Depression in Men: Causes, Symptoms and Treatment

According to the World Health Organization, Depression is a global epidemic and nearly 5% of the world’s population suffers from this condition. In North America, 9% of the population is said to suffer from depression, of which nearly 6 million are men. Although women are more prone to depression than men, men are four times more likely to commit suicide from depression, than women.

(Sources: EverydayHealth, CDC, NIMH and Healthline)
 

Unlike women who freely admit feelings of depression and seek treatment, men are less forthcoming. The primary reason for their inhibition is because of cultural stereotypes that expect men to be ‘strong’ or ‘in control’ of their emotions. As a result, men suffering from depression tend to discuss physical symptoms and mask the real reason for their problems. Consequently why, depression in men is not easily recognizable.

Other reasons are related to the way men cope with depression. Unlike women, men are more likely to camouflage their feelings of sadness with anger, irritability and aggression. While some men turn to alcohol or drugs to overcome the feeling of isolation, others may spend more hours at work. There is a stigma attached to mental illness of any kind, including depression, and admitting it can have an impact on the man’s career.

Undergoing treatment is again an issue, as taking time away from work can disrupt the man’s career, and in families where the man is the sole breadwinner, this can severely impact the financial health of the family. Further, depression and the treatment for depression causes sexual dysfunction in most men,thereby creating a vicious circle of despair. That is the reason men are more likely to use strong means of ending their lives (such as shooting or hanging themselves) unlike women who attempt suicide using soft methods.

Causes

Constant ongoing research and findings reveal that depression is not related to an individual’s moods or way of thinking, but is a serious condition that results from changes in the patient’s brain chemistry. However, despite extensive research, there is no clarity on the root cause of these changes. It has been found that neurotransmitters, or chemicals used by the nerves to communicate with each other, do not function properly at times. As a result, some areas of the brain are inactive while others are active causing an imbalance in the patient’s moods, thoughts, feelings and behavior.

Triggers and Risk Factors 

• Loneliness and lack of support system, such as friends and family
• Inability to handle stress at work, school or at home
• A history of substance abuse
• Marital, financial and career issues
• Trauma or abuse in childhood
• Disease and disability in old age
• Death of a friend or family member
• Chronic ailments such as Cancer, Diabetes, Heart disease, HIV and Stroke

Symptoms of Male Depression

• Fatigue, lack of energy and enthusiasm in routine activities
• Lack of interest in leisure or fun activities
• Inability to concentrate
• Suicidal thoughts
• Physical pain and discomfort, including headache, backache, indigestion, insomnia, and sexual dysfunction
• Angry, violent and abusive behavior
• Reckless behavior such as rash driving, playing dangerous sports, and unsafe sex

Forms of Depression

• Major depression: Lasts for weeks to a few months. Typical symptoms include inability to work, irregular eating, poor sleep, and lack of interest in any activity
• Psychotic depression:Lasts for weeks to a few months. Typical symptoms include inability to differentiate reality from imagination. Patients experience excessive guilt, despair, a feeling of worthlessness, imagined voices, and suicidal thoughts
• Persistent depressive disorder:Lasts for months to couple of years at a stretch. Typical symptoms include being permanently depressed along with some of the symptoms of major depression (dysthymia) and chronic major depression

Treatment 

• Drugs: Antidepressants, which manipulate specific chemicals in the brain, are used to treat depression. These are of two types: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotoninnorepinephrine reuptake inhibitors)
• Counseling or Talk Therapy: is found to be effective in treating mild forms of depression that last for several months
• Psychotherapy: Different forms of psychotherapy such as psychoanalysis, cognitive therapy, behavioral therapy, psychodynamic therapy, interpersonal therapy, experiential therapy and Insight-oriented therapy are employed to treat depression
• Lifestyle changes which include regular exercise, nutritious diet, adequate sleep and counseling for better stress management

Depression can be treated effectively when diagnosed in time. If you suffer from any of the symptoms mentioned here, contact your primary care physician. He/she will conduct a thorough examination and recommend you to a specialist who will plan the right course of treatment for you.

