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The Brain: The Story of You by David Eagleman

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The Brain: The Story of You by David Eagleman

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The Devastating Ways Depression and Anxiety Impact the Body

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The Devastating Ways Depression and Anxiety Impact the Body

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The number of people who become depressed and anxious after a pandemic. The biggest problem is that people get stressed out in their bodies when they feel stressed mentally, because the brain misunderstands, and there is a possibility of the opposite. Having enough sleep and talking about their problems with counselors are the best ways to reduce stress and avoid depression or anxiety.

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Mind and body form a two-way street.

Credit... Gracia Lam

It's no surprise that when a person gets a diagnosis of heart disease, cancer or some other life-limiting or life-threatening physical ailment, they become anxious or depressed. But the reverse can also be true: Undue anxiety or depression can foster the development of a serious physical disease, and even impede the ability to withstand or recover from one. The potential consequences are particularly timely, as the ongoing stress and disruptions of the pandemic continue to take a toll on mental health.

The human organism does not recognize the medical profession's artificial separation of mental and physical ills. Rather, mind and body form a two-way street. What happens inside a person's head can have damaging effects throughout the body, as well as the other way around. An untreated mental illness can significantly increase the risk of becoming physically ill, and physical disorders may result in behaviors that make mental conditions worse.

In studies that tracked how patients with breast cancer fared, for example, Dr. David Spiegel and his colleagues at Stanford University School of Medicine showed decades ago that women whose depression was easing lived longer than those whose depression was getting worse. His research and other studies have clearly shown that "the brain is intimately connected to the body and the body to the brain," Dr. Spiegel said in an interview. "The body tends to react to mental stress as if it was a physical stress."

Despite such evidence, he and other experts say, chronic emotional distress is too often overlooked by doctors. Commonly, a physician will prescribe a therapy for physical ailments like heart disease or diabetes, only to wonder why some patients get worse instead of better.

Many people are reluctant to seek treatment for emotional ills. Some people with anxiety or depression may fear being stigmatized, even if they recognize they have a serious psychological problem. Many attempt to self-treat their emotional distress by adopting behaviors like drinking too much or abusing drugs, which only adds insult to their pre-existing injury.

And sometimes, family and friends inadvertently reinforce a person's denial of mental distress by labeling it as "that's just the way he is" and do nothing to encourage them to seek professional help.

Anxiety disorders affect nearly 20 percent of American adults. That means millions are beset by an overabundance of the fight-or-flight response that primes the body for action. When you're stressed, the brain responds by prompting the release of cortisol, nature's built-in alarm system. It evolved to help animals facing physical threats by increasing respiration, raising the heart rate and redirecting blood flow from abdominal organs to muscles that assist in confronting or escaping danger.

These protective actions stem from the neurotransmitters epinephrine and norepinephrine, which stimulate the sympathetic nervous system and put the body on high alert. But when they are invoked too often and indiscriminately, the chronic overstimulation can result in all manner of physical ills, including digestive symptoms like indigestion, cramps, diarrhea or constipation, and an increased risk of heart attack or stroke.

Depression, while less common than chronic anxiety, can have even more devastating effects on physical health. While it's normal to feel depressed from time to time, more than 6 percent of adults have such persistent feelings of depression that it disrupts personal relationships, interferes with work and play, and impairs their ability to cope with the challenges of daily life. Persistent depression can also exacerbate a person's perception of pain and increase their chances of developing chronic pain.

"Depression diminishes a person's capacity to analyze and respond rationally to stress," Dr. Spiegel said. "They end up on a vicious cycle with limited capacity to get out of a negative mental state."

Potentially making matters worse, undue anxiety and depression often coexist, leaving people vulnerable to a panoply of physical ailments and an inability to adopt and stick with needed therapy.

A study of 1,204 elderly Korean men and women initially evaluated for depression and anxiety found that two years later, these emotional disorders increased their risk of physical disorders and disability. Anxiety alone was linked with heart disease, depression alone was linked with asthma, and the two together were linked with eyesight problems, persistent cough, asthma, hypertension, heart disease and gastrointestinal problems.

Although persistent anxiety and depression are highly treatable with medications, cognitive behavioral therapy and talk therapy, without treatment these conditions tend to get worse. According to Dr. John Frownfelter, treatment for any condition works better when doctors understand "the pressures patients face that affect their behavior and result in clinical harm."

