Flow Neuroscience
June 9, 2022
While women are twice as likely to be diagnosed with depression men are significantly more likely to die by suicide and much less likely to seek professional help. Why is this?
Here’s how one man with depression puts it:
“The guy who is depressed does not want anybody to know he’s depressed. And you develop coping skills – fake it till you make it… You do a lot of faking. You do a lot of kidding people that you’re okay. If somebody comes up to you and asks “Hi, how you’re doing”, you say “I’m just fine”. Lies. You’re not fine. But you’re not going to tell them that… I had to fake it till I made it. And sometimes that was very very difficult.”
This article dives deep into male depression in an effort to shed light on topics such as stigma, help-seeking behaviours and how the signs of depression in men differ from those in women, trans people and people with non-binary identities. At the end, you’ll be presented with treatment options recommended for men.
Note: Most mental health research taking gender differences into account focuses on the differences between men and women. However, depression, anxiety, self-harm and suicidality is generally higher in people with non-binary gender identities. Find more information in this research article by Reisner & Hughto.
The hidden signs of depression in men
Let’s consider why significantly fewer men than women are diagnosed with depression. This is a question with a complex answer. Or rather, it entails more than one.
Hormonal, environmental, psychological and sociological factors work together to create a gender difference.
Here are a few of the most deep-rooted causes, dug up by modern research:
Stigma
In general, men tend to experience stigma brought on by a social culture which celebrates self-reliance, toughness and repressing emotions. This sometimes prevents men from seeking professional help, or makes them wait longer before doing so.
So, if you’re a man, you may have been taught to believe that you are ‘weak’ or ‘unmanly’ when asking for treatment.
A misconception with deadly consequences.
A Canadian research study by Dr Mackenzie and colleagues found that depressed men reported significantly more self-stigma related to help-seeking than women, for example “I would feel embarrassed about seeking professional help for depression”.
In addition, Mackenzie’s team looked for public stigma concerning men’s depression. They found that men, as a group, were more likely to stigmatize men’s depression and suicide by reporting things like “Men with depression could snap out of it if they wanted”.
Also, younger men were more likely to normalize or glorify suicide by reporting things like “Men who suicide are strong, brave, noble, or dedicated”. In contrast, women were more likely to report that men who suicide are isolated or depressed.
So, masculine norms which typically glorify strength, taking care of your own problems and swallowing your emotions can stand in the way when you need a diagnosis and treatment.
The following story comes from a young man struggling with both depression and stigma:
“The reason why I think a lot of young men get depressed is they have no way of expressing what’s going on for them inside. The acceptable emotions for a man are anger… and you can fight and yell and get really upset. That’s socially acceptable. Whereas being chronically sad is not something many people find manly. I think what happens is that it leaves a sort of build-up of repressed emotions. I definitely felt that way. And I had an analogy for myself where if I felt very upset or sad that I would take a deep breath and picture myself putting a cork on a bottle and screwing it down tight. And I could feel the depression in my stomach and I thought “There. I pushed it away. I dealt with my feelings”. And that build-up takes a lot of energy. And I think that’s what triggered a lot of my depression in the past – holding all that toxic stuff inside…”
It’s more common for men to think that it’s not okay for them to discuss difficult experiences such as abuse or neglect. So, even though you know that talking is supposed to help, you have this voice vibrating through your brain saying that you should be able to ignore what happened to you. And if you don’t, you’re weak.
And no one wants to be seen as weak.
This could easily lead to projections. If you have been taught that feeling sad is a sign of weakness, it’s no wonder that it becomes very difficult to admit to yourself that you may have mental health problems. So, instead of facing your inner world, you direct your attention and frustration outwards.
This brings us to the next point. If it’s not okay to cry or ask for help, how do men handle the signs of depression?
Different signs of depression in men
Another reason why men are less frequently diagnosed with depression is that depression presents itself a bit differently in men than in women. In general, men are more likely to mask depressive symptoms through aggressive, risk taking and impulsive behaviours (which are not actually listed as symptoms of depression).
So, to understand the gender differences, let’s first have a look at the similarities.
There are nine common symptoms of depression that everyone experiences (men, women and non-binary). And you need to experience at least five of these to be diagnosed with depression:
- Depressed mood: Feeling blue most of the day, nearly every day.
