to keep taking medication until it has a chance to work,
though side effects may appear before antidepressant activity does. It’s important to
report any side effects to your physician. Once the person is feeling better, it’s important
to continue the medication for at least four to nine months to prevent a relapse into
depression. Some medications must be stopped gradually to give the body time to
adjust, and many can produce withdrawal symptoms if discontinued abruptly.
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Therefore, you should never discontinue your medication without first talking to
your doctor. For individuals with bipolar disorder and those with chronic or recurrent
major depression, medication may be a long-term intervention.
Medications for depressive disorders are not habit-forming. Nevertheless, as is

the case with any type of medication prescribed for more than a few days, doctors must
carefully monitor these treatments to determine if the patient is getting the most
effective dosage. The doctor should check regularly the dosage of each medicine and
its effectiveness.
Medications of any kind prescribed, over-the-counter, or borrowed should never

be mixed without consulting a doctor. Health professionals who may prescribe a
medication, such as a dentist or other medical specialist, should be told of all the
medications the patient is taking. Some medications, although safe when taken alone,
can cause severe and dangerous side effects if taken in combination with others.
I don’t think I need to say it at this point, but alcohol (including wine, beer, and
hard liquor) or street drugs may reduce the effectiveness of antidepressants and should
be avoided. You may get a mixed message from some health care professionals about
mixing alcohol with antidepressants, with some suggesting its okay for a modest
amount of alcohol to be consumed while taking one of the newer antidepressants. I
would disagree and lean towards avoiding alcohol totally.
Questions about any medication prescribed, or problems that may be related to
it, should be discussed with your doctor.
Side Effects of Antidepressants
Before starting a new medication, ask the doctor to tell you about any side effects
you may experience. Antidepressants may cause mild and, usually temporary, side
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effects (sometimes referred to as adverse effects) in some people. Typically, these are
annoying, but not serious. However, any unusual reactions or side effects, or those that
interfere with functioning, should be reported to the doctor immediately.
The most common side effects of the newer antidepressants (SSRIs and others)
are:
• Headache (will usually go away).
• Nausea also temporary, but even when it occurs, it is short-lived after each dose.
• Insomnia and nervousness (trouble falling asleep or waking often during the
night) may occur during the first few weeks but are usually resolved over time or
with a reduction in dosage.
• Agitation (feeling jittery): Notify your doctor if this happens for the first time after
the drug is taken and is persistent.
• Sexual problems: Consult your doctor if the problem is persistent or worrisome.
Although depression itself can lower libido and impair sexual performance, SSRIs
and some other antidepressants can provoke sexual dysfunction. These side effects
can affect more than half of adults taking SSRIs. In men, common problems include
reduced sexual drive, erectile dysfunction, and delayed ejaculation. For some men,
dosage reductions or acquired tolerance to the medication reduce sexual dysfunction
symptoms.
Tricyclic antidepressants have different types of side effects:
• Dry mouth: Drinking sips of water, chewing sugarless gum, and cleaning teeth
daily is helpful.
• Constipation: Adding bran cereals, prunes, fruit, and vegetables to your diet
should help.
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• Bladder problems: Emptying the bladder may be troublesome and the urine
stream may not be as strong as usual; notify your doctor if there is marked
difficulty or pain. This side effect may be particularly problematic in older men
with enlarged prostate conditions.
• Sexual problems: Sexual functioning may change; men may experience some
loss of interest in sex, difficulty in maintaining an erection or achieving orgasm. If
they are worrisome, discuss these side effects you're your doctor.
• Blurred vision: Will pass soon and will not usually necessitate a new glasses
prescription.
• Dizziness: Rising from the bed or chair slowly is helpful.
• Drowsiness as a daytime problem: Usually passes soon. If you feel drowsy or
sedated, you should not drive or operate heavy equipment. The more sedating
antidepressants are generally taken at bedtime to help sleep and minimize
daytime drowsiness.
You can quickly see why these are used less frequently and how the newer
antidepressants have eliminated many of these side effects.
In the past 15 years, the number of people seeking treatment for

depression in the U.S. has doubled; now 25 million a year. That’s bad
news, but what is worse is that according to recent research, 90% of
these people left their doctor’s offices with a prescription for
antidepressants. It is downright frightening that prescription drugs have
become the treatment of choice.
~“Hard to Swallow,” WC Douglass e-mail, March 28, 2003
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Aren’t There Other Options?

A Brief Overview Of
Complementary And Alternative
Medicine
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Complementary and alternative medicine (CAM) is a group of diverse medical and

health care systems, practices, and products that are not generally considered part of
“mainstream” medicine. Complementary medicine is used together with conventional
medicine, and alternative medicine is used in place of conventional medicine. This
includes, but is not limited to, herbal therapy, acupuncture and energy therapies.
Herbal Therapy
In the past several years, there has been an increase in public interest in the use
of herbs for the treatment of both depression and anxiety. Although many of these
products are widely used and prescribed, there is a limited amount of research at this
time to truly validate their effectiveness. Furthermore, since they are not regulated, the
quality may also not be consistent.
The extract from St. John's wort (Hypericum perforatum), a wild-growing plant,
has been used extensively in Europe as a treatment for mild to moderate depression,
and it now ranks among the top-selling botanical products in the United States.
Omega-3 fatty acids, which includes α-linolenic acid (ALA), eicosapentaenoic

acid (EPA), and docosahexaenoic acid (DHA), shows some promising preliminary
evidence that n-3 fatty acids supplementation might be helpful in cases of depression
and anxiety.
5-Hydroxytryptophan or 5-HTP is a naturally-occurring amino acid, a precursor

to the neurotransmitter serotonin and an intermediate in tryptophan metabolism. It is
marketed in the United States and other countries as a dietary supplement for use as an
antidepressant, appetite suppressant, and sleep aid.
S-adenosyl-L-methionine or SAMe is a synthetic form of a compound formed

