Why it gets missed
The picture most people carry of depression is someone tearful and withdrawn. Many men do not fit it. They are more likely to come across as tense, angry, checked out or simply busy. They may not describe themselves as sad at all.
The National Institute of Mental Health (NIMH) notes that women are diagnosed with depression more often than men, but men can also be depressed. Because men may be less likely to recognize, talk about and seek help for negative feelings, NIMH says they are at greater risk of their depression being undiagnosed and undertreated. NIMH's page on men and mental health adds that men are less likely than women to have received mental health treatment in the past year.
Signs that may show up instead of sadness
NIMH lists symptoms that are common in men with mental health conditions, including:
- Anger, irritability or aggressiveness
- Noticeable changes in mood, energy or appetite
- Sleeping too little or too much
- Feeling restless or on edge, or having trouble concentrating
- Misuse of alcohol, drugs or both
- Feeling flat, or having trouble feeling positive emotions
- Engaging in high-risk activities
- Aches, headaches or digestive problems without a clear cause
Cleveland Clinic quotes clinical psychologist Adam Borland, PsyD, who says that depressed men may be less likely to express sadness and more likely to express anger, irritability and aggression. He lists other possible signs, including impulsivity, apathy, low self-esteem, blaming others, isolation, an increased focus on work, needing to feel in control, gambling and risky sexual behavior. In his view, all of these can be cover-ups for sadness.
In daily life, that might look like snapping at your kids over small things, staying at the office later every month, needing a few drinks to fall asleep, or losing interest in the golf league or poker night you used to look forward to. Partners often notice the change before the man himself does.
Irritability is common enough to deserve its own discussion. Irritability and Anger as Signs of Depression or Anxiety looks at it in more detail.
When the body does the talking
NIMH notes that for some people, depression shows up as physical problems such as a racing heart, a tight chest, chronic headaches or digestive issues, and that many men are more likely to see a health care provider about physical symptoms than emotional ones. Cleveland Clinic adds that men may sleep or eat too little or too much, and may notice lower sex drive or trouble with sexual performance.
This is useful information rather than a problem. If seeing your regular doctor about fatigue, poor sleep or stomach trouble feels more doable than calling a therapist, start there. Just say plainly that your mood has changed too. Doctors can also check for medical causes of these symptoms.
Coping that hides the problem
NIMH notes that while increased alcohol or drug use can be a sign of depression in anyone, men are more likely to use these substances to cope. Long hours at work can serve the same purpose. So can a constant stream of screens, sports or projects that leave no quiet time to feel anything.
These habits are often described as stress relief, and in small amounts they can be. When they become the main way of getting through the week, they can keep depression out of view while it continues. Alcohol, Cannabis and Mood: What to Know in Michigan covers how substances and mood interact.
Ordinary bad moods versus depression
Not every short temper is depression. Dr. Borland notes in the Cleveland Clinic article that ordinary sadness or irritability is usually temporary and triggered by something specific. Depression may have no clear trigger, and symptoms tend to take over your life, emotionally and physically, for two weeks or longer. Men and women also share many core symptoms of depression, he adds, such as low energy, poor concentration and lost interest in activities they used to enjoy.
What can make it easier to start
- Use your own words. "I've been on a short fuse and I'm exhausted" is a perfectly good opening line with a doctor or therapist.
- Start with your primary care provider if that feels more familiar. NIMH notes a primary care provider can refer you to a psychologist, psychiatrist or clinical social worker.
- Bring specifics: how long things have been off, what has changed at work or at home, and how much you are drinking.
- Remember that therapy is not only talking about feelings. It can also be a place to solve practical problems, think through decisions and understand why certain situations set you off.
If you are worried about a man in your life
Cleveland Clinic suggests telling him you have noticed a change, and notes that it is sometimes best not to lead with the word "depressed." Offer support, be patient, and listen when he wants to talk. Offering to help schedule an appointment, or to go with him, can lower the barrier. He may be more open to seeing his regular doctor about physical signs first.
Cleveland Clinic also notes that men with depression are more likely than women to die by suicide. If he talks about death or wanting to die, take it seriously and contact his doctor or a crisis line. When Someone You Love Won't Get Help covers what you can do when encouragement is not enough.
Treatment works the same way
NIMH describes psychotherapy, medication or both as the usual treatments for depression. Dr. Lehmann offers depression therapy for adults, in person in Franklin or by telehealth for clients in Michigan, with daytime appointments Monday through Thursday. She does not prescribe; a physician or psychiatrist handles medication.