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Why do men experience depression differently from women? Part of it, certainly, is cultural. In a society that prizes strength in its men, there's little to be gained by them in exhibiting anything less. But part of it may be hormonal. Before puberty, boys and girls experience depression in more or less equal numbers. As they mature, however, girls fall prey to the blues more often, perhaps because of the hormone storms that accompany female adolescence. Could the different mix of hormones that boys produce--particularly testosterone--be somehow protective? If so, might the falloff of testosterone as men age slowly strip this protection away?
Dr. Harrison Pope Jr., director of the Biological Psychiatry Laboratory at McLean Hospital in Belmont, Mass., is exploring these kinds of questions. In a study published this year in the American Journal of Psychiatry, he reported recruiting 56 depressed men, checking their testosterone and finding that what he called an "astonishing" 24 of them had low or borderline levels of the hormone. To determine if this played a role in the men's depression, he had part of the group apply testosterone gel to their skin every day for eight weeks while another part did the same with a placebo. He found that the group that got the testosterone exhibited a brightening of mood that the placebo group didn't.
This research, to be sure, is preliminary. The study was small, and most of the average improvement in the hormone group was due to far-above-average improvement in just three men. But Pope's work suggests a genetic component to the hormonal connection. Testosterone's effectiveness is in part determined by the sensitivity of androgen receptors on the surface of cells--a variable that is itself determined by the genes. Other researchers, notably Dr. Stuart Seidman, a professor of psychiatry at Columbia University, are skeptical, insisting that there is nowhere near enough data to support the idea that testosterone has anything to do with depression. Other tentative links between genes and depression, however, are also emerging. Researchers at the University of Pittsburgh, for example, have found four spots on chromosomes that appear to help code for depression only in women and at least one that seems to do the same only in men.
If the roots of depression are different for men and women, however, the same treatments work equally well for both. The antidepressant revolution begun by Prozac in the early 1990s has transformed the therapeutic landscape. According to a recent study, 37% of people being treated for depression chose the drug option in 1987; 10 years later the percentage had doubled to 75%. And with newer and better antidepressants available all the time, those numbers are growing. Often just as effective as any drug is cognitive therapy, a form of the talking cure that teaches depressives to reframe their view of the world, questioning the catastrophic or fatalistic spin they put on otherwise innocuous events. The two approaches--medication and therapy--work especially well together.