Advancing age and mental health disorders

By age 75, there is a 50% chance you will have developed at least one mental health disorder, according to some research.

One study, published in the September 2023 issue of The Lancet Psychiatry and based on surveys of more than 150,000 adults in 29 countries, found that the type of mental disorder tends to differ by sex. Among men, the most common were alcohol use disorder, depression, and anxiety disorders, with social anxiety disorder being the most prevalent of those.

Why are people vulnerable to mental health disorders like these as they age?

“Advancing age erodes the buffers that can protect us from these disorders,” says Dr. Jungjin Kim, medical director of the Alcohol, Drugs and Addiction Inpatient Program at Harvard-affiliated McLean Hospital. “Friends and spouses pass away, our sense of purpose may diminish, and the body weakens.”

He adds that compared with women, many men miss the early warning signs, and when they do notice them, they often try to push through, which can worsen the symptoms. “Acknowledging you have a problem is always the first step to dealing with a mental health disorder,” says Dr. Kim. “Only then can you take action and get the treatment you need.”

Here’s a look at three mental health disorders men often face with age, their causes, and how to recognize them so you can seek help.

Alcohol use disorder

Alcohol intake can gradually shift from casual social drinking to an emotional dependence as changes occur in men’s lives, according to Dr. Kim. “Grief, isolation, or chronic pain can turn one occasional drink into three or more daily drinks,” he says. “Even men who were moderate drinkers can spiral, because aging lowers alcohol tolerance and amplifies its effects.”

Early symptoms of an alcohol use disorder include drinking more than planned, continuing to drink alcohol despite the concerns of others, and frequent attempts to cut down or quit.

As alcohol misuse progresses, a person develops a tolerance to alcohol and must drink more to get the desired good feeling or to get intoxicated. They often drink alone and say they use alcohol to help them sleep or deal with stress.

Someone suffering from alcohol use disorder can also become more irritable, and their ability to function (hold a job or maintain relationships with friends and family) can seriously deteriorate. As alcohol misuse worsens, health risks can include falls, liver damage, memory loss, and sleep disturbances.

Dr. Kim says many people in the early phases of alcohol use disorder are unaware of how much they drink. To find out if your drinking has become problematic, he recommends writing down how much you think is your usual amount of weekly drinking and then keeping a drinking diary where you record what you drink and how much for several weeks. Then compare the results.

For men under 65, moderate alcohol use means no more than two standard drinks per day. Men over 65 should restrict their drinking to no more than one drink daily. “If your diary shows drinking creeping up week to week, contact your health care team for advice,” says Dr. Kim.

There are many treatment options available for alcohol use disorder, including therapy to address what could trigger the excess drinking and participation in a support group. More formal treatments can include medications — such as the drug naltrexone (Vivitrol) or the oral tablet acamprosate — and relapse-prevention psychotherapy (andamp;ldquo;talk therapy”).

“It’s important to note that people who have been drinking heavily should never try to quit cold turkey,” says Dr. Kim. “Alcohol withdrawal can trigger seizures and hallucinations and even be fatal.”

Depression

Depression in older men is often overlooked, as it doesn’t always resemble the sadness usually associated with the condition. “Depression in men looks more like fatigue, disinterest, or irritability,” says Dr. Kim.

Another challenge is that depression can begin as a low-grade form known as persistent depressive disorder (PDD, formerly called dysthymia), which is even more difficult to notice. “PDD often mirrors regular everyday or age-related problems, which is why it’s tough to identify,” says Dr. Kim. Research has found that up to 75% of people with PDD will eventually have an episode of major depression.

PDD can occur in short episodes and be separated by considerable periods of time. You may suffer from PDD if your depressed mood is present more days than not, lingers for more than two years without at least two months of interruption, and is accompanied by some of the following symptoms:

• overeating or loss of appetite
• unintentional changes in weight (gain or loss of more than 5% within a month)
• insomnia or sleeping too much
• fatigue or loss of energy
• low self-esteem
• feelings of hopelessness or guilt
• loss of enjoyment in favorite activities
• trouble concentrating or making decisions.

Recognizing PDD can be a challenge, as many men resist admitting they are depressed, or they don’t feel comfortable talking about their feelings for fear of being seen as weak.

Dr. Kim suggests enlisting a friend, spouse, or relative to comment if they notice specific symptoms or changes in your behavior. “So often, we can more easily spot problems in other people and not ourselves,” says Dr. Kim.

PDD responds quite well to antidepressants, psychotherapy, or a combination. Ask your doctor about the best option for you and whether you should see a mental health expert.

Social anxiety disorder

Social anxiety disorder often occurs as people age, as their once-active social life begins to wane. “Over time, people can gradually become less engaged with others, so the idea of social interactions can seem like a chore rather than something they enjoy,” says Dr. Kim.

Social anxiety can also occur after a prolonged illness or personal loss, when people are even less motivated to socialize. Research has also found that the COVID pandemic has contributed to a rise in people with social anxiety disorder.

The main symptom of social anxiety disorder is an extreme fear of being scrutinized or embarrassed by other people. The fear is so great that it can cause people to avoid social settings altogether (often making up excuses on why they can’t attend), or they will ruminate for days over any social engagement, no matter how small. Physical symptoms — such as sweatiness, rapid heartbeat, trembling, nausea, and shortness of breath — may occur before or during social activities.

These are many available treatments for social anxiety disorder. Here are the most common.

Cognitive behavioral therapy (CBT). CBT is often a first-line treatment. Trained professionals help you understand your triggers and learn coping strategies. The goal of CBT is to challenge your negative thoughts and learn behavioral strategies to overcome them.

Exposure therapy. This involves gradually and repeatedly exposing individuals to social situations they fear, helping them to reduce their anxiety and avoidance behaviors. This process helps rewire the brain to associate social situations with safety rather than danger.

Antidepressants. They can be prescribed to help manage anxiety. The two most prescribed antidepressant drug classes are selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) and sertraline (Zoloft), and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor).

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