Dr. Frownfelter is an internist and chief medical officer of a start-up called Jvion. The organization uses artificial intelligence to identify not just medical factors but psychological, social and behavioral ones as well that can impact the effectiveness of treatment on patients' health. Its aim is to foster more holistic approaches to treatment that address the whole patient, body and mind combined.

The analyses used by Jvion, a Hindi word meaning life-giving, could alert a doctor when underlying depression might be hindering the effectiveness of prescribed treatments for another condition. For example, patients being treated for diabetes who are feeling hopeless may fail to improve because they take their prescribed medication only sporadically and don't follow a proper diet, Dr. Frownfelter said.

"We often talk about depression as a complication of chronic illness," Dr. Frownfelter wrote in Medpage Today in July. "But what we don't talk about enough is how depression can lead to chronic disease. Patients with depression may not have the motivation to exercise regularly or cook healthy meals. Many also have trouble getting adequate sleep."

Some changes to medical care during the pandemic have greatly increased patient access to depression and anxiety treatment. The expansion of telehealth has enabled patients to access treatment by psychotherapists who may be as far as a continent away.

Patients may also be able to treat themselves without the direct help of a therapist. For example, Dr. Spiegel and his co-workers created an app called Reveri that teaches people self-hypnosis techniques designed to help reduce stress and anxiety, improve sleep, reduce pain and suppress or quit smoking.

Improving sleep is especially helpful, Dr. Spiegel said, because "it enhances a person's ability to regulate the stress response system and not get stuck in a mental rut." Data demonstrating the effectiveness of the Reveri app has been collected but not yet published, he said.

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The Devastating Ways Depression and Anxiety Impact the Body

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Mind and body form a two-way street. It's no surprise that when a person gets a diagnosis of heart disease, cancer or some other life-limiting or life-threatening physical ailment, they become anxious or depressed. But the reverse can also be true: Undue anxiety or depression can foster the development of a serious physical disease, and even impede the ability to withstand or recover from one.

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Sex Differences and Emotion Regulation: An Event-Related Potential Study

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Sex Differences and Emotion Regulation: An Event-Related Potential Study

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The reason that women get depression easily is that they are sensitive and have more emotional swings than men. They feel especially negative emotions more easily and longer than positive emotions. Therefore, they think about negative thoughts and spread their imaginations more and more negatively when having trouble.

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As a result, many people feel women are more emotional than men. The reason is that people think women express their emotions more. However, female students tend to feel depression and anxiety more than male students. They feel anxiety before taking tests and having presentations or while facing problems and making mistakes.

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How COVID-19 is impacting men’s mental health differently

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How COVID-19 is impacting men’s mental health differently

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COVID-19 impacted people's health and men's health, and it was linked to depression in men. They have no idea how to deal with their depression without consulting a doctor because they do not show signs of depression. They need to understand what depression is and talk about it using some medical applications.

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Fifty nine percent of American men say the COVID-19 pandemic has had a greater negative impact on their mental health than the 2008 economic recession. Rizky Panuntun/Getty Images

A new survey has found that the COVID-19 pandemic is having a bigger impact on the mental and general health of American men than many admit.

77 percent of respondents said their stress levels increased during the pandemic, while 59 percent reported they felt isolated.

About 45 percent said their emotional and mental health declined during this difficult period.

Experts say a large percentage of men typically avoid seeking treatment for their physical or mental health.

They encourage men to reach out to their support systems.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.
As COVID-19 continues to reorient our daily lives, new research is giving us a deeper look at how the pandemic is impacting men in the United States.

It's part of the fifth annual MENtion It educational campaign from Cleveland Clinic that zeroes in on why men often shirk away from addressing concerns about their health.

The new online survey examined how the coronavirus outbreak has affected men mentally and physically as well as influenced their day-to-day health behaviors.

Cleveland Clinic's survey team reached about 1,000 adult males, 18 years or older, across the nation.

They found that 77 percent of respondents said their stress levels increased during the pandemic, while 59 percent reported they felt isolated.

About 45 percent said their emotional and mental health declined during this difficult period.

The data also showed that this has been a more troubling period for adult males than past crises - with 59 percent saying COVID-19 had a greater negative impact on mental health than the 2008 economic recession.

