This month is Movember, also known as men's mental health month, during which there are widespread initiatives to raise awareness of male mental health and wellbeing challenges, with a view to reducing stigma, improving understanding, and encouraging open dialogue about this important topic.
As a consultant psychiatrist who specialises in the assessment, diagnosis, and management of adult ADHD. I will explore ADHD in men, some of the mental health struggles commonly associated with this frequently misunderstood condition, when to seek help, and various treatment options.
Men are less likely to seek mental health support
Unfortunately we continue to live in a “man up” culture where many experience societal pressure to suffer in silence. Men are less likely to seek help and are at higher risk of poor outcomes, thus it is crucial for them to understand that struggling is not a sign of weakness and to view seeking help as a courageous act instead.
ADHD often goes undiagnosed in men until their 30s or 40s
It is estimated that up to 4% of the UK adult population have ADHD, however only a small minority (around 1 in 9) with the condition have been diagnosed.
Although childhood ADHD is better recognised in boys vs girls, headlines regarding “higher” rates of ADHD in men are somewhat misleading, as ADHD is certainly also underdiagnosed in UK males. The gender comparison is better understood in the context of even poorer recognition and health inequalities faced by neurodivergent women, girls, trans, non-binary, and other marginalised groups. In short, male adult ADHD remains an area that is underrecognised and woefully lacking in service provision.
Many undiagnosed men do not recognise their longstanding challenges as ADHD symptoms and instead experience “hitting a wall” when their coping strategies no longer work in the context of increasing adult responsibilities and demands. This “exposure” of underlying difficulties can be a watershed moment to gain insight into a diagnosis that is often experienced as a relief rather than a label, and provides a way forward to exploring treatment options.
Depression frequently accompanies ADHD in men
Years of struggling with undiagnosed ADHD takes a toll on one’s mental health and so it is unsurprising that people with ADHD are three times more likely to experience depression than the general population, with over 50% prevalence rates identified in some studies. Treating depression alone may not work if ADHD is an underlying cause, and so understanding the connection between these conditions for an individual often results in better treatment outcomes.
Why ADHD in Men Often Goes Unnoticed
You Don't Fit the Stereotype
For the majority of adults, there is a shift in how ADHD shows up as people age and mature. Physical hyperactivity often becomes more internalised and can instead be experienced as a sense of restlessness or anxiety. It is also common for people with ADHD to report an increase in cognitive hyperactivity from young adulthood (aka relentless racing thoughts).
Inattentive ADHD features tend to be highly problematic in terms of adult functioning, such as challenges in regulating focus, daydreaming, finding it difficult to initiate or complete tasks, struggling to be organised in daily life, and forgetfulness. These quieter symptoms are much easier to miss but have less direct impact on others compared to the kind of hyperactivity that may inconvenience or irritate people when you were a child.
You learned to hide and compensate
Many men will have a range of coping strategies and external structures that help them function, such as exercising frequently, self medicating with caffeine, working in a “boom or bust” pattern to cope with deadlines, relying on support from a partner, or gravitating to jobs that provide pressure and variety that fit with the neurodivergent brain. People can often rely on their natural ability, intelligence, and creativity to “get by” and compensate for areas of challenge thus masking their ADHD, until this no longer works, resulting in experiencing burnout.
Mental health issues still seen as weakness
Men are impacted by generational attitudes, workplace culture and stigma around mental health challenges. There can be fear of judgment from partners, friends, and employers. Men are three timeless less likely to seek support such as psychological therapy than women, are more likely to misuse alcohol or drugs as a way of coping, and are three times more likely to die by suicide compared to women. Untreated ADHD further increases these risks.
The Hidden Link: How ADHD Fuels Depression and Anxiety
When Years of Struggling Become Depression
- Accumulated "failures" erode self-worth
Men with ADHD will be all too familiar with the pattern of enthusiastically starting new projects only for these to end up abandoned with a sense of failure. Likewise, ADHD related challenges resulting in missed promotions, forgotten commitments, and relationship difficulties, build a negative self narrative of regrets and missed potential over time. However, it's important to remember to recognise that with ADHD, brain wiring is the issue, and these problems are not due to character flaws.
- Executive dysfunction feels like personal failure
Executive functioning (EF) describes our ability to perform all aspects of our life, including planning, organising, and following through on things. The typical ADHD brain has a patchy EF profile with areas of underdeveloped EF skills. Emotional regulation is part of executive functioning and is a common area of ADHD challenge. This shows up as being emotionally intense, easily reactive, and irritable or “snappy” with others. This feature can also overlap with depression, which in men may often present with irritability, frustration, becoming withdrawn, and poor motivation. In both ADHD and depression, we see underactivity in the same area of the brain known as the dorsolateral prefrontal cortex (DLPFC).
The Constant Mental Overload Creates Anxiety
- Your brain never switches off
Adults with ADHD typically describe racing thoughts and constant mental chatter also known as cognitive hyperactivity. This makes it very difficult to ever feel relaxed or be truly “present” in the moment. ADHD people frequently report difficulties getting to sleep or returning to sleep after waking due to this. Men with ADHD often describe ruminating over new ideas, worrying about important tasks, thinking about things they don’t want to forget, and feeling concerned about letting others down. - Social anxiety from past experiences
Over time, undiagnosed ADHD impacts on social confidence. For many, verbal hyperactivity and impulsivity leading to overtalking, interrupting others in conversation, or saying the “wrong thing” can result in sensitivity to criticism or social withdrawal to avoid embarrassment or rejection. Furthermore, inattentive issues can make it very difficult to follow group conversations or manage external distractions such as background noise.