Detection and Treatment of Lung Cancer

Lung Cancer is the most prevalent form of cancer in the US currently, and causes more deaths than other chronic types of cancer such as prostrate, colorectal and breast cancer combined 

• In 1987, deaths due to lung cancer in women exceeded the number of deaths due to breast cancer
• The estimated number of deaths from lung cancer this year, are nearly 160,000
• Survival rate of people diagnosed with lung cancer is the lowest compared to other forms of cancer. Over 50% of people diagnosed with lung cancer die within a year of diagnosis

(Sources: www.cdc.gov and www.lung.org)

Risk Factors

• Smoking - is the primary cause of lung cancer. Even if you have quit smoking recently, you could still be at risk through years of smoking, and must be screened for lung cancer
• Second-hand smoke -If you live with a spouse, sibling, partner or roommate who smokes, you are at as much risk as the smoker
• Exposure to Radiation–this is a natural element that is produced by the breakdown of uranium,and itemanates significant levels of radiation. Radon accumulates in buildings, soil, air and water, which can put the resident at risk
• Exposure to harmful chemicals -toxic chemicals like asbestos, arsenic and chromium can be carcinogenic with prolonged exposure. If you work in a production plant and handle these chemicals routinely, you are at high risk of developing lung cancer
• Heredity - If you have a family history of lung cancer, you are at risk even if you are not a smoker or exposed to toxic substances, constantly

Symptoms

Compared to other types of cancer which exhibit symptoms, lung cancer does not present typical symptoms till an advanced stage (late Stage II and early Stage III). Common symptoms include:

• Persistent cough that doesn't cease with time
• Rasping and prolonged bouts of cough typical of smokers, called "smoker's cough"
• Traces of blood in the sputum
• Fluid in the chest, or ‘Pleural effusion’
• Shortness of breath caused by pleural effusion
• Chest pain, wheezing and hoarse voice
• Weight loss
• Pain in the bones and headache, which can be due to the cancer metastasizing to other parts of the body, like the bones and brain

Diagnosis

• Regular screening: If you are over 55 years of age, smoke regularly or have quit smoking in the recent past, you are required to take a CT scan of your lungs once a year. The CT scan may show small lesions (tissue that looks abnormal) which could be cancerous
• Sputum cytology:You will be asked to cough and produce sputum which is then examined under a microscope for lung cancer cells
• Biopsy: Tissue samples from your lung(s), lymph nodes and liver are collected using endoscopic methods and examined for lung cancer cells

 
Treatment

• Staging – this is the first step in the treatment process, wherein the Oncologist (cancer specialist) will analyze the stage of lung cancer (stage I, II, III or IV)
• Surgery -this is preferred, as the surgeon can remove the cancerous tissue completely
• Radiation -when the cancerous tissue is inaccessible, high-energy X-rays are used to burn out the cancerous tissue
• Chemotherapy -this is generally administratedafter surgery and radiation, to destroy any remnants of cancerous tissue
• Drugs - New-age drugs that target specific behaviors in cancerous cells, such as Bevacizumab, Erlotinib and Crizotinib are used to disable and destroy the cancerous tissue

If you are a smoker, handle hazardous chemicals, or have a family history of lung cancer, contact your primary care physician, who will conduct the requisite tests and recommend a comprehensive course of treatment.

Male Infertility: Detection and Treatment

Infertility or the inability to conceive a child has been regarded as a woman’s health issue, through the centuries. However, in the last few decades, there is a significant change in outlook, and more men are accepting the reality of male infertility. 

Causes

The most common causes attributed to male infertility are low count and motility of sperms. However, there are other factors which affect the production and transportation of sperms, consequently causing infertility. 

Factors Relating to Sperm Production 

• Chromosomal or genetic defects such as Klinefelter’s syndrome, Kallman’s syndrome and cystic fibrosis
• Undescended testes, a condition wherethe testes have not descended from the abdomen into the scrotal sac after birth
• Infections: Sexually transmitted diseases such as Chlamydia, Gonorrhea, Syphilis, and inflammations of the prostate or testicles
• Varicocele, a condition where the veins that drain the testicles are swollen up
•  Medications and drugs: Prolonged use of medicines containing anabolic steroids, and abuse of drugs such as crack, cocaine, marijuana among others

Blockage of Sperm Transportation

The testicles produce sperms andthe prostate produce semen. The testicles and prostateare connected by two ducts called thevas deferens, whichend in the urethra, from where the sperms are transported out of the body during ejaculation. Prostate issues, or vasectomy, or in rare cases, a missing vas deferens can inhibit the transportation of sperms outside the body. 

Factors Related to Sexual Performance 

Erectile dysfunction, premature ejaculation or retrograde ejaculation (sperms enter the bladder instead of the urethra) affects sperm production and sperm count. These factors could occur due to surgery, or injuries to the back and spine.  

