Depression symptoms in men may look quite different from expectations, which can lead to underdiagnosis and barriers to treatment.

The symptoms of depression in men can get overlooked, even in a doctor’s office. Depression is underdiagnosed in men and may be more common than expected.

According to the National Institute of Mental Health (NIMH), the symptoms may appear different between genders. Some men hide their emotions and appear angry or aggressive, while women might express sadness. The NIMH notes that depression in men could show up as fatigue and loss of interest in work life, relationships, and hobbies.

Men may be reluctant to talk about depression and are less likely to seek help, contributing to underdiagnosis. Receiving support is essential — effective treatments are available and can significantly boost your quality of life.

According to the NIMH, about 19.4 million adults in the United States had at least one major depressive episode in 2019. The incidence was higher in females (9.6%) than males (6%). But these lower prevalence rates may be partly due to the underdiagnosis of depression in men.

Depression is characterized by a period of at least 2 weeks when you experience a depressed mood or loss of interest in daily activities. Specific symptoms of depression can include:

  • irritability
  • restlessness
  • problems with sleep
  • changes in eating habits
  • lack of exercise
  • difficulty concentrating
  • low self-worth

Though depression is often associated with crying and low mood, these might not be the most obvious signs in men.

Men with depressive symptoms may mask or ignore difficult emotions by overworking, overexercising, substance use, or changes in sexual behavior. Diagnosis and treatment are less accessible to men, which contributes to higher rates of suicide in men than women.

Substance use

While substance use can accompany depression in all genders, men may be more likely to lean on substances to manage their emotions than women. Anger attacks associated with substance use are more characteristic of depression in men than women.

Men may be more likely to see their doctor about physical rather than emotional symptoms. This means that men seek help for the physical symptoms of depression, such as ongoing headaches, digestive issues, a tight chest, or sleep problems.

Suicidality

Women are more likely to attempt suicide, while men are more likely to die by suicide. Men tend to use more lethal means. This may be partly due to lower treatment rates and diagnosis in men.

Symptom differences in adolescence

Research from 2017 suggests that gender differences in depression symptoms could appear as early as age 12. The gender differences peaked in adolescence, then declined and stabilized in adulthood in this study.

Another study from 2017 collected data over 10 years on 191 adolescents with depression (108 males and 83 females) ages 13 to 19. The findings suggested that boys with depression were likely to report irritability and suicidal thoughts, while girls were more likely to report sadness, worthlessness, and low energy.

Women are diagnosed with depression twice as often as men in Western and non-Western community studies. But is it really because men are half as likely to have depression, or is this a problem with detecting depression in men?

Many believe that traditional depression criteria could be biased toward detecting symptoms in women.

Research from 2013 suggests that if clinicians relied solely on men’s reporting of traditional symptoms of depression, this could lead to an underdiagnosis of depression in men. The study authors note that clinicians should consider other clues when assessing depression in men.

Some men may be reluctant to report traditional symptoms like crying, as this may not be considered “masculine.” Some men may see depression as a “feminine” illness, preventing some masculine people from seeking help and getting a diagnosis.

Some research suggests that if the criteria for a diagnosis of depression were changed, there would be a higher rate of diagnosis of depression among men. For example, research from 2013 used a depression scale with alternative symptoms, finding that a higher proportion of men (26.3%) than women (21.9%) met the criteria for depression.

The researchers also conducted analyses using a scale that included both traditional and alternative depression symptoms, finding that men and women met the criteria for depression in relatively equal proportions: 30.6% of men and 33.3% of women.

Finding depression treatments that work for you — which may include therapy, medication, or a combination of these methods — can set you on your journey to wellness.

There are also some things you can do at home. Lifestyle changes can provide an excellent source of depression prevention and symptom relief alongside your main treatments.

For example, a 2020 study suggests that men who engaged in 150 minutes of activity per week were less likely to experience depression. Another 2020 study suggests that eating more vegetables, fiber, and whole grains — along with reducing processed foods and added sugars — could help with depression.

Many studies in this area are correlation studies, which means they don’t show that exercise or diet can directly lead to less depression. It may also be that those who eat well and exercise tend to have better health and coping behaviors overall.

Other studies — including a 2008 meta-analysis — suggest that exercise could directly reduce depression. Overall, more research is needed before scientists know the actual effects of exercise and diet on depression.

If you or someone you love is experiencing symptoms of depression, reaching out to a healthcare professional can help you get the proper support. Though it might not feel easy, depression is one of the most common mental health conditions, and there’s no shame in seeking help.

If reaching out to a therapist is too much right now, consider opening to a trusted friend or colleague who might understand. Talking about what’s bothering you can be a decisive first step.

Looking for mental health support, but you’re unsure where to start? Consider checking out Psych Central’s Find a Therapist resource page or the American Psychological Association search tool to find a psychologist.

For more information about how depression affects men, Heads Up Guys offer many resources for men and their loved ones.