naturally in the body from the essential amino acid methionine and adenosine
triphosphate (ATP), the energy-producing compound found in all cells in the body. It has
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been hypothesized that SAMe increases the availaibility of neurotransmitter serotonin

and dopamine.
Ginkgo biloba improves blood flow through the brain, accounting for its use as
an aid in mental acuity. It appears to normalize neurotransmitter levels and studies have
shown that ginkgo biloba may be used to improve mood and may be useful in
conjunction with standard antidepressants to enhance effectiveness in patients who are
resistant to standard drug therapies. Another study showed ginkgo's effectiveness in
decreasing sexual dysfunction problems caused by antidepressant drugs.
You should always consult a health care provider before taking any herbal
supplement.
Acupuncture
Acupuncture is among the oldest healing practices in the world. It’s part of
Traditional Chinese Medicine (TCM) that originated in China thousands of years ago.
It’s based on the concept that disease results from disruption in the flow of “qi”
(pronounced "chee,” meaning energy) and imbalance in the forces of “yin and yang.”
Practices such as herbs, meditation, massage, and acupuncture are all parts of TCM
and seek to aid healing by restoring the yin-yang balance and the flow of qi.
Acupuncture is the stimulation of specific points on the body by a variety of

techniques, including the insertion of thin metal needles though the skin. It is intended to
remove blockages in the flow of qi and restore and maintain health. The acupuncture
technique that has been most often used involves penetrating the skin with thin, solid,
metallic needles that are manipulated by the hands or by electrical stimulation.
In TCM, the body is seen as a delicate balance of two opposing and inseparable
forces: Yin and Yang. The concept of two opposing yet complementary forces described
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in traditional Chinese medicine. Yin represents cold, slow, or passive aspects of the
person, while yang represents hot, excited, or active aspects. A major theory is that
health is achieved through balancing Yin and Yang and disease is caused by an
imbalance leading to a blockage in the flow of qi.
In traditional Chinese medicine, the vital energy or life force proposed to regulate
a person's spiritual, emotional, mental, and physical health and to be influenced by the
opposing forces of Yin and Yang (vital energy) along pathways known as meridians.
Qi can be unblocked, according to TCM, by using acupuncture at certain points

on the body that connect with these meridians. Sources vary on the number of
meridians, with numbers ranging from 14 to 20. One commonly cited source describes
meridians as 14 main channels "connecting the body in a web-like interconnecting
matrix" of at least 2,000 acupuncture points.
Acupuncture Use in the United States
The report from a Consensus Development Conference on Acupuncture held at

the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely"
practiced - by thousands of physicians, dentists, acupuncturists, and other practitioners
- for relief or prevention of pain and for various other health conditions. According to the
2002 National Health Interview Survey an estimated 8.2 million U.S. adults had used
acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the
previous year.
What to Expect from Acupuncture Visits
During your first office visit, the practitioner, like all other thorough practitioners,
may ask you at length about your health condition, lifestyle, and behavior. The
practitioner will want to obtain a complete picture of your treatment needs and behaviors
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that may contribute to your condition. Inform the acupuncturist about all treatments or
medications you are taking and all medical conditions you have.
Acupuncture needles are metallic, solid, hair-thin and sterile. People experience
acupuncture differently, but most feel no or minimal pain as the needles are inserted.
Some people feel energized by treatment, while others feel relaxed. Improper needle
placement, movement of the patient, or a defect in the needle can cause soreness and
pain during treatment. This is why it is important to seek treatment from a qualified
acupuncture practitioner.
Treatment may take place over a period of several weeks or more.
“A lot of what passes for depression these days is nothing more than a
body saying that it needs work.”
~Geoffrey Norman
Energy Medicine: An Overview

Energy medicine is a domain in CAM that deals with energy fields of two types:
• Veritable, which can be measured

• Putative, which have yet to be measured
The veritable energies employ mechanical vibrations (such as sound) and

electromagnetic forces, including visible light, magnetism, monochromatic radiation
(such as laser beams), and rays from other parts of the electromagnetic spectrum. They
involve the use of specific, measurable wavelengths and frequencies to treat patients.
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In contrast, putative energy fields (also called biofields) have defied measurement to
date by reproducible methods. Therapies involving putative energy fields are based on
the concept that human beings are infused with a subtle form of energy. This vital
energy or life force is known under different names in different cultures, such as qi in
Traditional Chinese Medicine, ki in the Japanese Kampo system, doshas in Ayurvedic
medicine.
Ayurvedic medicine is a whole medical system that originated in India. It aims to

integrate the body, mind, and spirit to prevent and treat disease. Therapies used include
herbs, massage, and yoga.
Vital energy is believed to flow throughout the material human body, but it has not
been unequivocally measured by means of conventional instrumentation. Nonetheless,
therapists claim that they can work with this subtle energy, see it with their own eyes,
and use it to effect changes in the physical body and influence health.
Practitioners of energy medicine believe that illness results from disturbances of

these subtle energies. The biofield is an energy field that is proposed to surround and
flow throughout the human body and play a role in health. Biofields have not been
measured by conventional instruments. Reiki and qi gong (pronounced "chee-gung,")
are examples of therapies that involve biofields.
Examples of practices involving putative energy fields include:
• Reiki and Johrei, both of Japanese origin