Factors Related to Hormonal Imbalances

The production and count of sperms, is regulated by the Pituitary Gland, through the hormones LH (Luteinizing hormone) and SFH (follicle stimulating hormone). Prolonged use/abuse of anabolic steroids, and tumors in the pituitary gland can severely hinder the production of these hormones, and hence sperm production. 

Sperm Antibodies      

The human immune system wrongly interprets sperms as anti-bodies and tries to eliminate them.

Surgery

Surgeries forHernia, testicular cancer, prostate problems, prostate cancer and rectal cancercan cause minor damage to the reproductive system and inhibit production of sperm.

EnvironmentalCauses

People who are exposed to industrial chemicals, heavy metals such as lead, and X-rays, as part of their occupation are at a high risk of low sperm count or motility.

Lifestyle Related Causes

• Cycling, saunas and hot tub baths raise the temperature in the genital area and hinder sperm production
• Excessive smoking and alcohol consumption
• Obesity
• Mental or emotional distress
• Occupations that involve sitting for long hours, night shifts, and bearing heavy load

Diagnosis

Diagnosis of male infertility issues involves a physical examination of the genitalia followed by a thorough understanding of the patient’s genetic history and sexual behavior. Subsequently, the patient’s semen is analyzed for shape, count and motility of the sperms. Depending on theresults, the specialist may recommend secondary tests such as an ultrasound of the scrotal and transrectal area, an analysis of the urine after ejaculation, anda blood test to measure levels of testosterone, LH and SFH hormones. In some cases, the doctor may also recommend a biopsy of the testicles.

Treatment

There are several options available for treating male infertility. A physician who specializes in male infertility may recommend surgery to correct conditions such as varicocele or blocked vas deferens, or to reverse a vasectomy. Medication and hormone replacement are used to cure infections and various causes that hinder sperm production or count. Counseling is used to overcome psychological causes that affect sexual performance. If none of these options work, the man’s sperms are extracted using different methods and 

ARTs (assisted reproductive technologies) are used to help the woman conceive.

If you suspect that you sufferfrom any of the conditions listed above, consult a doctor who specializes in male infertility. He will conduct various tests and recommend a relevant course of actionbased on the results. This will help your partner conceive and fulfill your dream of havinga family.

Cholesterol Tests: What do they reveal?

Cholesterol related health disorders are one of the primary causes of adult mortality in the United States.

According to the Physicians Committee for Responsible Medicine (source: www.pcrm.org):

• As many as 2200 adult Americans die of Cardio Vascular Disease (CVD) every day
• More than 7% of Americans have some form of CVD
• According to the Center for Disease Control and Prevention (source: www.cdc.gov):
• Nearly 31.7 % of the adult US population have high ‘bad cholesterol’ (LDL) levels. Out of this:
• 29.5 % have the condition in control
• 48.1 % are receiving treatment

Cholesterol, a waxy, fat-like substance, is regularly produced by the liver, and it is needed by the body, to generate specific hormones, Vitamin D, and bile. Cholesterol is also ingested from animal and plant products, consumed through food. Over time, cholesterol levels in the blood can build up to unhealthy levels. The excess cholesterol depositson the inner walls of the arteries, in the heart, and hardens over time. This restricts the flow of blood to the heart and triggers heart attacks.

Cholesterol levels, poor diet, sedentary lifestyle, and heart health are closely linked to each other. Doctors recommend that people above 40 years of age, undergo a cholesterol test, one every two years.

It is recommended that men undergo a Cholesterol Testbefore they turn 35 years of age, and women, before their 45thyear. People with high risk factors are advised to undergo the cholesterol test in their early 20s.

Risk Factors for High Cholesterol 

• Family background of high cholesterol, CVD or CHD (coronary heart disease)
• Slightly to excessively overweight
• Consumption of alcohol on a regular basis
• Sedentary or inactive lifestyle
• Desk job
• Smoking
• Suffering from Diabetes mellitus, kidney diseases, thyroid issues, or polycystic ovary syndrome

Purpose of the Cholesterol Test

The Cholesterol Test measures four primary types of lipids (or ‘fat’) in the blood:

• Total cholesterol: This is a function of the other three types mentioned below and is calculated as LDL + HDL + triglycerides/5
• LDL: Low-density lipoprotein (LDL), also called ‘bad cholesterol’ is attributed to health risks such as stroke,heart attack, and atherosclerosis. Ideally, LDL levels must be low.
• HDL: High-density lipoprotein (HDL), also called ‘good cholesterol’ is beneficial to heart health as it transports bad cholesterol to the liver where it is processed and then excreted from the body. Ideally, HDL levels must be high.
• Triglycerides: The food that we consume is converted into energy, which is required for functioning of the body. The excess calories not used by the body are converted into triglycerides and stored in fat cells of the body. People who are overweight or those who follow a sedentary lifestyle or consume unhealthy foods, have high levels of triglycerides.

