Gay and Depressed

By Frank Spinelli, M D

Originally published on Advocate.com October 13 2010 7:00 AM ET

Have you ever experienced periods in your life when you felt sad but also physical drained by depression? Have you ever lost interest in carrying out functions of daily life like shopping or meeting friends for dinner, or worse, not even wanted to get out of bed because you were too tired or didn’t get a good night’s sleep? Well, then you might be suffering from major depressive disorder. Characterized by symptoms that interfere with your ability to work, sleep, and eat that persist for at least two weeks, MDD is very common and affects millions of people. As reported in the American Journal of Psychiatry, gay men indeed have higher rates of depression than the general population. As a result, gay men are more likely to engage in high-risk sexual behavior and to abuse alcohol and drugs with more frequency.

The World Health Organization categorizes depression into typical, mild, moderate, or severe episodes. Patients with depression may suffer from low energy, decreased activity, and gloomy moods. Often there is a diminished capacity for enjoyment and interests. Concentration is reduced, and there can be marked lethargy even in performing minimal tasks. Depressed men complain about disturbed sleep patterns in which they either sleep too much or suffer from insomnia. Appetite is usually affected in much the same way, with patients complaining that they eat too much or too little. Usually the depressed male expresses feelings of low self-worth, lack of self-esteem, and diminished self-confidence. Men with prolonged depression describe a sense of utter worthlessness and associated guilt. Moods can vary from one day to the next and are often accompanied by “somatic” complaints, such as body aches and pains. One of the most striking complaints for gay men is a loss of sexual interest and pronounced erectile dysfunction.

There are a myriad of causes for depression, including genetic and environmental ones, but scientists agree that people who suffer from depression have low levels of specific neurotransmitters—chemicals that affect brain function—specifically serotonin, norepinephrine, and dopamine. Changes in one or more of these can result in depression. Often a person with depression will have family members with similar symptoms. But not all depressed people have genetic links. Some are affected by childhood traumas. A traumatizing event like molestation or homicide can affect developing brains. Others are influenced by external factors like stress, bereavement, and trouble at work. Yet medical conditions can also manifest as depression. Thyroid disease and certain vitamin deficiencies can result in depression. Having a chronic illness itself can often lead to depression.

More and more primary care doctors are asking about depression because mood is intrinsically related to a patient’s overall health. Studies have shown that depressed people often take more sick leave. That is why it is important to determine if you have symptoms of depression and then see your health care provider to find out what is causing them.

In certain cases your doctor may want to prescribe an antidepressant. That can be very frightening for some people, particularly if you’re already depressed. There are also some important side effects that you should know about. There are several different categories of antidepressants that act on the brain in different ways to affect the levels of neurotransmitters. When levels of one or more neurotransmitters are low or unbalanced, depression can result. Generally, antidepressants work by increasing the production or decreasing the breakdown of one or more neurotransmitters. I review a few.

SSRIs, or selective serotonin reuptake inhibitors, act to increase the level of serotonin in the brain. Serotonin is known to elevate mood.

One of the newest classes of antidepressants is the selective serotonin and norepinephrine reuptake inhibitors (SNRIs), affecting both norepinephrine and serotonin. While low levels of both neurotransmitters are associated with depression, norepinephrine is thought to be involved more with alertness and energy, while serotonin influences mood. By increasing levels of both, SNRIs work on different aspects of depression.

Another class, called antipsychotics, has existed for many years. Often given a bum rap for their name, because they were initially indicated for the treatment of schizophrenia, antipsychotics used in appropriate doses alleviate depression.

An important review of your symptoms, along with a good history and physical, will aid your doctor in determining which medication is right for you. Often this may take time to figure out, and sometimes a combination of medications is necessary. Everyone is different, so some trial and error is to be expected. Your doctor may also recommend psychological counseling in conjunction with medical therapy. Through these sessions you will learn about the causes of depression so that you can better understand them, and you will also learn to identify unhealthy behavior and thoughts. You can explore ways to help you cope and set realistic goals for yourself.

Depression generally isn’t something you can treat on your own, but there are things you can do to help. Here are some tips:

1. Get regular exercise.
2. Avoid drugs and alcohol.
3. Maintain a daily routine.
4. Eat healthily and try to get an appropriate amount of sleep.
5. Take care of your general health.
6. Don’t overschedule yourself.
7. And finally, postpone major decision-making.

Remember, major depressive disorder is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. So don’t get discouraged. Most people with depression feel better with medication combined with psychological counseling.