Prevention
Aging Well
Scientists set out to fathom medical mysteries of older men
By KELLY GREENE
Staff Reporter of THE WALL STREET JOURNAL
October 10, 2005;
Jed Diamond, a 61-year-old psychotherapist in Willits, Calif., showed no signs
of depression when he and his wife filled out screening questionnaires 12 years
ago as part of their effort to help their son with a drug problem.
His wife, however, scored high on the test, indicating she could be depressed.
She ``got treated and, over six months or so, she was starting to feel better,``
Mr. Diamond recalls. But when his wife suggested that his snappish behavior
might mean that he was depressed, too, he balked. ``I said, `I`m a therapist --
I`d know if I were depressed.` ``
Finally, after several years during which ``things were really stressful between
us, I agreed to go and see somebody,`` Mr. Diamond says. ``And I started to
wonder, maybe I and a lot of other men were experiencing depression in a
different way. Maybe we`re measuring depression more accurately in women and not
recognizing it in men.``
As a result, he designed a new depression test specifically for men -- and
identified what he calls ``irritable male syndrome,`` adding up scientific
studies that, taken together, suggest that many men go through changes as they
grow older that are different -- in ways big and small -- than the changes women
go through. And they involve changes that are both psychological and physical.
The problem, as Mr. Diamond`s experience shows, is that those changes in men
sometimes go undetected or untreated. While scientists have turned their
attention in recent years to more effectively recognizing and treating problems
common to older women, researchers have just started to focus on the medical
mysteries surrounding older men.
Rephrase That
One reason that male changes often go undetected is that men generally aren`t
conditioned to get annual medical exams, as many women do with gynecologists.
They often write off signs of change in their bodies or emotions as a normal
part of aging.
When that happens, the result can be a grumpy old man -- or worse. Fifteen
percent of the 60,622 Americans who killed themselves in 2001 were men over age
65, according to a recent analysis by the Centers for Disease Control and
Prevention in Atlanta. And most elderly suicide victims had been recently
diagnosed with their first episode of depression, the CDC says.
In trying to better detect depression, Mr. Diamond decided that he needed to
find a way to get men to open up about their emotional issues. So he came up
with a list of questions different from those typically used to pinpoint
depression because ``men may be depressed at higher rates than women, but [they]
may express depression in different ways. That may be particularly true as we
age.``
Indeed, a recent study by J. Douglas Bremner, an Emory University psychiatrist,
tested a group of former depression patients by giving them a drink that blocked
the brain`s ability to absorb serotonin, the neurotransmitter that lets us feel
happy. The women cried and talked about their pain; the men typically didn`t
want to talk and said they felt fine. Instead, they wanted to get away to a
nearby bar.
Mr. Diamond says he replaced typical questions like, ``Are you sad? Do you cry
more often? Are you feeling hopeless?`` with questions asking if, over the past
month, the subject has felt more aggressive or irritable, has had trouble
sleeping, or has ``over-consumed`` alcohol.
More Than the Mind
It`s not just men`s psychological issues that are starting to get some
attention. Researchers also are trying to find better ways to recognize and deal
with the physical ailments that affect older men.
The National Cancer Institute is currently trying to determine the value of
certain screenings for prostate cancer. Scientists are following 38,350 men who
started with no indication of cancer to see whether prostate-specific antigen,
or PSA, screening and digital rectal exams decrease deaths due to prostate
cancer. A high PSA concentration can indicate the existence of prostate cancer
-- but the test doesn`t necessarily tell whether the cancer would be deadly.
That means men with cancer that isn`t life-threatening could wind up undergoing
procedures that might do more harm than good.
The National Institute on Aging, meanwhile, is gearing up for a large-scale
trial on testosterone-replacement therapy. For the few men whose bodies make
very little or no testosterone, such as men whose pituitary glands have been
destroyed or whose testes have been damaged, supplements may help maintain
strong muscles and bones, and also increase sex drive, the institute said in a
recent statement. But more research is needed to determine the risks and
benefits of testosterone therapy for older men with normal testosterone levels.
For men who have determined that they have psychological issues, treatment is
varied.
Some take treatment into their own hands. Mike Love, a 50-year-old hospital
worker in Rathdrum, Idaho, turned to antidepressants for about 10 years to help
him get his anger toward his family in check. But he always worried that the
drugs were doing more harm than good, he says. After reading about B-complex
vitamins a few years ago, he started taking them instead, and feels that they
have worked much better.
``Going into my 40s, I didn`t know what was going on inside my body,`` he says.
``I just felt like a lot of weird things were going on that I couldn`t quite
explain. I was feeling uptight and depressed -- like there was some kind of
chemical imbalance.``
Bob Gallagher, a 50-year-old program-administration worker at a nonprofit group
in Bloomington, Ill., has found men`s retreats and a related weekly support
group the most important parts of dealing with problems he experienced. In his
former position as an insurance executive, he had taken on more work than he
could handle -- and ended up having to leave his job.
The Value of Venting
``This [support] group...recognizes that there`s nothing wrong with going to a
counselor or a psychiatrist for help,`` he says. ``If you hold in your emotions,
you start having health problems and heart attacks. But if you release those
emotions in a men`s group, it helps the man and your family. You don`t come home
angry.``
John Upton, a 49-year-old filmmaker, turned to acupuncture after the stress of
working with Romanian orphans 14 years ago sent him into a downward spiral in
which he ``screwed up`` two marriages. He was opposed to taking antidepressants,
so his condition largely went untreated.
Of middle-aged men dealing with depression and related problems, he says, ``It`s
kind of a like a free fall where you feel like a kid who isn`t understood, isn`t
heard. You seek to replace the things that are missing through externals.``
While filming a project about spinal-cord recovery, ``I was seeing people with
needles in their heads`` and decided to try acupuncture, Mr. Upton says. ``It
took three treatments, and I got my sense of well-being back. That`s when my
turnaround really began.``