Taking the Test

After a preliminary diagnosis, the physician may recommend that either Total Cholesterol + HDL be measured; or a full lipid profile of the patient be created (called ‘Lipid Panel’ test). In case of the former, the patient can eat or drink before the test. In case of a full lipid profile test, the patient cannot consume anything other than water 9-12 hours before the test. The test is usually conducted in the morning. A few ml of blood is drawn from the arm of the patient, and then diagnosed in a laboratory.

Next steps

Based on the test results, the doctor may infer that the lipid levels are either normal, or outside the healthy range. Subsequently, he/she may recommend other tests such as blood glucose and thyroid function tests to be conducted.

If you have a family history of high cholesterol, or match any of the risk factors mentioned above, contact your primary care physician, who will conductthese tests and recommend a comprehensive course of treatment. This may include changes to your diet, your lifestyle, and an exercise program that willregulate your cholesterol levels.

Timely Detection and Treatment of Tuberculosis

Tuberculosis (TB) has been, and remains one of the greatest public health concerns since the Neolithic ages. Unlike small pox, chicken pox, plague, leprosy, and to a certain extent AIDS, where medical science has been able to eradicate or control the ailment to a large extent, tuberculosis is one disease that continues to challenge the medical fraternity. 

There are several reasons for this:

• This airborne disease is highly contagious and simple actions like coughing, sneezing and talking, helps spread the bacteria
• Several new strains of the two primary types of bacteria that cause TB, are detected all the time
• These new strains have developed resistance to the existing medications, making treatment difficult
• TB does not present typical symptoms and most of its symptoms can be confused with that of other diseases
• Growing the bacteria in laboratory cultures, is a slow process and it often produces unreliable results. The lab cultures are used to detect TB
• Similarly, the TB bacteria take a long time to die which makes the treatment an extremely lengthy process

Risk Factors

• AIDS and HIV infection
• Poverty and poor hygiene / Poor living conditions
• A weak immune system
• Diabetes
• Medication used to prevent rejection of transplanted organs
• Certain cancer treatments (Chemotherapy)
• Drug and alcohol abuse
• Diseases that are immunosuppressant in nature, such as the final stages of kidney disease, certain types of cancer
• Exposure to migrants from high TB-risk countries
• Healthcare professionals who treat TB patients

Typical symptoms

Depending on the type of TB contracted by the patient, and the stage of the disease, the symptoms can vary. However, the most common symptoms are:

• Consistent coughing that produces sputum every time
• Few drops of blood in the sputum
• Fever
• Poor to no appetite
• Rapid loss of weight and muscle
• Excessive sweating, while asleep at night

Diagnosing TB

There are several tests used to diagnose TB; tests which use a mix of physical and diagnostic examinations.

• Chest X-ray: Used to detect acute pulmonary TB that shows up as small cavities in the lungs
• Mantoux skin test: A dose of tuberculin is injected into the arm of the patient. The site is checked for any swelling 2 or 3 days later, on the patient’s return visit to the laboratory. Swelling at the site of the injection, is a positive sign of the existence of TB
• IGRA or Interferon Gamma Release Assays: The human immune response is known to produce a particular molecule called cytokine in response to TB bacteria. In this procedure or ‘assay’, a small sample of the patient’s blood is examined, to find the presence of a particular strain of cytokine called Interferon Gamma Cytokine
• Serodiagnostic tests: The blood sample of a patient suspected to have TB, is analyzed for the presence of specific antibodies
• Sputum smear microscopy: The patient’s sputum is smeared on slides and a particular stain is added. TB bacteria are known to pick up the stain (hence called “acid-fast bacteria”), thereby confirming the presence of TB
• Ziehl-Neelsen Florescent light microscopy: The sputum smears on the slides are examined under either a quartz halogen lamp, a mercury vapor lamp, or LED lamp, to detect the presence of TB bacteria

Once the strain of TB bacteria is detected, a relevant course of treatment is designed. Depending on the diagnosis, the treatment period could be anywhere from 6 to 9 to 12 months or even longer. All medications prescribed must be taken at the time specified. The medications may contain one or more types of antibiotics.

If you suspect that you may have been infected, then contact your primary care physician immediately, who after performing the preliminary tests and confirms the presence of TB, will refer you to a doctor who specializes in lung or infectious diseases.