• Qi gong, a Chinese practice
• Healing Touch, in which the therapist is purported to identify imbalances and
correct a client's energy by passing his or her hands over the patient
• Intercessory Prayer, in which a person intercedes through prayer on behalf of
another
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Energy medicine is gaining popularity in the American marketplace and has become
a subject of investigations at some academic medical centers. A recent National Center
for Health Statistics survey indicated that approximately 1 percent of the participants
had used Reiki, which can be best described as a therapy in which practitioners seek to
transmit a universal energy to a person, either from a distance or by placing their hands
on or near that person. The intent is to heal the spirit and thus the body.
In the same survey, 0.5 percent had used qi gong, which is a component of Traditional
Chinese Medicine that combines movement, meditation, and controlled breathing. The
intent is to improve blood flow and the flow of qi. Additionally, another 4.6 percent had
used some other kind of healing ritual.
Magnetic Therapy
Static magnets have been used for centuries in efforts to relieve pain or to obtain
other alleged benefits (e.g., increased energy). Numerous reports have indicated that
individuals have experienced significant, and, at times, dramatic relief of pain after the
application of static magnets over a painful area. There is growing evidence that
magnetic fields can influence physiological processes.
Sound Energy Therapy
Sound energy therapy, sometimes referred to as vibrational or frequency

therapy, includes music therapy as well as wind chime and tuning fork therapy. The
presumptive basis of its effect is that specific sound frequencies resonate with specific
organs of the body to heal and support the body. Music therapy has been the most
studied among these interventions, with studies dating back to the 1920s, when it was
reported that music affected blood pressure. Other studies have suggested that music
can help reduce pain and anxiety.
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Music and imagery, alone and in combination, have been used to entrain mood
states, reduce acute or chronic pain, and alter certain biochemicals, such as plasma
beta-endorphin levels. These uses of energy fields truly overlap with the domain of
mind-body medicine. Mind-body medicine focuses on the interactions among the brain,
mind, body, and behavior, with the intent to use the mind to affect physical functioning
and promote health. Examples include meditation and yoga.
Light Therapy
Light therapy is the use of natural or artificial light to treat various ailments, but
unproven uses of light extend to lasers, colors, and monochromatic lights. High-intensity
light therapy - the use of natural or artificial light - including colored light and high-
intensity light - for health purposes has been documented to be useful for seasonal
affective disorder, which is, like its name suggests, a seasonal depressive disorder.
Hormonal changes have been detected after treatment.
Homeopathy
One Western approach with implications for energy medicine is homeopathy,

which is a medical system that originated in Europe. Homeopathy seeks to stimulate the
body's ability to heal itself by giving very small doses of highly diluted substances that in
larger doses would produce illness or symptoms (an approach called "like cures like").
Homeopaths believe that their remedies mobilize the body's vital force to
orchestrate coordinated healing responses throughout the organism. The body
translates the information on the vital force into local physical changes that lead to
recovery from acute and chronic diseases. Homeopaths use their assessment of the
deficits in vital force to guide dose (potency) selection and treatment pace, and to judge
the likely clinical course and prognosis.
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Therapeutic Touch and Related Practices
Numerous other practices have evolved over the years to promote or maintain
the balance of vital energy fields in the body. Examples of these modalities include
Therapeutic Touch, which is a therapy in which practitioners pass their hands over
another person's body with the intent to use their own perceived healing energy to
identify energy imbalances and promote health. Healing Touch, Reiki, Johrei, Vortex
Healing, and Polarity Therapy are other examples. All these modalities involve
movement of the practitioner's hands over the patient's body to become attuned to the
condition of the patient, with the idea that by so doing, the practitioner is able to
strengthen and reorient the patient's energies.
Many small studies of Therapeutic Touch have suggested its effectiveness in a

wide variety of conditions, including wound healing, osteoarthritis, migraine headaches,
and anxiety in burn patients.
Reiki and Johrei practitioners claim that the therapies boost the body's immune
system, enhance the body's ability to heal itself, and are beneficial for a wide range of
problems, such as stress-related conditions, allergies, heart conditions, high blood
pressure, and chronic pain.
You can see that there are numerous choices for you to pick from in receiving
treatment for depression.
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"You start to have these little thoughts, 'Wait, maybe I can get through
this. Maybe these things that are happening to me aren't so bad. Maybe I
can deal with things for now.' And it's just little tiny thoughts until you
realize that it's gone and then you go, 'Oh my God, thank you, I don't feel
sad anymore.' And then when it was finally gone, when I felt happy, I was
back to the usual things that I was doing in my life. You get so happy
because you think to yourself, 'I never thought it would leave.'"
~Shawn Colten, National Diving Champion
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I Don’t Need Any Help!

I Can Handle It On My Own!
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"A vigorous five-mile walk will do more good for an unhappy

but otherwise healthy adult than all the medicine and
psychology in the world.”
~Paul Dudley White
Yes, we men like to “handle” life on our terms in our own ways. Nothing bad or
wrong about that, but I would ask you one question:
How’s that working for you?
If it’s not working so well and you’re not where you want to be in life, then I’d like
to invite you to rethink your independent and self-reliant stance.
Depressive disorders can make you feel exhausted, worthless, helpless, and
hopeless. It is important to realize that these negative views are part of the depression
and do not accurately reflect the actual circumstances. Negative thinking fades as
treatment begins to take effect. In the meantime, here are a few actions steps that can
bring more life energy into your life that you can take on your own:
1. Listen to your favorite music.
2. Enjoy a long, warm shower or bubble bath (Yes, real men take bubble baths!)
3. Go for a walk.
4. Share a hug with a loved one.
5. Relax outside.
6. Exercise (of your choice).
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7. Spiritual prayer.
8. Attend a support group.
9. Practice diaphragmatic (deep) breathing.
10. Do “stretching” exercises.
11. Reflect on your positive qualities: “I am….”
12. Watch the sunrise or sunset.
13. Laugh.
14. Concentrate on visualizing a relaxing scene.
15. Create a collage representing “The real me.”
16. Receive a massage.
17. Reflect on “I appreciate…”
18. Write your thoughts and feelings in a personal journal.
19. Attend a favorite athletic event.
20. Do something adventurous (Ex. Skydiving).
21. Read an uplifting book or magazine.
22. Sing, hum, whistle a happy tune.
23. Swing, slide, teeter totter...yes, real men do this too!
24. Play a musical instrument.
25. Spiritual meditation.
26. Work with plants or do some gardening and yard work.
27. Learn a new skill.
28. See a special play.
29. Work out with weights or equipment.
30. Ride a bike or motorcycle.
31. Make a nutritious meal.
32. Draw or paint a picture.
33. Swim, float, wade, and relax in a pool on the beach.
34. Do aerobics, dance.
35. Visit a special place you enjoy
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36. Smile/Say “I love myself!”

