Michael Phelps, the most decorated athlete in Olympic history with 28 medals, has acknowledged that after the 2012 games, his longtime depression was so overwhelming he thought about killing himself.1 "There was one point I didn't want to be alive," he tells CBS News.2 "I think it's something that nobody's really talked about in the past because we're supposed to be this big, macho, strong person that has no weaknesses. You know, we're supposed to be perfect.” The swimmer's candid disclosure is among other recent admissions by top athletes of their own mental health struggles. In March, the NBA's Kevin Love wrote an essay about his experience with panic attacks for The Players Tribune and the NFL's Brandon Brooks of the Philadelphia Eagles told ESPN about his struggles with anxiety.3,4 Phelps had previously disclosed to US Weekly that he battled depression and said he was speaking out about his experience to let others know "it is OK to not be OK."5 "These male athletes that have stepped up and shared publicly that they've been struggling takes a lot of guts, takes a lot of strength to do that and it's incredibly important," says Dr. John Ogrodniczuk, PhD, professor and Director of the Psychotherapy Program in the department of psychiatry at the University of British Columbia. Dr. Ogrodniczuk is also the founder of HeadsUpGuys.org, a website for boys and men devoted to busting depression myths and providing resources and help. "It can't be underestimated how powerful that seemingly simple act is for others struggling with these challenges," he says of these top athletes speaking out.  "I get the sense that guys need permission from other guys to say it is ok that they may be having some struggles. These guys are often held in high regard in society; if it is ok for them to do it, it's ok for me." Ruben C. Gur, PhD, a professor of psychiatry and neurology at the University of Pennsylvania's Perelman School of Medicine, concurs, adding that a major obstacle in treating mental illness is the stigma that goes with it. "Imagine if there was a stigma like that about heart disease or kidney disease," Dr. Gur says.  "People would have those symptoms and think they should hide the symptoms. Unfortunately that is the situation with mental disorders. People don't admit it to themselves and when they do, they try to hide it, cope with it without seeking professional help." "Right now there are treatments and they work," he says. "The problem is people don't come to get those treatments." That stigma -- particularly among males -- includes the myths that depression is a sign of weakness, that feeling sad or down is not manly, and that men should not ask for help and be able to cope on their own, according to Dr. Ogrodniczuk, who studies males and depression. “One of the prime reasons for depression in men is the inability to express themselves openly and with emotion,” Henry Montero, MSW of Alquimedez Mental Health Counseling in New York City, says.  "This is the reason I believe why men are more likely to use external methods to cope with the inward turmoil and pain caused by depression. Men deal with depression by over-working; they see substance abuse (self-medication) as a way out of depression and anxiety, outbursts of anger that could lead to abusive behavior pattern on others including their partners,” Montero says. "Sharing that something is not right takes a helluva lot more strength than keeping things bottled up and hidden from everyone," he says. Men are likely to exhibit some of the following symptoms of depression:
  • Feel sad or “empty”
  • Feeling irritable, angry, hopeless, or anxious
  • Loss of interest in work, family, or other hobbies or interests (including sex)
  • Feeling very tired
  • Difficulty concentrating
  • Sleep disturbance (unable to sleep or sleeping too much)
  • Changes in eating habits (overeating or not eating at all)
  • Thoughts of suicide, suicide attempts
  • Somatic complaints (aches or pains, headaches, digestive problems)
  • Inability to meet daily responsibilities.
Other potential symptoms include:
  • Significant weight loss when not dieting or weight gain and changes in appetite
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive guilt
  • Impaired ability to think or concentrate, and/or indecisiveness
  • Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan
According to a June 2015 report from the U.S. Centers for Disease Control and Prevention, (7) close to one in 10 American men suffers from depression or anxiety, but fewer than half get treatment. In the hypermasculine culture of most sports, says Dr. Ogrodniczuk, being open about anxiety or depression may be even more difficult for male athletes. "There may be consequences socially on the team, they may be afraid their field time or ice time may be cut, maybe the coach will think the player isn't all into it and needs some time away from it and that may not be what the player wants," Dr. Ogrodniczuk says. To create a healthy culture for men to express emotions better, they need to feel safe expressing them in the first place. “Crying must not be associated with gender roles. Boy (and men) don’t cry because they are weak,” Montero says, “they cry because crying—like other emotions—is a normal expression for all people. Addressing and processing emotions is what makes us human and crying is a fundamental emotion. It’s time to change how society perceives emotional responses in men. This version of  masculinity is toxic and must stop.” Loved ones and friends of boys and men are integral in providing help for sufferers. "You can't go it alone," he says.  "Whether it's a spouse, a friend, a close colleague at work, the family doctor trying to help, fighting any mental health challenge is tough. It's so much easier when there are people around you to help, when you can share the burden." For those trying to help, realize that males "are not naturally inclined to talk," says Dr. Gur. "Gentle prodding can sometimes get them to reveal what is on their mind, and let them know there is nothing to be ashamed of. This is true for any disorder. If a kid doesn't tell you their stomach hurts, we won't know they have a problem with their stomach. The same is true with their mental life." "If you are wondering if a guy you know may be dealing with depression and you don't quite know how to start that conversation, it could be something as simple as saying, 'Hey Joe, how are things?' or 'You don't seem to be your normal self lately, anything up?'" says Dr. Ogrodniczuk. "You don't want to immediately say, 'I wonder if you are depressed.' You are trying to create an open forum for a conversation to happen in the first place and with that you are demonstrating you have an open and willing ear. And you want to help him connect with services." After voicing observations, as Dr. Ogrodniczuk suggested, it’s important to be empathic, open-minded, and non-judgmental in your conversation.  (10)  For a lot of guys, it’s hard to open up to another person, so it’s key to let him know that you’re open to whatever he has to say. Encourage male loved ones dealing with depressive symptoms to see a health care professional—it’s a critical first step. A family doctor should be able to refer him to other resources as needed.

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