Like past MENtion It surveys, these findings underscored just how rare it is for adult American men to seek medical and psychological health. The survey showed that 66 percent say they rarely even discuss the toll that COVID-19 has been taking on their mental health, while 48 percent say they put off seeing a doctor for non-COVID-19 health concerns.

It's not all bad news. The results showed 45 percent feel healthier now than before the pandemic, while 28 percent are sleeping more and 22 percent are adding more exercise to their routines. About 19 percent say they're eating healthier meals.

The survey shows a nuanced look at men in the United States - like all other demographic groups, they aren't a monolith, with COVID-19 impacting them in varying degrees.

"Men have more difficulties with addressing their mental health and that can impact their physical health in turn," said Dr. Petar Bajic, one of the doctors associated with the campaign and a urologist at Cleveland Clinic's Glickman Urological & Kidney Institute. "I encourage all men to talk to their partners, talk to their support system."

Dr. Michael Young, service chief of The Retreat at Sheppard Pratt, a psychiatric hospital in the Baltimore, Maryland, suburb of Towson, said the uncertainty of this era has had a significant impact on men's mental health.

"The findings from the Cleveland Clinic survey that over three quarters of men are experiencing increased stress levels and nearly half are reporting that their mental health has worsened during the pandemic is consistent with what we are seeing in clinical practice," said Young, who is not affiliated with this research.

Bajic said that when asked about their own health priorities and stressors, the men surveyed cited the economy and their family's well-being ahead of their own personal health.

He explained that this is in many ways a cultural and societal issue - many men view themselves as what he called "the primary bread winner." They feel that if their own health suffers, they might be concerned they won't be able to fill that role in their family or community.

Young added that the COVID-19 era of working from home and sheltering in place has been disorienting for men in some of these traditional family roles.

"Many men are having difficulty adjusting to new and different roles such as increased caregiving responsibilities or helping their children adjust to remote learning while keeping up with online work, household chores, and other responsibilities," Young said. "Additionally, the reduction of income and uncertainty surrounding investments and financial stability is playing a large part in increasing men's stress levels."

Young said that many men tend to derive the base of their own "self-esteem and sense of purpose from their careers and ability to provide financially for their families." Job loss and the economic problems that can come from it can be a major stressor for men who might have been the top earners in their households before the pandemic.

The new norm of life away from others can also lead to a sense of isolation.

"Isolation from important aspects of social networks such as work colleagues, friends, and extended family have also been contributing to feelings of loneliness, which is a well-known factor that can contribute negatively to both mental and physical health," Young added.

Both Bajic and Young stressed that it is a serious problem that many men avoid seeking medical attention and mental health resources.

"Anybody who knows men knows that men are not great about going to the doctor and that is something we've seen as part of the reason we started this survey and the MENntion It campaign," Bajic added. "The goal is to understand men's health behaviors in order to spread the word and understand that health is important and that it's important to take care of themselves."

Young said that unfortunately many men view having depression and anxiety as "a sign of weakness." He added that despite advances in medical knowledge of mental illness, stigma still exists, particularly among American males.

"Cultural pressures for men to appear strong and not vulnerable also contribute to men seeking medical attention and mental health treatment less frequently than the population as a whole," Young explained.

"It is important to shine a light on the shame and guilt that men may be experiencing. Reframing the narrative to emphasize that asking for help is a sign of strength, not weakness, may help more men be willing to ask for help when they need it," he added.

When asked what resources are out there, Bajic told Healthline that telemedicine is an accessible and less intimidating way to engage safely with your health team if you are having a hard time during COVID-19.

Many men might not always fully disclose what is going on with their health when visiting their primary doctor, might shy away from seeking an in-person therapist, or could be wary of entering a medical facility during the pandemic. A phone or virtual appointment from home could be an easy way to begin to address health problems with a medical professional.

Bajic said most hospitals and healthcare centers have resources on their websites where you can find out how to schedule one of these appointments as well as how to schedule in-person visits with doctors and counselors if those are preferred.

He added that it is important to note that not everyone is being impacted by COVID-19 the same.

For instance, the survey was nearly split down the middle when it came to healthy behaviors - around half reported being less healthy and around half reported being healthier now. Bajic said a lot of different factors account for this. Some of these men might have been more inclined than others to begin with, to embrace physical activity and nutritious eating.