37. Take time to smell the roses (and other flowers!).
38. Imagine achieving your goals and dreams.
39. Go horseback riding.
40. Reflect on: “My most enjoyable memories.”
41. Enjoy a relaxing nap.
42. Visit a museum or art gallery.
43. Practice yoga.
44. Relax in a whirlpool or sauna.
45. Enjoy a cool, refreshing glass of water or fruit juice.
46. Enjoy the beauty of nature.
47. Count blessings: “I am thankful for….”
48. Play as you did as a child.
49. Star gaze.
50. “Window shop”
51. Daydream.
52. Tell yourself the loving words you want to hear from others.
53. Attend a special workshop.
54. Go sailing, kayaking or canoeing.
55. Reward yourself with a special gift you can afford.
56. Take yourself on a vacation.
57. Create with clay or pottery.
58. Practice positive affirmations.
59. Pet an animal.
60. Watch your favorite TV show.
61. Reflect on your successes: “I can…..”
62. Write a poem expressing your feelings.
63. Work on a craft or hobby.
64. RELAX and watch the clouds.
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65. Make yourself something nice.

66. Visit a park, woods, or forest.
67. Read positive, motivational literature.
68. Reflect on: “What I value most in life!”
69. Phone a special friend.
70. Go on a picnic in a beautiful setting.
71. Enjoy a gourmet cup of herbal tea.
72. Participate in a favorite sport, game, and recreation.
73. Practice a relaxation exercise.
74. Practice the art of forgiveness.
75. Treat yourself to a nutritious meal at a favorite restaurant or café.
76. Create your own unique list of “self nurturing” activities.
77. Go to a movie.
78. Go to a ballgame.
79. Participate in social or other activities.
80. Set realistic goals.
81. Assume a reasonable amount of responsibility.
82. Break large tasks into small ones.
83. Set some priorities.
84. Do what you can as you can (And be nice to yourself!).
85. Try to be with other people.
86. Find someone to confide in (it’s better than being alone and seclusive).
87. Participate in any activities that may make you feel better.
88. Let your family and friends help you.
The sun is nature's Prozac.

~Astrid Alauda
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Expect your mood to improve gradually, not immediately. Feeling better takes time.
Do not expect to 'snap out of' a depression. But do expect to feel a little better day-by-
day.
Often during treatment of depression, sleep and appetite will begin to improve before
depressed mood lifts.
Try to postpone any major decisions during this time, as you may not have the best
judgment. Before deciding to make a significant transition - change jobs, get married or
divorced - discuss it with others who know you well and have a more objective view of
your situation.
Remember, positive thinking will replace the negative thinking as your depression
responds to treatment.
What else can you do for yourself? Eat right!
The Anti-Depression Diet
“Sex is good, but not as good as fresh, sweet corn. “
~Garrison Keillor
No studies have proven that any particular diet actually reduces the symptoms of
depression, but the following is an excellent plan to make sure you’re eating balanced
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and nutritious meals. This may help as part of an overall treatment for depression as
there is more and more research indicating that food and mood are connected.
1. Eat a diet high in nutrients
Nutrients in foods support the body's repair, growth, and wellness. Nutrients we
all need include vitamins, minerals, carbohydrate, protein, and even a small amount of
fat. A deficiency in any of these nutrients leads to our bodies not working at full capacity
– and can even cause illness.
2. Fill your plate with essential antioxidants
Damaging molecules called free radicals are produced in our bodies during
normal body functions – and these free radicals contribute to aging and dysfunction.
Antioxidants such as beta-carotene and vitamins C and E combat the effects of free
radicals. Antioxidants have been shown to tie up these free radicals and take away their
destructive power.
Studies show that the brain is particularly at risk for free radical damage. Although
there’s no way to stop free radicals completely, we can reduce their destructive effect
on the body by eating foods high in powerful antioxidants, including:
• Sources of beta-carotene: apricots, broccoli, cantaloupe, carrots, collards,

peaches, pumpkin, spinach, sweet potato.
• Sources of vitamin C: blueberries, broccoli, grapefruit, kiwi, oranges, peppers,
potatoes, strawberries, tomato.
• Sources of vitamin E: margarine, nuts and seeds, vegetable oils, wheat germ.
3. Eat “smart” carbs for a calming effect
The connection between carbohydrates and mood is linked to the mood-boosting

brain chemical, serotonin. We know that eating persuasive foods high in carbohydrates
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(breads, cereal, and pasta) raises the level of serotonin in the brain. When serotonin
levels rise, we feel a calming effect with less anxiety.
So, don’t shun carbs – just make smart choices. Limit sugary foods and opt for
smart carbs, such as whole grains, fruits, vegetables, and legumes, which all contribute
healthy carbs as well as fiber.
4. Eat protein rich foods to boost alertness
Foods rich in protein, like turkey, tuna, or chicken, are rich in an amino acid called
tyrosine. Tyrosine boosts levels of the brain chemicals dopamine and norepinephrine.
This boost helps you feel alert and makes it easier to concentrate. Try to include a
protein source in your diet several times a day, especially when you need to clear your
mind and boost your energy.
• Good sources of protein foods that boost alertness: beans and peas, lean
beef, low-fat cheese, fish, milk, poultry, soy products, yogurt.
5. Eat a Mediterranean type diet
The Mediterranean diet is a balanced, healthy eating pattern that includes plenty
of fruits, nuts, vegetables, cereals, legumes, and fish. All of these are important sources
of nutrients linked to preventing depression.
A recent Spanish study, using data from 4,211 men and 5,459 women, found that
rates of depression tended to increase in men -- especially smokers -- as folate intake
decreased. The same increase occurred for women -- especially those who smoked or
were physically active -- but with a decreased intake of another B-vitamin: B12. This
wasn't the first study to discover an association between these two vitamins and
depression. Researchers wonder whether poor nutrient intake leads to depression or
whether depression leads people to eat a poor diet.
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Folate is found in Mediterranean diet staples like legumes, nuts, many fruits, and
particularly dark green vegetables. B12 can be found in all lean and low-fat animal
products, such as fish and low-fat dairy products.
6. Get plenty of vitamin D
Vitamin D increases levels of serotonin in the brain. Researchers, though, are