- Loss of interest and pleasure: Markedly reduced interest/pleasure in all (or almost all) activities most of the day.
- Changed appetite or weight (eating more or less than usual).
- Sleep disturbance (too much or too little).
- Moving more slowly than usual or making meaningless movements due to anxiety (for example twisting your hands).
- Lacking energy: Feeling tired nearly every day.
- Feeling excessively guilty and/or worthless.
- Having difficulty concentrating and/or making decisions.
- Having repeated thoughts about death, suicidal thoughts, or sometimes wishing you were dead.
In addition to the common symptoms above, signs of depression in men can look like this:
- Exaggerated anger and aggressive behaviour.
- Chronic irritability.
- Risk-taking or impulsiveness.
- A tendency to overwork (as a way to cope with depression).
- Drinking too much or abusing other substances.
- Arrogance (as a way to mask insecurity).
The signs of depression in men doesn’t always look like the nine common symptoms. So, there is a risk you’ll get the wrong diagnosis or that your health care provider will miss your depression. That’s why it’s important to be aware of how the signs of depression sometimes differ between sexes.
Here is Trevor’s story. Hopefully, it can serve as an example of how the signs of depression in men can manifest:
Trevor’s signs of depression were difficult to recognize. It took him a long time to realize what was bothering him, perhaps because nothing ‘bad’ had happened to him prior to his depression. Instead, Trevor received a promotion at the law firm where he worked, which meant higher salary, higher social status and more responsibilities. This was an opportunity that everyone thought would make him happier.
Before the promotion, Trevor’s family and colleagues described him as fair and easygoing. But soon after he had gotten the new job, Trevor became much more ill-tempered and demanding. He would yell at colleagues for minor mistakes and overreact to insignificant issues at home. He developed the habit of arriving late for work and he neglected some of his work assignments. His colleagues started to believe that the new title had made him arrogant and quite mean.
Trevor became less and less interested in sex. When his wife tried to address the problem, he refused to talk about it. She suspected that he didn’t love her anymore and maybe that he had an affair.
None of Trevor’s close friends or family members would have guessed that depression was the reason behind his behaviour. Trevor looked like a successful lawyer on the outside, but felt completely differently on the inside. He started having negative thoughts about other people, such as “no one really cares about me”, “people are unreliable”, “I can’t trust anyone”. As time passed, his thoughts about himself got increasingly negative, such as “I’m not good enough”, “I’m a fraud”, “I can’t do anything right”. Later, his thoughts about the world in general started to become gray and hopeless, such as “life is pointless”, “we’re all alone”, “nothing will ever get better”.
Because Trevor still managed his work and other necessary chores, it took him several months to realize that what he was experiencing was actually a mental health disorder. One day, he stumbled across a documentary about depression. Trevor recognized so many of the symptoms that he understood that depression was a probable cause behind his low mood and negative thoughts. And after some additional research, he made an appointment with a psychologist.
11 causes of depression tells you more about what causes depression in the first place.
About violence
If you allow yourself to paint with broad brushstrokes, you will find that a difference between the signs of depression in men and in women is that men have a greater tendency to actively express their depression, for example by yelling or fighting. This is of course a generalization and individual differences should never be ignored. Still, the potential risk of violence is too important to overlook.
As you can see from the list of symptoms above, the signs of depression in men can, when untreated, become a danger to family and friends. Aggression doesn’t necessarily end in violence. But sometimes it does. And learning more about the relationship between aggression and depression in men can help protect both the depressed person and the people around him.
Andrew Solomon (author of the award-winning book about depression – The Noonday Demon), who has survived several episodes of severe depression himself, describes his own shockingly intense bursts of anger like this:
I have had several episodes of violence since my first depression, and I have wondered whether these episodes, for which there was no precedent in my life, were connected to depression, were part of its aftermath, or were somehow to be associated with the antidepressants I have taken. …one day when I was in my thirties, I became so irrationally angry that I began plotting murders in my mind; I eventually off-loaded that anger by smashing the glass on a series of pictures of myself that hung in a girlfriend’s house… A year later, I had a serious falling-out with a man whom I had loved very much and by whom I felt profoundly and cruelly betrayed. I was already in a somewhat depressed state, and I became enraged. I attacked him with a ferocity unlike any I had experienced before, threw him against a wall, and socked him repeatedly, breaking both his jaw and his nose… I felt as though I was disappearing, and somewhere deep in the most primitive part of my brain, I felt that violence was the only way I could keep my self and mind in the world.”