He said those who reported worse health habits were more likely to increase their alcohol consumption, for instance, and lean into more sedentary behavior.

"Again, it's about how people deal with difficult times - it's important for men to talk things through and use their support system, use resources that are available to them in terms of dealing with stress in a healthy way," Bajic said.

"It has never been more essential for men who are suffering from a decline in mental health to seek help. We know that several million men are affected by depression in the United States every year and that suicide is among the leading causes of death among men. And the pandemic is increasing the incidence of mental health crises, which are already so prevalent, even further," Young added.

He also stressed that if men aren't willing to seek help then symptoms of anxiety and depression will continue, leading to increased drug and alcohol use "as a maladaptive coping strategy."

"Alcohol and drug abuse, which are highly prevalent and exacerbated in settings of increased stress, can also contribute significantly to other leading causes of death among men such as heart disease and non-intentional injuries," Young said. "Reaching out for help with problematic substance use is also essential, especially right now with the increased stress of the pandemic."

To manage mental and physical health declines during this difficult time, Young said paying attention to a healthy diet, exercising, getting enough sleep, maintaining social ties with others even when in-person experiences are hard to find - hello, Zoom calls - and "prioritizing self-care" are all key.

"Spending time in the outdoors, developing hobbies, practicing meditation, and engaging in other wellness initiatives such yoga can also be very helpful. However, reaching out for help from others is often an essential step," he added.

Young said that he wants men to know that "it is essential to get out the message that mental health conditions are medical problems with available, effective treatments, and there is hope."

If your symptoms worsen or you experience more severe mental health symptoms such as thoughts of self-harm or suicide, seek help by either calling 911 or visit the closest emergency room to connect with mental health professionals, Young said.

He also suggested calling the National Suicide Prevention Hotline at 800-273-8255 for resources and support or reaching the Crisis Text Line by texting HOME to 741741 "from anywhere in the United States to reach a live, trained crisis counselor."

When it came to COVID-19 itself, the study showed that while 70 percent of men wear protective face masks in public, about 30 percent haven't been using this method to stop the spread of the virus.

Only 51 percent of young men ages 18 to 34 avoid large groups of people, a stark comparison from the 67 percent of men 55 and older who are more adherent to social distancing.

Bajic said this is a product of the national representation of the survey. As is widely known, the United States is inconsistent in its approach to suppressing the virus, with some states seeing more spikes in the spread of COVID-19 than others. Bajic stressed that people of all kinds - men included - listen to public health guidelines, wear masks, and adhere to social distancing recommendations to protect themselves and others.

He added that it seemed to depend on life experience, too. Men who were either married or had children under the age of 18 were more likely to treat COVID-19 prevention more seriously.

Despite all of the stress and anxiety surrounding the pandemic, the survey did find that while 64 percent of respondents did not see an end to COVID-19 in the near future, 71 percent remained "optimistic about the future," Bajic said.

"Even though many men are not sure when things will go back to what we considered 'normal' in the past, it's still important to have a positive outlook and talk about feelings with your support system," Bajic added. "It's necessary to tell that support system how you are doing and what you need as time goes on."

A survey that is part of the fifth MENtion It health campaign from Cleveland Clinic showed how the COVID-19 pandemic has impacted American adult males.

Some of the results: 77 percent of respondents said their stress levels increased during the pandemic, while 59 percent reported they felt isolated. About 45 percent said their emotional and mental health declined during this difficult period.

Experts say men typically avoid seeking treatment for their physical or mental health. They encourage men to reach out to their support systems. If seeing a doctor or a therapist is too uncomfortable at this time, seek one of the telemedicine options made more available during the pandemic as a way to move forward in addressing your health needs.

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How COVID-19 Is Impacting Men's Mental Health Differently

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A new survey has found that the COVID-19 pandemic is having a bigger impact on the mental and general health of American men than many admit. 77 percent of respondents said their stress levels increased during the pandemic, while 59 percent reported they felt isolated.

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Author: Thompson Jr, Dennis
Published by Everyday Health

There are many differences between women and men in how they express their emotions because some parents distinguish how to take care of their children’s emotions by gender. It creates stereotypes in children, causing them to be unable to express their emotions to others, and it causes depression and emotional distress. Men do not express their emotions, so it is easy to be depressed. However, they tend to drink more or smoke more instead of feeling it.