Do You Recognise These Signs?
Common ADHD Symptoms in Adult Men
Focus and attention
- Starting conversations then losing track
- Reading without absorbing information
- Zoning out in meetings despite trying to listen
- Finding it hard to sustain focus on anything non-urgent or dull
- Difficulty completing tasks
Organisation and memory
- Constantly misplacing or losing keys, wallet, phone
- Missing appointments or important deadlines
- Piles of unfinished projects
- Forgetting what you walked into room for or what someone has just said
Time and impulsivity
- Always running late despite best intentions
- Underestimating how long tasks take
- Impulsive purchases or decisions
- Interrupting others or speaking before thinking
Emotional regulation
- Quick to frustration or anger
- Overreacting to minor setbacks
- Difficulty managing stress
- Extreme reactions to perceived criticism
Treatment Options: You Don't Have to Do This Alone
Getting Assessed: The First Step
- Speak to your GP
Many will find it useful to access online resources and screening tools as a first step. A discussion with your GP should be the next port of call. If ADHD seems likely, a full assessment and if confirmed having the diagnosis formalised brings clarity and relief.
Adult ADHD assessment is available on the NHS although waiting times can vary. Additionally, GPs can refer via the "Right to Choose" scheme in England; this enables NHS patients to access a range of providers faster than their local waiting list may allow. Private assessments are also available and it is advised to discuss this with your GP in advance to understand which private services they may recommend and be willing to work with. - What to expect
An ADHD assessment will cover both your childhood and current symptoms, with a focus on how these impact daily life. It is important to explore all aspects of your mental and physical health to fully understand your individual situation, whether the ADHD diagnosis applies, and whether there are other issues such as autistic traits or depression also present. If an ADHD diagnosis is confirmed then this opens the door to a range of treatment options.
ADHD Medication: Managing Symptoms
- Stimulant medications can be life-changing
For the majority with ADHD, stimulants such as methylphenidate or lisdexamfetamine greatly help improve ADHD symptom control. Many men describe feeling their brain as feeling “calm” for the first time and will experience improved focus, greater emotional control, reduced impulsivity, and better functioning. These medications are started slowly and adjusted depending on response and tolerability, so it can take time working with a specialist to find the right medication and dose. Medication doesn't “fix” everything but reduces the level of daily struggle to allow people to be more productive, able to realise their potential, and to work on developing their skills further.
- Non-stimulant options exist
There are non-stimulant medications such as atomoxetine for those who can't tolerate or do not respond to stimulants. Some other non-stimulant medications may also be useful and can be considered for “off label” use on a case by case basis in discussion with your prescriber. Non-stimulants generally have a different side effect profile and take longer to work but achieve steady results for those who respond well. Additionally, fully understanding your ADHD diagnosis and finding useful strategies to build executive function skills via self-help resources or ADHD coaching can be extremely powerful in helping you move forward.
Treating Depression Alongside ADHD
- Depression treatment may be needed
In many cases, treating ADHD alone may improve mood significantly, however some men may require a treatment approach that incorporates both ADHD medication and treatment for depression. In those with both conditions, it is not uncommon for the response to treatment for one to become more effective once the other condition is well managed so it’s important to understand that there is no “failure” to need multiple treatments to optimise your health.
- Brain stimulation: An innovative option
The Flow headset uses tDCS (transcranial direct current stimulation) to treat depression. This CE-certified medical device sends a very safe, gentle electrical current to target the area of the brain (the DLPFC) that we know to be underactive in both ADHD and depression. 56% of Flow users are depression-free within 10 weeks. The headset is used at home for 30 minutes several times per week. Flow can be used alongside ADHD (and other) medication. Flow treatment may be particularly relevant for men who prefer non-pharmaceutical options for depression; the device has minimal side effects, and does not cause issues such as sexual dysfunction, weight gain, or sedation. I have supported many of my male ADHD patients with depression to use Flow with great patient feedback and results. Flow is a popular treatment choice in this group of men, who frequently report as their depression lifts, experiencing a significant shift in their motivation, ability to initiate tasks, and engage in building new healthy habits.
Moving Forward: This Men's Mental Health Month
- You're Not Broken, Your Brain Just Works Differently
ADHD is best understood as a neurological difference, not a character flaw. There are many successful, inspirational, and fulfilled men who have ADHD. ADHD brains have many strengths such as creativity, problem-solving, hyperfocus, and determination. With the right support, you can thrive. - Taking Action Is Strength
Remember no matter what the latest headlines say, ADHD is still under-recognised in UK adults and millions of men struggle with the same issues. Accurate ADHD diagnosis and treatment significantly improves lives. Consider taking first steps such as accessing online information and /or screening, and approach your GP for support. Consider reaching out to others and sharing this article with others who might also be struggling.
- Resources and Support:
- ADHD UK charity and support groups
- Men's mental health organisations (CALM, Andy's Man Club)
- Crisis support: Samaritans 116 123
- Flow assessment for depression symptoms
- NHS adult ADHD services