Dear New Shrink,

My family is very worried about my brother. Over the past year he has become increasingly sullen, moody, irritable and difficult to get along with. He is very successful in his career and he is also the oldest child, which seems to contribute to his attitude of “you can’t tell me anything.” His wife is getting kind of fed up and frankly, we don’t understand how this change in him — he is almost like a stranger — could keep from interfering with his job performance. We think he is depressed, but he insists that he is not. Is it possible that he is depressed and how can we tell for sure and how can we tell him?

Signed,

Worried

Dear Worried,

Depression is absolutely a possibility, in fact it sounds like a pretty good hunch on your part. The fact that he denies it means nothing and actually is fairly common among men. In our society, men tend to think they are not real men, that they are somehow weak, if they admit to the feelings or symptoms that go along with depression such as hopelessness, feeling overwhelmed or inadequate, exhaustion, sadness, moodiness, or not being able to take care of oneself.

Depression can take on many forms but there are two that I want to highlight. In the mental health field we refer to these as retarded depression or agitated depression. The first is evidenced by someone being slowed down, sad, tired, and weepy and actually, more obviously depressed. The agitated type shows up as agitation, irritability, short-tempered, difficult. Unfortunately, it is the type we are least sympathetic to and it can be the most dangerous. These are the folks that can put their foot to the pedal and drive off a cliff.

An agitated depression often causes others to get fed up and walk away from the person they once loved, or admired or worked so well with. You have good reason to worry about your brother because many men simply will not admit to this and they stand a four times greater chance of committing suicide. Depression is also linked to heart attacks, strokes and other serious medical problems. Men are more likely to try to mask their problem with alcohol, drugs or other addictive behavior that becomes a distraction and makes them feel better temporarily, but can lead to dire consequences.

Women are much more likely to discuss their depressed feelings openly. Unfortunately, we have come to accept depression in women and actually for hundreds of years, depression was thought of as a woman’s disease. It was literally thought to be connected to the hormonal problems that women can experience along with their menstrual periods or menopause.

We now know that depression exists in the brain, whether it started there or not. It is not something one chooses to have; it is actually very painful. This is not to say that we do not make our own choices along the way that may lead us into a depression, we do. Anger turned inward is a major cause of depression. But by the time you have these symptoms and it becomes unbearable to you or those around you, it is in the brain.

Fortunately, there are many excellent treatments now and new ones coming all the time. Neuroscience has shown that certain types of talk therapy can actually change depression in the brain and there is also an array of good medication. The problem is in getting someone to admit to depression and seek the help that they need. It can be difficult for anyone to admit to; we are a society that likes to think we can control just about anything.

If you are a guy who is feeling irritable, becomes easily frustrated over small things, finds yourself screaming at people you care about and you simply do not feel good, be courageous and take charge of your life now. Get the help you need. Talk to your doctor or call a mental health professional. Go online and find out about depression; it really can happen to anyone, a man or a woman.

For men who just cannot seem to do it, maybe their wives, sisters or relatives will have to start the process. Worried, you and your family can see a professional to help you find the best way to approach your brother, if he can’t do it. Usually, it is worth the effort.

Good Luck!

Dr. Barge is a licensed psychologist and marriage and family therapist with offices in Brentwood. Please send your questions to newshrink.com. All questions will be kept strictly anonymous and confidential. Let us help you with your life matters.