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Gender Differences in Emotional Health - Emotional Health Center - Everyday Health

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Gender differences are real and can affect the emotional health of men and women. Learn what the research says about how men and women express emotions.

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Author: Stepko, Barbara
Published by AARP

Women are more prone to depression than men due to stress and social status, but they are more likely to seek help from counselors. When depressed, women feel more anxious and tend to be more seriously ill. Men, however, tend to smoke, drink, and use drugs more. Therefore, they tend to try to solve their problems by themselves and even commit suicide.

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Indeed, research has established that men often are more deeply depressed before they are willing to seek help. "This may explain why men report higher rates of substance abuse when depressed and, more importantly, why men with depression die by suicide at higher rates than women," says Cole, who notes that this is especially true for older men, who have the highest rate of death by suicide in the U.S. "It is important that we normalize the fact that men get depressed and that it is acceptable to seek help from family, friends and professionals."

Treatment and coping strategies

Depression can be treated with talk therapy, antidepressants, or a combination of the two.

More than 15 percent of women take antidepressants, often selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that includes Prozac and Zoloft. These drugs act on the serotonin system that affects mood and anxiety.

But taming depression is often possible without downing a pill. Milder forms of the disorder, especially, can be managed with coping strategies. A few:

Get moving. Engaging in healthy behaviors can help to move the depression along, says Bruce Sutor, M.D., a psychiatrist at the Mayo Clinic in Rochester, Minnesota. Probably the simplest, most effective treatment is exercise. A 2016 study in the Journal of Psychiatric Research found that regular moderate intensity aerobic exercise had "a large and significant antidepressant effect in people with depression, (including [major depressive disorder])." What's more, it appears that even modest levels - say, taking a brisk walk around the neighborhood - may have benefits.

Stick to a healthy diet. There's evidence that eating healthy (yes, a Mediterranean diet, chockful of fruits, vegetables and whole grains) can help reduce symptoms of depression. It makes sense: About 95 percent of serotonin, a neurotransmitter that helps regulate our moods, is produced in your gastrointestinal tract.

Avoid alcohol. A depressant, alcohol lowers the levels of serotonin, the feel-good chemical that regulates mood, in your brain. So, overindulging may cause your depression to worsen. The American Heart Association recommends women have only one drink or less per day.

Practice age-old calming techniques such as meditation, yoga or focused breathing exercises. Lower stress levels can help treat depression. When we slow our breathing, it regulates our heart rate and calms the body down. A study out of Boston University School of Medicine has found evidence that yoga - which incorporates mindful breathing - can provide relief not only while you're doing it, but also cumulatively, over time, as well.

Reach out. Spend time with friends and family to build social support. And let's not forget the power of interaction. A study in The American Journal of Psychiatry focused on 106 modifiable factors that might affect people's risk of depression and found that, according to a coauthor of the study, "far and away the most prominent of these factors was the frequency of confiding in others."

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Why Women Are More at Risk for Depression Than Men

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Indeed, research has established that men often are more deeply depressed before they are willing to seek help. "This may explain why men report higher rates of substance abuse when depressed and, more importantly, why men with depression die by suicide at higher rates than women," says Cole, who notes that this is especially true for older men, who have the highest rate of death by suicide in the U.S.

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Author: Schimelpfening, Nancy
Published by Verywell Mind

There are three reasons why women feel depression more easily than men. The first factor is the cycle of hormones changing all the time during your period, being pregnant, and menopause. The other factors are differences in diagnosis and social roles between genders. Women feel stress and are more sensitive than men, and they also feel depression from their emotions and thoughts.

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It has been widely documented that there are gender differences in depression prevalence, with women experiencing major depression about twice as often as men. This risk exists independent of race or ethnicity. Several risk factors have been studied which might account for gender differences in depression prevalence. Let's take a look.

Why Women's Hormones Increase the Prevalence of Depression

Given that the peak onset of depressive disorders in women coincides with their reproductive years (between the ages of 25 to 44 years of age), hormonal risk factors may play a role. Estrogen and progesterone have been shown to affect neurotransmitter, neuroendocrine, and circadian systems that have been implicated in mood disorders.

