The Prairie Doc Perspective

The miserable masculine blues

By Richard P. Holm MD

Suicide and depression is on the rise, especially in men.

A recent report from Minnesota notes overall suicide rates there are the highest in 20 years, showing an increase by 13% from 2010 to 2011, especially in 50 to 59 year-old men. The CDC speculates that the world-wide suicide increase in 50-59 year-old men is a consequence of the recent international economic crisis. Illustrating further the story of male gloom is that the highest suicide rate of all still is in white men older than 84.

It is no leap to say that if suicide in men is on the rise, then so is depression.

Shakespeare speaks to his own low-down blues in sonnet 29, after the plague closed his theater:

When, in disgrace with fortune and men’s eyes,

I all alone beweep my outcast state

And trouble deaf heaven with my bootless cries

And look upon myself and curse my fate…

But I submit, if we asked Bill if he were depressed, he would say, “No!”

In my experience, men commonly do not admit to having depression. Instead they express increasing anger, building stress, a shortening fuse, and an intolerance of the boss, the spouse, the incompetent, the government. Sometimes they speak of loneliness, financial problems, or divorce, and then complain of back pain, stomach trouble, insomnia, or new weakness. Other times they will label themselves with “post traumatic stress disorder” or even justified sadness, but only rarely will they admit to depression.

A careful evaluation by an astute clinician should be the first order of business since some of these men may have a medical problem causing this outcast state. A careful history and physical exam will sometimes reveal clues to an underlying brain, lung, kidney, heart, or other condition. Following findings from the exam it might be appropriate to order thyroid, vitamin B12, testosterone, or heavy metal levels, and perhaps a sleep oxygen study, an X-Ray, or a stress test.

But many times there is no medical, social, or even post traumatic stress to cause our man to be so down. He just is, and for some undefinable reason is at significantly higher risk for successful suicide than a woman with the same condition.

Indeed, if you are that guy cursing your fate, realize that your condition: is very common; might indicate a medical problem; and will definitely get better, unless you end it.

Whatever this low-down blues thing is called, it is something that can be fixed without violence.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at 

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