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MEN’S HEALTH 45 DEPRESSION: the silent killer for men By Margaret Mielczarek. With concerns about mental health exacerbated during the pandemic era, this month Retail Pharmacy looks at the issue from the viewpoint of men, with a focus on the important role of community pharmacy in this space. A recent study published in BMJ Open, which monitored the health service use of 1500 Australian men aged 35 to 80 in a five-year period, has found that despite what might be popular perception, men do go to the doctor when they need to, such as when they’re experiencing symptoms of mental health problems. However, the issue appears to be that often these men are misdiagnosed. According to a co-author of the study, CSIRO clinical psychologist Dr Ian Zajac, while the reason for this is probably multifactorial, one explanation is that “GPs may not be recognising the symptoms or even asking the right questions”. “However, it’s also true that many men describe their experience of depression using different terms than women, meaning it’s possible to misunderstand their symptoms as potentially due to some other issue,” he said. Given this scenario and that community pharmacy is often seen as the frontline when it comes to healthcare, it’s important that pharmacists and pharmacy staff are aware of the signs and symptoms of mental health problems, such as depression and anxiety, and most importantly, how to work with these customers in ensuring they receive the best care and support. Depression rates, symptoms and diagnosis “The lifetime prevalence of depression among males in Australia is about one in eight, with one in five Australian men likely to experience an anxiety condition in their lifetime,” said Professor Greg Murray, Director of the Centre for Mental Health at Swinburne University of Technology in Melbourne. “Around one in eight adults, or 13 per cent, experienced high or very high levels of psychological distress in 2017-18, an increase from 11.7 per cent, or 2.1 million adults, in 2014-15.” The increasing rate of mental health issues within the community has been further exacerbated by the Covid-19 pandemic. Professor Murray points to the example of the rising number of calls to telephone and online counselling service MensLine Australia throughout the pandemic. “August had the highest number of calls received after a six-month period,” he said. “Calls related to Covid-19 also increased by 26 per cent compared with the previous month.” However, despite the prevalence of depression, Professor Murray says “there’s no objective measure” when it comes to diagnosis. He adds that while “depression is typically seen as an extended period of lowered mood, motivation and energy”, diagnosis is made “on the basis of behaviours reported by the patient or observed by the clinician.” “The most common diagnostic criteria are found in the American Psychiatric Association’s DSM-5 \[Diagnostic and Statistical Manual of Mental Disorders\],” he said. “Depression in men can present in many ways. Sometimes we might see sadness, but perhaps more commonly we might notice apathy (the ‘can’t be bothereds’), and sometimes men report problems with sleep, increased tiredness or poor concentration.” A sign that someone might be experiencing a mental health issue is when their day-to-day functioning is affected, according to Simon Knowles, Associate Professor of Clinical and Health Psychology and Clinical Psychologist at the Department of Psychological Sciences, Swinburne University of Technology in Melbourne. They may not be “bothered” to do the things they would normally find enjoyable, he says, echoing Professor Murray’s explanation. “Common symptoms associated with depression include feeling helpless, guilty and/or worthless, loss of pleasure from activities that would normally be associated with pleasure, feeling tired for no good reason, feeling low and unable to improve mood, and feeling everything is an effort,” Associate Professor Knowles said. “In relation to anxiety, common symptoms include feeling nervous, inability to sit still, restlessness, experiencing racing thoughts, rapid breathing and hypervigilance.” While “it’s normal to feel anxious or sad occasionally,” Associate Professor Knowles says it becomes problematic if these feelings “occur for long periods of time – for example, weeks or more TO PAGE 46 RETAIL PHARMACY • JUN 2021