Depression in men often masked in addictions, manifests as anger: Experts

Depression in men often masked in addictions, manifests as anger: Experts

SINGAPORE: For many years, Jason Tan* struggled to come to terms with an incident that had caused him to lose trust in his parents at the age of 16.  He also had to deal with his parents' separation and low self-esteem as a result of being afflicted with various medical conditions.

Being removed from a leadership position in a student organisation and experiencing burn out as a result of academic overloading also took a toll on Jason while in university. By 2008, he was feeling lost, worthless and was experiencing “a lot of inner pain and turmoil”.

Jason sought help at university that same year, but it was short-lived.

“In 2012, because my issues had not been treated in 2008, joining the workforce without being emotionally stable made it worse,” the 34-year-old teacher at an independent school said.

The issue of depression in men has been in the spotlight since swimming legend Michael Phelps revealed in an interview that he has battled severe anxiety and depression.

At his worst, Phelps even contemplated suicide. It took him about eight years from his first depression “spell” to finally seek help.


In December last year, researchers from the Institute of Mental Health (IMH) released the findings of a survey, which found that women aged between 18 and 34 are more prone to depression than men.

The survey spoke to more than 6,000 Singaporeans and permanent residents, and was based on data gathered between December 2009 and December 2010. Researchers said the results are similar to that from studies done in other countries.

But Dr Mok Yee Ming, a senior consultant and chief of IMH’s Department of Mood and Anxiety told Channel NewsAsia that researchers are unsure if the gap is a reflection of the disease or because men are less likely to seek help than women.

“It is likely a combination of such factors,” Dr Mok said.

“However, there are studies overseas that have found that men are less likely to seek help than women for mental health disorders.”

Dr Mok cited a British study published in 2005, that found that men, young people and those living in affluent areas were the least likely to seek help for mental health problems.

Medical Director at the Resilienz Clinic, Dr Thomas Lee, also experiences this at his practice, saying a majority of clients that come to him to treat depression are women.

“Generally, women are more likely to know why they are feeling this way and to seek help,” Dr Lee said.

“They may have been encouraged by friends to seek help after talking to them.”

Experts said apart from confusion surrounding the mental health issue amongst both sexes, there is an added stigma that often prevents men from coming forward.

“For men, there is the additional expectation of being 'manly' and masculine and not being emotional,” Dr Mok said.


Dr Lee said by the time his male clients seek help they have often been trying to cope with depression for many years using various methods. Some, he said, turn to sports to cope.

Others turned to alcohol and illicit drugs.

At his lowest, Jason was also chain-smoking and binge drinking to cope with the emotional and verbal abuse inflicted by his boss at the workplace.

This is a coping mechanism that is all too common among men, Dr Lee, who is an addictions specialist, said.

“A lot (of clients) turn to alcohol to help them deal with their emotions. They use this as a crutch and when it becomes too problematic, they come to me for drinking issues, not depression. It is only from the drinking issue that we realise the root cause is depression.”

Dr Lee added many come to him only when the alcohol abuse is starting to impact their work, sleep and daily activities.

“Of course, alcohol complicates the matter, but the main symptoms of depression are the ones that are paralysing them,” he said.

Dr Radiah Salim, who started voluntary welfare organisation Club Heal in 2012, said when this happens, clients end up having two mental health issues.

“They have underlying depression and an addiction, which is also a mental health issue.”

In fact, Dr Radiah said counsellors at Club Heal, which helps clients deal with mental health issues, often look out for depression when a client comes in for addiction-related treatment.

Dr Radiah said by the time men decide to seek help, their mental health has often spiralled to a dangerous low, sometimes to the point of suicide.

Indeed, statistics by Samaritans of Singapore (SOS) revealed that more men committed suicide over a ten-year period up to 2014, with the most significant increase among older men. This was despite overall decreasing suicide numbers in 2014.

When assessing clients, experts also said depression manifests differently among men and women. Dr Lee said while women tend to have symptoms of anxiety and worrying, depression surfaces in men through anger outbursts.

This may be seen as aggression with the family, at the workplace or even incidents of road rage.


For Jason, his second attempt at therapy was when he came close to a nervous breakdown.

“My students were consulting me and I just froze,” he recalled.

“I couldn't respond to them and had to motion to them to come back later. I arranged for therapy immediately after.”

Jason said apart from speaking to a counsellor, he was also taught cognitive behaviour therapy techniques to cope.

“There was also journalling, sketching and mind-mapping as it catered to what suited me best,” he said of his 18-month therapy experience.

He said there are opportunity costs in not treating depression early. In his case, it included settling down with a life partner later than his peers and lagging in terms of promotion and salary as he was distracted by his “emotional state of affairs”.

Jason said his experience has taught him that no one is truly perfect. He gave the analogy of being assigned to a physical employment status (PES) before being enlisted in national service.

“In their youth, most enlistees would want to be PES A, the ideal or pinnacle of physical perfection, because it gives them more chances to serve in the special forces or go to command school,” Jason said.

“The truth is that no one is truly 'PES A' when it comes to their overall state of health. Everyone has that something holding him or her back mentally, where it would do them well to seek treatment.

"The best maxim is this, seek help early and seek it as often as you need.” 

Source: CNA/mo