As I am asked to see so many men who are depressed I thought it would be a good idea to talk about depression particularly in relation to "prostates" as both often appear to go hand-in-hand.

To be given a diagnosis of prostate cancer is distressing. Thoughts of mortality start to come and sometimes issues relating to loved ones and ones own death need to be faced, perhaps for the first time – and all of this is perfectly natural. But, in some men these thoughts lead to a depression.

Before treatment, men with a diagnosis of prostate cancer often express fears of what is to happen in the future, will the treatment work? Following treatment men may be worried about the side effects of treatment (such as incontinence and impotence), their relationships and also fears for the future.

However a man responds to knowing he has prostate cancer – it changes his life and the lives of those around him.

Depression affects all parts of a mans life, both physical and emotional.

• You describe feeling "flat", "tired" and "listless".
• Things that once brought you pleasure now no longer do.
• Thoughts may go round and round inside your head about all sorts of things that may be distressing but you are unable to stop thinking about them – thoughts about the future, the past, things you should have done, regrets and fears.
• You may wish to sleep all the time or be unable to; once in bed you become wide awake and that can be when the thoughts begin.
• Your appetite may become less than usual or you might become fussy with your food.
• You might find yourself using alcohol or other drugs to help you cope with these feelings.
• You may become emotional and tearful for no apparent reason – one man said he would burst into tears whenever he saw a particular TV advertisement.Or emotions might become cut-off; you might say you feel nothing at all.
• Some men say that they feel anxious all the time, needing to be with partners and loved ones. Others say they want to be alone and isolate themselves, not being able to cope with intimacy.
• Symptoms may become physical - vague aches and pains that stop you from doing things or feelings that the cancer is spreading are not uncommon.
• And some men will have thoughts about suicide.
• The symptoms are many and varied and are individual to each man. Does this sound like somebody you know?

All of these feelings are very confusing for a man. After all, haven’t you got enough to deal with? Now people around you are saying you are behaving "strangely" or you are "not yourself". In fact, you don’t feel "yourself" but you put it down to all the stress you are under…Well, if people who care about you are saying these things then it’s time you did something about it. In fact it is vital that you do!

A word of warning – remember how you may have put off going to your doctor when you didn’t feel too well? Remember when you had lots of important things to do which stopped you taking care of yourself? Well, as men we are bad at looking after ourselves. Some men might think that seeking treatment for depression is a slight upon their masculinity or in some way shows weakness – this is not true, this is a condition that needs treatment just as your prostate cancer did. For some men treating their depression is a matter of life and death.

To begin with we generally try to tough it out, or we try to ignore it (sounds familiar?). For very few people this works, for most it is a recipe for disaster. Some men try to treat the depression with alcohol or more and more activity – but that doesn’t work either.This sort of depression is a reaction to what is happening to you, and is in fact called Reactive Depression – it is the most common depression seen today.

But what is the best way to go about treating this depression? The first port of call may be your local GP or your urologist, or you might go directly to a psychotherapist. If you go to a medical practitioner they might give you a course of antidepressants and may even ask to see you in a couple of weeks…but there is a problem to this treatment.

As this is a Reactive Depression – caused by what is happening with your life, just an antidepressant alone or a couple of visits to the GP won’t address the important issues of this particular type of depression.

It is necessary for the man with depression to have time to talk and that can only be done with a counsellor or therapist who is experienced with the issues of prostate cancer and all its forms of treatment and outcomes. So why is "the talking cure" better than antidepressants alone. Just taking a pill does not change a man’s circumstances, he still has prostate cancer and it is the issues around this fact that need to be addressed. Also, very specific treatments for the symptoms of depression can be given that are personal to the man.

By far the best treatment for depression is a combination of antidepressants AND psychotherapy. This duel approach has been demonstrated in large evidence - based research studies and is now the preferred method for the treatment of depression.

If you feel that you, or someone you know, is depressed, it is important to talk about the treatment possibilities.