Talking About Men's Health™

This week’s deadly plane crash in Austin, Texas raises important questions regarding national security, anti-government violence, and aviation licensing. One could also make the argument that at the core of the tragedy are questions regarding failure in mental health management. As is frequently mentioned at TAMH, the ability for men to come to terms with personal health issues proves extremely difficult. Mental health is no exception, and in some ways is an even tougher condition to discuss, let alone seek treatment for.

No doubt the above incident is an extreme case, but it nevertheless can act as a learning experience of how best to deal with the demons that we all face. No one piece of the puzzle is to blame, as everything from self-assessment to family support to organizational therapy could have played a larger role. Though the attacker had a history of anti-government sentiments, he reveals in his suicide note that he would write about his disdains ‘as a form of therapy.’ Writing is a common tool for psychotherapy and should be encouraged, though in this case Mr. Stack’s anger management reached a breaking point stating that violence ‘is the only answer.’ With decades of simmering hatred, it is hard to fathom how those close to him could not have seen warning signs at some point. Numerous run-ins with tax officials and auditors could have also raised concerns.

This examination is not meant to highlight the failures that led to the tragedy, but rather raise awareness of the very real sensations that we face every day. No matter the antagonists in our life, it is important to be able to cope with our reactions through personal processes, healthy support from our loved ones, and if needed professional expertise. This is especially relevant during tough economic times. How can I better manage my own trepidations? Would I be able to ask for help if I needed it? How can I act a source of support for a troubled loved one? What other ‘checkpoints’ can be utilized to give people opportunities to work out their thoughts in healthy ways; occupational health systems, government points of contact, or other social services? How does the equilibrium of incarceration versus rehabilitation come into play? To break the social norm of men’s emotional internalization, we must be able to have more thoughtful discussions regarding questions such as these.

Men’s Health issues are featured in an article by Teddi Dineley Johnson in the current issue of The Nation’s Health, a print and online publication of the American Public Health Association.  You can access the article here: http://TheNationsHealth.AphaPublications.org/content/40/1/28.full.  This piece, which quotes both MHN Vice President Scott Williams and Advisory Board member Dr. Perry Karfunkel, is a call to action for men to consider and improve their health.  It’s also a reminder that men’s health issues do not always show up on the radar in discussions about national health in general.

One of the key points in the article is the gap of 2-3 decades in which a large percentage of men have very little contact with health professionals.  Having passed through high school and possibly college, men in their 20s, 30s and even 40s become alienated from the healthcare system.  This can be attributed to a combination of factors, including fear and the classic tough-guy belief that you don’t need to see a doctor unless you’re in extreme pain.  Also, unlike women, men have much less frequent contact with doctors during their adolescence for routine care and never get into a healthy habit of regular check-ups to detect potential problems.  When men finally do present themselves in a medical facility, perhaps years after developing mild pain or a nagging health condition, many have missed the chance to catch a serious ailment early.

If this sounds like you, don’t wait any longer to see a professional about any health issues that are bothering you.  And if you know someone who is struggling with an ailment, let them know you care enough about them to ensure they get the help they need.  Finally, be sure to share information like this article with those you know, and to advocate for more coverage of men’s health issues in both publications and public policy debates.  MHN is excited to see this article published in The Nation’s Health and looks forward to engaging in more educational activities about men’s health around the country.

I wanted to draw your attention to an article published in the February 8^th issue of Newsweek magazine that highlights recently released research that solidly confirms the nearly imperceptible difference between the effectiveness of medications and placebos for the treatment of mild, moderate, and even severe depression.  Drawing primarily from a met-analysis published in the January issue of the Journal of the American Medical Association (JAMA), the article explains how it was discovered that after analyzing just published research it was shown that patients taking a placebo improved 75% as often as those taking the actual medication.  However, only sixty-percent of clinical trials performed on the main drugs for the treatment of depression have ever been published.  After using the Freedom of Information Act to gain access to the remaining 40% of unpublished studies, this number rose to 82%.  In addition, when combining both the published and unpublished trials, researchers found that over half showed “the drug alleviated depression no better than a placebo”.  Further, in the trials that did show an improvement with those taking the actual medication, it successfully reduced severity of depression by only 1.8 points on the 54-point scale.  The final conclusion of the meta-analysis was that the true effect of antidepressants was “nonexistent to negligible” in 87% of people.  The only statistically significant drug benefit was in individuals with very severe, chronic symptoms.  Just in case there was any doubt remaining, researchers exposed that even the very basis of the effectiveness of antidepressants is based only on a single study from the 1950s.  This study showed that a drug called Iproniazid increased serotonin and norepinephrine levels in the brain and seemed to help a number of people with depressive symptoms.  Therefore it was decided that it was an imbalance in these two chemicals that must be the cause of depression.  Yet a new drug sold in Europe has been shown to be as effective as most current antidepressants and actually lowers levels of serotonin.  One of the authors of the ineffectiveness studies puts it plainly, “If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it, it’s hard to imagine how the benefits can be due to their chemical activity.”

Strangely enough, the arguments against this study revolves not around the accuracy of the science, which is admitted even by physicians as well as drug proponents, but whether or not it is morally right to overturn the belief of hundreds of millions of people about the effectiveness of their treatment.  It is argued that, even if the improvement truly is fantasy, this belief is necessary for the benefit to continue. Further many fear that exposing the truth might even cause those receiving treatment to abruptly stop taking their medication, which can cause severe withdrawal symptoms such as nausea, vision problems, tremors, and even depression and anxiety.   That is certainly an understandable and noble stance if it is indeed patient well-being and not a financial bottom-line influencing such a stance.  However, this could easily be the most slippery of slopes.  Is it really the moral option to continue to allow millions of people to spend thousands of dollars on drugs that serve no actual benefit?  Who is it that is qualified to determine what is best for each of us?  Physicians?  Pharmaceutical companies?  Do the lobbyists for Prozac have depressed people’s best interests at heart?

Both the news and journal articles focus primarily on the lack of a difference between the effectiveness of pharmaceuticals and placebos and the potential consequences.  However, it does mention documented methods for successful alternatives, such as psychotherapy, which has been shown to be highly effective for all levels of depression, including very severe.  It also makes the case for how the combination of medication and psychotherapy can be even more effective for some people, but warns that this may also be due to the expectation for success.

All this research has important implications for men’s health since men are equally as likely to suffer from depression as women, but are much more likely to successfully commit suicide because of it.  The National Institute of Mental Health estimates that depression affects approximately six million men in the United States and between three and five-percent of men worldwide.  Additionally, a number of sources confirm that worldwide sales of antidepressants are currently over $20 billion.  Therefore any decisions about the distribution and use of these drugs will have profound effects not only on people suffering from depression and the economics that support their treatment, but also the functioning of mental health care systems throughout the world.

References

Begley, S.  The Depressing News About Antidepressants.  29 January 2010.  Newsweek.

Fournier JC, DeRubeis J., Hollon SD; et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303():47-53.