The best way to prevent aggressive symptoms from turning into violence is to get the right depression treatment as soon as possible. The last paragraph of this article will tell you more about where to get treatment.
Hormonal differences & the specific signs of depression in men
Biology plays a part in depression, though not necessarily the lead role.
Hormones can, to some extent, explain why depression less frequently affects men. Women as a group suffer from several forms of depression, such as postpartum depression, premenstrual depression and menopausal depression. In addition, they are affected by all the forms of depression that afflict men.
But biology alone does not explain the high rate of women’s depression, which leads us to the next point.
Position of power
Women’s and non-binary people’s lives are more likely to include circumstances which lead to depression. As Andrew Solomon so eloquently expresses it:
“There are evident social differences between men’s and women’s positions of strength and power. Part of the reason women become depressed more frequently than men is that they are more frequently disenfranchised… The world is dominated by men, and that makes things rough for women. Women are less well able physically to defend themselves. They are more likely to be poor. They are more likely to be victims of abuse. They are less likely to be educated. They are more likely to suffer regular humiliations. They are more likely to lose social position through the visible signs of aging. They are more likely to be subordinate to their husbands.”
In conclusion: signs of depression in men are less frequently diagnosed and the consequences can be tragic
It seems as though we need to consider biological, environmental, psychological and sociological factors to understand why men are less frequently diagnosed with depression. Part of the reason is that fewer men than women get depressed. But when depression affects men, they are less likely to identify their symptoms as depression and less likely to seek professional help. So, there is reason to believe that not all depressed men are diagnosed.
And the stigma surrounding men’s depression, telling us that chronic sadness and male attributes just don’t go together, can have deadly consequences. It keeps men from getting the treatment they need.
Where can men with depression get treatment?
This section presents psychological strategies specifically helpful to men with depression. You’ll also find treatment options with links to online clinics.
Become more assertive
According to Dr. Ryan M Denney (clinical psychologist at Connections with extensive experience of treating depression in men), depressed men need to practice becoming more assertive. This may seem counterintuitive because depression in men often displays itself through aggression.
But remember, assertive is not aggressive.
Being assertive is (appropriately) asking for what you need in your relationships and other areas of your life. To get your needs met. And to calmly say no to people who violate your boundaries, without yelling or attacking.
Being assertive in a relationship can be saying things like:
“I had a rough day. I really need to talk about it.”
“I very much enjoy spending time with you, but right now I need to rest.”
“I’m going through something and I need you to listen to my story.”
“My plate is completely full right now. I’m sorry I can’t help you this week.”
“I need a hug.”
Develop your emotional intelligence
Men feel. Men feel deeply. However, men are not always sure of what to do with strong emotions when they arise. This is of course not the case for all men, but in general, boys are not always given the same opportunity as girls to develop their emotional intelligence. They risk being told to “man up”. To suppress that thing they’re feeling and act as if nothing happened, rather than to explore reactions and use them in a constructive way.
Sounds familiar? I really hope it doesn’t, but unfortunately it’s quite common.
So, learning how to identify feelings and how to express them in an appropriate way (instead of building up and exploding) will help you get out of depression. And the easiest way to accomplish this is through talk therapy with a licensed psychologist.
Online Therapy
My Online Therapy is an online clinic which offers online face-to-face sessions with highly qualified psychologists.
Talk therapy and medication
The Chelsea Psychology Clinic in London has a team of experienced psychologists and psychiatrists who offer carefully tailored depression treatments.
tDCS treatment
If you’re not ready or interested in seeing a psychiatrist or psychologist, you may want to check out the Flow Depression Treatment. It combines gentle brain stimulation (through a tDCS headset) with a depression app informing you of antidepressant lifestyle changes. It’s the first medically approved tDCS treatment for home use. And you can have it delivered to your home without any prescription.
This is how Steve, who was depressed for 20 years, and Mike describe their experiences with the Flow treatment:
Do you want to know more about how to recover from depression on your own?
Perhaps these articles will give you what you need:
12 natural treatments for depression – science-based and medication free depression treatments
4 at-home remedies for anxiety and depression – Treat depression and anxiety without medication
How to cope with depression – by finding the meaning of life
Thank you for your attention!