unsure how much vitamin D is ideal. There are individual differences based on where
you live, the time of year, your skin type, and your level of sun exposure. Researchers
from the University of Toronto noticed that people who were suffering from depression,
particularly those with seasonal affective disorder, tended to improve as their levels of
vitamin D in the body increased over the normal course of a year. The recommendation
is to try to get about 600 international units (IU) of vitamin D a day from food if possible.
7. Select selenium-rich foods
Selenium is a mineral that is essential to good health. In a small study from

Texas Tech University, supplementation of 200 micrograms a day for seven weeks
improved mild and moderate depression in 16 elderly participants. Other studies have
also reported an association between low selenium intakes and poorer moods.
It is possible to take in too much selenium so that it becomes toxic. But this is
unlikely if you're getting it from foods rather than supplements, and it can't hurt to make
sure you're eating foods that help you meet the recommended intake for selenium,
which is 55 micrograms a day. The good news is that foods rich in selenium are foods
we should be eating anyway. They include:
• Beans and legumes

• Lean meat (lean pork and beef, skinless chicken and turkey)
• Low-fat dairy products
• Nuts and seeds (particularly brazil nuts)
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• Seafood (oysters, clams, sardines, crab, saltwater fish, and freshwater fish)
• Whole grains (whole-grain pasta, brown rice, oatmeal, etc.)
8. Include omega-3 fatty acids in your diet
We know that omega-3 fatty acids have innumerable health benefits. Recently,
scientists have revealed that a deficit of omega-3 fatty acids is associated with
depression. In one study, researchers determined that societies that eat a small amount
of omega-3 fatty acids have a higher prevalence of major depressive disorder than
societies that get ample omega-3 fatty acids. Other epidemiological studies show that
people who infrequently eat fish, which is a rich source of omega-3 fatty acids, are more
likely to suffer from depression.
• Sources of omega-3 fatty acids: fatty fish (anchovy, mackerel, salmon,

sardines, shad, and tuna), flaxseed, and nuts.
• Sources alpha-linolenic acid (another type of omega-3 fatty acid): flaxseed,
canola oil, soybean oil, walnuts, and dark green leafy vegetables.
9. Watch your lifestyle habits
As you already know, many people who are depressed also have problems with
alcohol and/or drugs. Not only can alcohol and drugs interfere with mood, sleep, and
motivation, but they can also affect the effectiveness of anti-depression medications. In
addition, drinks and foods containing caffeine can trigger anxiety and make it difficult to
sleep at night. Cutting out caffeine or stopping caffeine after noon each day can also
help you get a better night's sleep.
10. Stay at a healthy weight
Recent findings show a link between obesity and depression, indicating that
people who are obese may be more likely to become depressed. In addition, according
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to this study, people who are depressed are more likely to become obese. Researchers
believe the link between obesity and depression may result from physiological changes
that occur in the immune system and hormones with depression. If you have a weight
problem, talk with your doctor about healthy ways to manage it with diet and exercise.
An Anti-Depression Exercise Program
“Those who think they have not time for bodily exercise
will sooner or later have to find time for illness.” ~Edward Stanley
Many studies indicate that people who exercise regularly benefit with a positive
boost in mood and lower rates of depression. When you exercise, your body releases
chemicals called endorphins. These endorphins interact with the receptors in your brain
that reduce your perception of pain. In other words, they naturally make you feel better.
Endorphins also trigger a positive feeling in the body, similar to that of morphine.
For example, the feeling that follows a run or workout is often described as "euphoric."
That feeling, known as a "runner's high," can be accompanied by a positive and
energizing outlook on life.
Endorphins act as analgesics which means they diminish the perception of pain.
They also act as sedatives. They are manufactured in your brain, spinal cord, and many
other parts of your body and are released in response to brain chemicals called
neurotransmitters. The neuron receptors endorphins bind to are the same ones that
bind to some pain medicines. However, unlike with morphine, the activation of these
receptors by the body's endorphins does not lead to addiction or dependence, although
people can use the “runner’s high” as a way to avoid feeling other feelings, as noted
previously.
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Regular exercise has been proven to help:
• Reduce stress
• Ward off anxiety and feelings of depression
• Boost self-esteem
• Improve sleep
Exercise also has these added health benefits:
• It strengthens your heart.

• It increases energy levels.
• It lowers blood pressure.
• It improves muscle tone and strength.
• It strengthens and builds bones.
• It helps reduce body fat.
• It makes you look fit and healthy.
Research has shown that exercise is an effective but often underused treatment for
mild to moderate depression. It appears that any form of exercise can help depression.
Some examples of moderate exercise include:
• Biking
• Dancing
• Gardening, yard work, especially mowing or raking
• Golf (walking instead of using the cart)
• Housework, especially sweeping, mopping, or vacuuming
• Walking or jogging at a moderate pace
• Low-impact aerobics
• Playing tennis
• Swimming
• Yoga
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“Yoga is the practice of quieting the mind.”
~Patanjali, translated from Sanskrit
Because strong social support is important for those with depression, joining a group
exercise class may be beneficial. Or you can exercise with a close friend or your
partner. In doing so, you will benefit from the physical activity and emotional comfort,
knowing that others are supportive of you.
For most people, it is OK to start an exercise program without checking with a health
care provider. However, if you have not exercised in a while, are over age 50, or have a
medical condition such as diabetes or heart disease, contact your health care provider
before starting an exercise program.
Before you begin an exercise program for anti-depression, here are some questions
you should consider:
• What physical activities do I enjoy?

• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example: weight loss, strengthening muscles,
improving flexibility, or mood enhancement)
Try to exercise at least 20 to 30 minutes, three times a week. Studies indicate that
exercising four or five times a week is best. Take it easy if you are just beginning. Start
exercising for 20 minutes. Then you can build up to 30 minutes.
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When you first start your exercise program, you should plan a routine that is
easy to follow and maintain. When you start feeling comfortable with your routine, then
you can start varying your exercise times and activities.
Here are some tips to help you get started:
• Choose an activity you enjoy. Exercising should be fun.

• Put your exercise routine into your schedule. If you need reminding, put it on your
calendar.
• Variety is the spice of life. Make sure you vary your exercises so that you don't
get bored. Check your local gymnasium or community center for an assortment
of exercise programs.
• Don't let exercise programs break the bank. Unless you are going to be using
them regularly, avoid buying health club memberships or expensive equipment.
• Stick with it. If you exercise regularly, it will soon become part of your lifestyle
and will help reduce your depression.
Never ignore pain. You may cause stress and damage to your joints and muscles if
you continue exercising through pain. If you still feel pain a couple hours after
exercising, you have probably overexerted yourself and need to decrease your activity
level. If your pain persists or is severe, or if you suspect you have injured yourself,
contact your doctor.
If you are unable to regularly participate in exercise or athletics, you can also try other
tools to help boost your mood. Studies of meditation and massage therapy have
demonstrated that these techniques can stimulate endorphin secretion, increase
relaxation, and aid in boosting mood.
“Lack of activity destroys the good condition of every human being,

while movement and methodical physical exercise save it and preserve
it.” ~Plato
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You Can Give Your Friends And

Family Members The Next Few
Pages
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The most important thing anyone can do for a man who may have depression is to
help him get to a doctor for a diagnostic evaluation and treatment. First, try to talk to him
about depression and help him understand that depression is a common illness among
men and is nothing to be ashamed about (share this booklet with him if you obtained it).
Then encourage him to see a doctor to determine the cause of his symptoms and obtain
appropriate treatment.
Occasionally, you may need to make an appointment for the depressed person
and accompany him to the doctor. Once he is in treatment, you may continue to help by
encouraging him to stay with treatment until symptoms begin to lift (several weeks) or to
seek different treatment if no improvement occurs. Encourage him to be honest with the
doctor about his use of alcohol and prescription or recreational drugs, and to follow the
doctor's orders about the use of these substances while on antidepressant medication.
The second most important thing is to offer emotional support to the depressed
person. This involves understanding, patience, affection, and encouragement. Engage
him in conversation and listen carefully. Do not disparage the feelings he may express
but point out realities and offer hope. Do not ignore remarks about suicide. Report them
to the depressed person's doctor. In an emergency, call 911.
Invite him for walks, outings, to the movies, and other activities. Be gently
insistent if your invitation is refused. Encourage participation in some activities that once
gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push
him to undertake too much too soon. The depressed person needs diversion and
company, but too many demands can increase feelings of failure.
Do not accuse the depressed person of laziness or of faking illness, or expect
him 'just to snap out of it.' Eventually, with treatment, most people do get better. Keep
that in mind, and keep reassuring him that, with time and help, he will feel better.
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Where to Get Help
If you’re unsure where to go for help, talk to people you trust who have
experience in mental health, for example, a doctor, nurse, social worker, or religious
counselor. Ask their advice on where to seek treatment. If there is a university nearby,
its departments of psychiatry or psychology may offer private and/or sliding-scale fee
clinic treatment options. Otherwise, check the Yellow Pages under "mental health,"
"health," "social services," "suicide prevention," "crisis intervention services," "hotlines,"
"hospitals," or "physicians," for phone numbers and addresses. In times of crisis, the
emergency room doctor at a hospital may be able to provide temporary help for a
mental health problem and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or
provide, diagnostic and treatment services.
• Family doctors
• Mental health specialists, such as psychiatrists, psychologists, social workers, or
mental health counselors
• Religious leaders/counselors
• Health maintenance organizations
• Community mental health centers
• Hospital psychiatry departments and outpatient clinics
• University - or medical school-affiliated programs
• State hospital outpatient clinics
• Social service agencies
• Private clinics and facilities
• Employee assistance programs
95
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Musician and singer-songwriter Billy Joel experienced serious

depression and admitted himself into a hospital for treatment after
attempting to end his life by drinking furniture polish.
Within the Federal government, the Substance Abuse and Mental Health Services
Administration (SAMHSA) offers a "Services Locator" for mental health and substance
abuse treatment programs and resources nationwide. Visit their Web site at
http://www.mentalhealth.samhsa.gov/databases/ or call 1-800-789-2647 (toll-free).
Here are a few more resources for you:
National Foundation for Depressive Illness, Inc.

