Depression in men: why it often does not look like sadness

What does depression look like in men?

Depression in men often looks like irritability, anger, withdrawal, risk-taking, overwork or heavier drinking, rather than visible sadness. The National Institute of Mental Health (NIMH) notes that men, as well as women, may show symptoms other than sadness, instead seeming angry or irritable, and that for some people depression shows up mainly as physical problems.

This is one reason depression in men gets missed, by the men themselves and by the people around them. A man who snaps at his family, stays late at the office and has a few more drinks each evening may look stressed or difficult rather than unwell. NIMH puts it plainly: because men may be less likely to recognize, talk about and seek help for their negative feelings, they are at greater risk of their depression going undiagnosed and undertreated.

Signs to take seriously

NIMH's Men and Mental Health page lists symptoms that are common in men. None of these alone means depression, and everyone has bad weeks. What matters is a change from how you usually are, lasting most days for a couple of weeks or more, that is getting in the way of work, family or friendships.

• Anger, irritability or aggressiveness, often out of proportion to what set it off.
• Feeling flat or numb, or having trouble feeling anything positive.
• Changes in sleep, energy or appetite: lying awake at three in the morning, or sleeping and still feeling tired.
• Drinking more, or using drugs, to wind down or get through the evening.
• Taking risks you would not usually take, such as driving dangerously.
• Aches, headaches or digestive problems without a clear cause.
• Pulling back from friends, family or things you used to enjoy, and filling the space with work, screens or the garage.
• Thoughts of death or suicide.

Why do men hold off on getting help?

NIMH reports that men are less likely than women to have received mental health treatment in the past year. Research helps explain why. A systematic review led by Zac Seidler, published in Clinical Psychology Review in 2016, pulled together 37 studies on masculinity and help-seeking for depression. It found that holding tightly to traditional masculine norms, such as self-reliance and keeping emotions under control, affected men in three ways: how their symptoms showed up, whether and how they sought help, and how they tried to manage on their own.

In everyday terms, that might sound like: I should be able to handle this myself. It is just stress. Other people have it worse. If I talk about it, it becomes real. None of those thoughts are unusual, and none of them are reasons to keep going alone. Many men find it easier to start by talking about the practical problem, the sleep, the temper, the drinking, the work, than about feelings, and that is a perfectly good place to begin.

When depression shows up at work and at home

For many men, work is where depression first becomes visible, either because it starts to slip or because they throw themselves into it to avoid everything else. Chronic pressure, a layoff or the fear of one can be both a trigger and a hiding place. Our pages on chronic work stress and who you are without your job look at that side of it.

At home, depression in men often shows up as distance or irritability that a partner notices before he does. Partners often describe feeling shut out, or walking on eggshells. If you are the partner, NIMH suggests offering support, patience and encouragement, inviting him out for walks or activities, and helping him get to a health care provider. You cannot make someone get help, but you can say clearly what you have seen and that you are worried.

Irritability is not the same as danger. If anger at home has turned into threats, intimidation or violence, that is a safety issue first. The National Domestic Violence Hotline is confidential, and in immediate danger call 911.

Some men are also living with a quieter version: still performing well, still showing up, but empty underneath. High-functioning depression describes that pattern.

Suicide risk in men

NIMH, citing the Centers for Disease Control and Prevention, notes that men are more likely than women to die by suicide. That makes it important to take warning signs seriously, even in a man who seems to be handling everything. NIMH's list of warning signs includes talking about wanting to die, being a burden or feeling trapped, withdrawing and giving things away, drinking more, taking dangerous risks and extreme mood swings, especially when the behavior is new or has increased recently.

If you are having thoughts of suicide, or you are worried about a man in your life, call or text 988 to reach the 988 Suicide and Crisis Lifeline, at any hour. Veterans can press 1 after dialing 988. If someone is in immediate danger, call 911.

Where to start

A primary care appointment is a sensible first step. NIMH notes that a primary care provider can screen for mental health concerns, check for medical causes, and refer you on. Many men are already seeing a doctor for the headaches, the sleep or the stomach; it is worth saying out loud that your mood has changed too.

Depression in men responds to the same treatments as depression in anyone: talk therapy, medication, or both. Our page on therapy for depression and anxiety explains the main approaches, and when to get help covers how to tell it is time.

Laura Bass is a psychotherapist in Charlotte, North Carolina, who works with adults, individually and as couples, and depression is among the concerns she sees. She does not prescribe medication; that conversation belongs with a physician or psychiatric prescriber. You do not need to arrive with the right vocabulary. You can read about individual counseling or contact Laura with any questions about how she works.

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