The fact that women often undergo mood disorders associated with their menstrual cycle, such as premenstrual dysphoric disorder (though this is a fairly new disorder that has not been embraced by everyone in the healthcare field), also points to a relationship between female sex hormones and mood.

In addition, the hormonal fluctuations associated with childbirth are a common trigger for mood disorders.

Although menopause is a time when a woman's risk of depression declines, the perimenopausal period is a time of increased risk for those with a history of major depression. Other hormonal factors that may contribute to a woman's risk for depression are sex differences related to the hypothalamic-pituitary-adrenal (HPA) axis and to thyroid function.

Gender Differences in Socialization

Researchers have found that gender differences in socialization could play a role as well. Little girls are socialized by their parents and teachers to be more nurturing and sensitive to the opinions of others, while little boys are encouraged to develop a greater sense of mastery and independence in their lives.

This type of socialization is theorized to lead to greater depression in women, who must look outside themselves for validation.

Gender Differences in Coping Style

Studies show that women tend to use a more emotion-focused, ruminative coping style, mulling their problems over in their minds, while men tend to use a more problem-focused, distracting coping style to help them forget their troubles.

It has been hypothesized that this ruminative coping style could lead to longer and more severe episodes of depression and contribute to women's greater vulnerability to depression.

Differences in Frequency of and Reaction to Stressful Life Events

Evidence suggests that, throughout their lifetimes, women may experience more stressful life events and have a greater sensitivity to them than men.

Adolescent girls tend to report more negative life events than boys, usually related to their relationships with their parents and peers, and to experience higher levels of distress related to them. Studies of adult women have found that women are more likely than men to become depressed in response to a stressful life event and to have experienced a stressful event within six months prior to a major depressive episode.

Social Roles and Cultural Influences

It has also been theorized that women who become housewives and mothers may find their roles devalued by society while women who pursue a career outside the home may face discrimination and job inequality or may feel conflicts between their role as a wife and mother and their work.

Due to their social circumstances, adverse life events associated with children, housing or reproduction may hit women especially hard because they perceive these areas as important to their definition of themselves and may feel they have no alternative ways to define themselves when these areas are threatened.

Several researchers have also suggested that there may actually be no difference in prevalence between men and women. These researchers have proposed the idea that it may actually be that women seek help more often than men or report their symptoms differently, leading to them being diagnosed more often than men. However, other studies have refuted these claims.

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Article Sources

Katz, Vern L. et. al., eds. Comprehensive Gynecology 5th ed. Philadelphia: Mosby, 2007.

Kornstein, Susan G., and Anita H. Clayton. Women's Mental Health: A Comprehensive Textbook New York: Guilford Press, 2002.

Piccinelli, Marco, and Greg Wilkinson. "Gender Differences in Depression." British Journal of Psychiatry 177 (2000): 486-492.

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Is Depression Really More Common in Women?

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It has been widely documented that there are gender differences in depression prevalence, with women experiencing major depression about twice as often as men. This risk exists independent of race or ethnicity. Several risk factors have been studied which might account for gender differences in depression prevalence. Let's take a look.

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Men and women experience happiness differently - here’s why.

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Men and women experience happiness differently - here’s why.

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Women are twice as likely to suffer from depression as men because they feel happy and sad more easily than men. The biggest reason why women get depression is that women do not tend to work outside and express themselves more. It is connected to this problem, but women have the strength that they can recover from depression and anxiety more quickly than men.

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Men and women experience happiness differently – here’s why

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With the exception of anger, women experience emotions more intensely and share their emotions more openly with others.

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Women's mental health: depression and anxiety

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Women's mental health: depression and anxiety

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Women get disorders more easily than men because their brains are more complex and have larger frontal lobes. The percentage of women who are over 18 with depression is increasing. There are many reasons, such as hormones, periods, and the environment surrounding them.

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What are the signs of depression in men?

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What are the signs of depression in men?

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Some men have depression, but they misunderstand their symptoms as stress because their symptoms are similar to when they have stress. They tend to drink alcohol, smoke, and use drugs to reduce their stress. As a result, the number of men who suiside is higher than women.

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Signs of depression in men: What to know

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The signs of depression can vary between men and women. Men are generally more likely to feel anger and to engage in substance abuse and risky behavior. In this article, we discuss the behavioral, physical, and emotional signs of depression in men and explain how to get help.