P.O. Box 2257
New York, NY 10116
Toll-Free: 1-800-239-1265
Phone: 1-212-268-4260
Web site: http://www.depression.org
A foundation that informs the public about depressive illness and its treatability and
promotes programs of research, education, and treatment.
National Institute of Mental Health

Office of Communications
Information Resources and Inquiries Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Toll-Free: 1-866-227-NIMH (-6464)
Phone: 1-301-443-4513
FAX: 1-301-443-4279
TTY: 1-301-443-8431
FAX4U: 1-301-443-5158
Web site: http://www.nimh.nih.gov
E-mail: nimhinfo@nih.gov
The Federal government agency whose mission is to reduce the burden of mental
illness and behavioral disorders through research on mind, brain, and behavior. NIMH is
a part of the National Institutes of Health, U.S. Department of Health and Human
Services.
96
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Substance Abuse and Mental Health Services Administration
National Mental Health Information Center
P.O. Box 42490
Washington, DC 20015
Toll-Free: 1-800-789-2647 / FAX: 1-301-984-8796
TTY: 1-866-889-2647
Web site: http://www.mentalhealth.samhsa.gov
E-mail: info@mentalhealth.org
SAMHSA’s National Mental Health Information Center provides the public information
on mental health services and referrals to Federal, State, or local resources for more
information and help.
Depression and Bipolar Support Alliance

(formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60601-7204
Toll-Free: 1-800-826-3632
Phone: 1-312-642-0049 / FAX: 1-312-642-7243
Web site: http://www.ndmda.org
A patient-directed organization whose mission is to improve the lives of people living
with mood disorders.
National Alliance for the Mentally Ill

Colonial Place Three
2107 Wilson Blvd., 3rd Floor
Arlington, VA 22201
Toll-Free: 1-800-950-NAMI (-6264)
Phone: 1-703-524-7600 / FAX: 1-703-524-9094
Web site: http://www.nami.org
A support and advocacy organization of consumers, families, and friends of people with
severe mental illness—over 1,200 state and local affiliates. Local affiliates often give
guidance in finding treatment.
National Mental Health Association

2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Toll-Free: 1-800-969-NMHA (-6642)
Phone: 1-703-684-7722 / FAX: 1-703-684-5968
TTY: 1-800-433-5959
Web site: http://www.nmha.org
An association that works with more than 340 affiliates nationwide to promote mental
health through advocacy, education, research, and services.
97
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
“When alcohol wears off, you will be more depressed than ever.”
~Ann Landers' to readers, Dec. 5, 1993
And since there are sometimes addictive behaviors, here also some other addiction
related resources:
• ACA - Adult Children of Alcoholics (also abbreviated as ACOA)

www.AdultChildren.org
• Al-Anon/Alateen, for friends and family members of alcoholics

http://www.al-anon.alateen.org
• AA - Alcoholics Anonymous
http://www.aa.org
• CA - Cocaine Anonymous
http://www.ca.org
• CMA - Crystal Meth Anonymous

http://www.crystalmeth.org
• CoDA - Co-Dependents Anonymous

http://www.coda.org
• COSA - Codependents of Sex Addicts

http://www.cosa-recovery.org
98
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
• CO-SLAA - CoSex and Love Addicts Anonymous

http://www.coslaa.org
• DA - Debtors Anonymous
http://www.debtorsanonymous.org
• EA - Emotions Anonymous
http://www.emotionsanonymous.org
• GA - Gamblers Anonymous
http://www.gamblersanonymous.org
• Gam-Anon/Gam-A-Teen, for friends and family members of problem gamblers

http://www.gam-anon.org
• MA - Marijuana Anonymous
http://www.marijuana-anonymous.org
• NA - Narcotics Anonymous
http://www.na.org
• Nar-Anon, for friends and family members of addicts

http://nar-anon.org
• NicA - Nicotine Anonymous

http://www.nicotine-anonymous.org
99
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
• OA - Overeaters Anonymous
http://www.oa.org
• OLGA - Online Gamers Anonymous
http://www.olganon.org
• SAA - Sex Addicts Anonymous

http://www.saa-recovery.org
• SA - Smokers Anonymous
http://www.realfriendsandfamily.org/sa.html
• SLAA - Sex and Love Addicts Anonymous

http://www.slaafws.org
• WA - Workaholics Anonymous
http://www.workaholics-anonymous.org
"And pretty soon you start having good thoughts about yourself and
that you're not worthless and you kind of turn your head
over your shoulder and look back at that, that rutted, muddy,
dirt road that you just traveled and now you're on some
smooth asphalt and go, 'Wow, what a trip. Still got a ways
to go, but I wouldn't want to go down that road again.'"
~Patrick McCathern, First Sergeant, U.S. Air Force, Retired
100
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Yes…It Does Get Better!
“Mental health problems do not affect three or four out of every five
persons but one out of one.”
~William Menninger, psychiatrist and co-founder of

The Menninger Foundation
101
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
You may experience depression in many different ways. You may be grumpy or
irritable, or you might lose your sense of humor. There may be times when you might
drink too much or abuse drugs. You may even physically or verbally abuses your
spouse and kids. You might try to work all the time, or compulsively seek thrills in high-
risk behavior. Or you may become isolated, withdrawn, and no longer interested in the
people or activities you used to enjoy.
Perhaps this sounds like you. If so, it is important to understand that there is a
brain disorder called depression that may be underlying these feelings and behaviors.
It's real: scientists have developed sensitive imaging devices that enable us to see
depression in the brain. And it's treatable: more than 80 percent of those suffering from
depression respond to existing treatments, and new ones are continually becoming
available and helping more people. Talk to a healthcare provider about how you are
feeling and ask for help.
Or perhaps this may sound like someone you care about. Try to talk to him, or to
someone who has a chance of getting through to him. Help him to understand that
depression is a common illness among men and is nothing to be ashamed about.
Encourage him to see a doctor and get an evaluation for depression. Give him this book
and ask him to read it.
For men with depression, life doesn't have to be so dark and hopeless. Life is
hard enough as it is; and treating depression can free up vital resources to cope with
life's challenges effectively. When you’re depressed, you’re not the only one who
suffers. Your depression also darkens the lives of your family, your friends, virtually
everyone close to you. Getting into treatment can send ripples of healing and hope into
all of those lives, as well as your own.
102
Ken Donaldson, LMHC
(727) 394-7325
___________________________________________________________________
Depression is a real illness; it is treatable; and men can have it. It takes courage to
ask for help, but help can make all the difference.
"Persistence. Nothing in the world can take the place of persistence.

Talent will not; nothing is more common than unsuccessful men with
talent.
Genius will not; unrewarded genius is almost a proverb.
Education will not; the world is full of educated derelicts.
Persistence and determination alone are omnipotent.
The slogan, 'Press on,' has solved and always will solve the problems of
the human race."
~Calvin Coolidge
103
Ken Donaldson, LMHC
(727) 394-7325
Eric Hipple was living two lives. Everyone knew him as the quarterback of the
Detroit Lions and, before that, as the quarterback for Utah State University. But
there was a darker side. There was a man few knew. The man who once threw
himself out of a speeding car; the man who flew his airplane between trees; the
man who quit going to work simply because he didn't and couldn't care anymore.
Then Jeff took his own life and Eric's life bottomed out.
He not only wound up in jail, but he was also glad to be there. His eventual quest
to understand his son's death turned into a journey of self-discovery and healing.
Hipple found an explanation for his behavior and his son's: Depression. It became
his cause and his vocation.
Eric Hipple is a former professional American football player who played in 9 NFL
seasons for the Lions from 1980-1986 and 1988-1989. As a result of the suicide in
2000 of Hipple's fifteen-year-old son, Hipple is involved in educating people about
the dangers of depression. Hipple travels the country and gives speeches to High
Schools, Youth Groups and Corporations on suicide prevention and Mental
Illness. In this role, he is the Outreach Coordinator of the Depression Center of the
University of Michigan at Ann Arbor. http://www.med.umich.edu/depression
~ Doug Robinson, Deseret News, Nov. 27, 2008 (article and picture)
Men And Depression: What it is…Where it came
from…What to do about it!
What’s Next?
Rejuvenate your career, restore your life purpose and create lasting success in
your life and relationships through the 20 core principles from Marry YourSelf First!
Say “I Do” to a Life of Passion, Power, Purpose and Prosperity. Join me as I
creatively guide you through these 20 life-enhancing principles and shows you how to
apply them to your life to overcome self-limiting patterns and create abundant
happiness, fulfillment and success.
The issues and topics covered include: Discovering one’s life purpose and
vision; values identification and clarification; using the laws of action and attraction;
developing your personal spiritual path; effective communication strategies; life
balance and stress management tactics and systems; development of boundaries
with others and with yourself; and creating a powerful and lasting support system.
Through the Marry YourSelf First website, you’re invited to join the
complimentary Personal Empowerment Program Monthly Coaching series. Every
month, you’ll receive new strategies and tactics to continue your life and relationship
growth and development, as well as answers to your most challenging questions via
teleclasses, special interviews and special reports.
Go to: https://kendonaldson.com/the-marry-yourself-first-store/

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Depression Men Update 1021

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Why The Hell Am I Feeling This Way?

Men and The Dreaded “D” Word:

Why The Hell Am I Feeling This Way?

All Rights Reserved

Published by Kenilee Ink, a division of Kenilee, Inc.

Created in the United States.

DISCLAIMER AND TERMS OF USE AGREEMENT

MANY FACTORS WILL BE IMPORTANT IN DETERMINING YOUR ACTUAL RESULTS AND

The author/publisher disclaims any warranties (express or implied), merchantability, or fitness

The book is dedicated to all my brothers:

Who IS Ken Donaldson?.......6

Introduction: Why Am I Writing This?.......7

Depression Facts, Stats and Acts:

“But I Don’t Feel That Way”

The Depression Connection With

Okay, Now That I Got It,

Aren’t There Other Options?

I Don’t Need Any Help!

You Can Give Your Friends And Family

Who IS Ken Donaldson?

I’ve been based in Tampa Bay, Florida offering counseling, coaching,

I am also the author of the breakthrough life and relationship success

I founded the REALationship Coaching programs that empower

The Marry YourSelf First! program has assisted numerous singles in

“One in five Americans are depressed or unhappy, and report

~Reuters Health, HealthCentral.com - Nov. 2000

Hiding in my room, safe within my womb,

And a rock feels no pain;

Here’s a few you’ve probably heard of:

1. Abraham Lincoln - Former President

2. Adam Ant - British Musician

3. Adam Duritz - Lead singer for the group Counting Crows

4. Billy Corgan - Musician from the band The Smashing Pumpkins

5. Billy Joel - Musician

6. Boris Yeltsin – Former Russian President

7. Brian Wilson – One of the Beach Boys

8. Buzz Aldrin – Former astronaut

9. Dick Cavett - American talk show host

10. Drew Carey - Comedian and host of The Price Is Right

11. Harrison Ford - Actor

12. Heath Ledger - Actor

14. Jim Carrey - Comedian and actor

15. John Denver – Singer and songwriter

16. Kurt Cobain - Lead singer and guitarist for Nirvana

17. Mark Roget - Creator of Roget's Thesaurus

18. Mike Wallace – Newscaster

19. Owen Wilson - Actor

20. Richard Jeni - Comedian

21. Rodney Dangerfield – Actor and comedian

22. Tennessee Williams - American playwright

23. Terry Bradshaw – Former Football Hall of Fame star

24. Thomas F. Eagleton - 1972 running mate of presidential candidate

26. Vincent Van Gogh – Artist

27. Winston Churchill – Prime Minister of Great Britain

“From his mid-20s, Abraham Lincoln was recognized by

~ Joshua Wolf Shenk

“Just like other illnesses, depression can be

~Tom Bosley, Actor

“I cry a lot. My emotions are very close to my surface.

~Nicolas Cage, Actor

Through the Darkness, I Do Go…

These days of night overcome my Soul

“You largely constructed your depression. It wasn't given