Depression in Men

As men, we often believe we have to be strong and in control of our emotions at all times. When we feel hopeless, helpless, or overwhelmed by despair we tend to deny it or cover it up by drinking too much, behaving recklessly, or exploding with anger. But depression in men is a common condition. The first step to recovery is to understand there’s no reason to feel ashamed. Then you can face the challenge head on and start working to feel better.

Understanding depression in men

Depression is not a sign of emotional weakness or failing of masculinity. It is a treatable health condition that affects millions of men of all ages and backgrounds, as well as those who care about them—spouses, partners, friends, and family. It can also lead to heart disease and other serious medical problems. Of course, it’s normal for anyone to feel down from time to time—dips in mood are an ordinary reaction to losses, setbacks, and disappointments in life. However, if intense feelings of despair and hopelessness take hold of you, and interfere with work, family, and your ability to enjoy life, you may be suffering from depression.
Unfortunately, depression in men can often be overlooked as many of us find it difficult to talk about our feelings. Instead, we tend to focus on the physical symptoms that often accompany depression, such as back pain, headaches, difficulty sleeping, or sexual problems. This can result in the underlying depression going untreated, which can have serious consequences. In fact, men suffering from depression are four times more likely to commit suicide than women. It’s important for any man to seek help with depression before feelings of despair become feelings of suicide. You need to talk honestly with a friend, loved one, or doctor about what’s going on in your mind as well as your body. Once correctly diagnosed, there is plenty you can do to successfully treat and manage depression.

If you're feeling suicidal...

When you’re feeling depressed or suicidal, problems don’t seem temporary—they seem overwhelming and permanent. But with time, you will feel better, especially if you reach out for help.
Read Helpguide’s Suicide Prevention articles or call the National Suicide Prevention Lifeline at 1-800-273-8255.
For help outside the U.S., visit Befrienders Worldwide.

Signs and symptoms of depression in men

Men can experience depression in different ways to women. You may develop the standard symptoms of depression and become sad and withdrawn, losing interest in friends and activities you used to enjoy. Or you may become irritable and aggressive, compulsively working, drinking more than normal, and engaging in high risk activities.
Unfortunately, men are far less adept at recognizing their symptoms than women. A man is more likely to deny his feelings, hide them from himself and others, or try to mask them with other behaviors. The three most common signs of depression in men are:

• Physical pain. Sometimes depression in men shows up as physical symptoms—such as backache, frequent headaches, sleep problems, sexual dysfunction, or digestive disorders—that don’t respond to normal treatment.
• Anger. This could range from irritability, sensitivity to criticism, or a loss of your sense of humor to road rage, a short temper, or even violence. Some men become abusive, controlling, verbally or physically abusive to wives, children, or other loved ones.  
• Reckless behavior. A man suffering from depression may start exhibiting escapist or risky behavior. This could mean pursuing dangerous sports, driving recklessly, or engaging in unsafe sex. You might drink too much, abuse drugs, or gamble compulsively.

Differences between male and female depression
Women tend to:	Men tend to:
Blame themselves	Blame others
Feel sad, apathetic, and worthless	Feel angry, irritable, and ego inflated
Feel anxious and scared	Feel suspicious and guarded
Avoid conflicts at all costs	Create conflicts
Feel slowed down and nervous	Feel restless and agitated
Have trouble setting boundaries	Need to feel in control at all costs
Find it easy to talk about self-doubt and despair	Find it “weak” to admit self-doubt or despair
Use food, friends, and "love" to self-medicate	Use alcohol, TV, sports, and sex to self-medicate
Adapted from: Male Menopause by Jed Diamond

Triggers for depression in men

There’s no single cause of depression in men. Biological, psychological, and social factors all play a part, as do lifestyle choices, relationships, and coping skills. Stressful life events or anything that makes you feel useless, helpless, alone, profoundly sad, or overwhelmed by stress can also trigger depression in men. These could include:

• Overwhelming stress at work, school, or home
• Marital or relationship problems
• Not reaching important goals
• Losing or changing a job; embarking on military service
• Constant money problems
• Health problems such as chronic illness, injury, disability
• Recently quitting smoking
• Death of a loved one
• Family responsibilities such as caring for children, spouse, or aging parents
• Retirement; loss of independence

Depression in men and erectile dysfunction

Impotence or erectile dysfunction is not only a cause of depression in men, it can also be a side effect of many antidepressant medications.

• Men with sexual function problems are almost twice as likely to be depressed as those without.
• Depression increases the risk of erectile dysfunction.
• Many men are reluctant to acknowledge sexual problems, thinking it’s a reflection on their manhood rather than a treatable problem caused by depression.

Risk factors for depression in men

While any man can suffer from depression, there are some risk factors that make a man more vulnerable to the illness, such us:

• Loneliness and lack of social support
• Inability to effectively deal with stress
• A history of alcohol or drug abuse
• Early childhood trauma or abuse
• Aging in isolation, with few social outlets

Treating depression in men

Don't try to tough out depression on your own. It takes courage to seek help, but most men with depression respond well to treatments such as lifestyle changes, social support, therapy, or medication—or a combination of treatments.
The first step is to talk to your doctor. Be open about how you’re feeling as well as the physical symptoms you’re experiencing so your mental health specialist can make an accurate diagnosis.

• Therapy. You may feel that talking to a stranger about your problems is ‘unmanly,’ or that therapy carries with it a victim status. However, if therapy is available to you, it can be an extremely effective treatment for depression in men. Opening up to a therapist can often bring a swift sense of relief, even to the most skeptical male. If therapy isn’t available to you, open up to a friend, family member, or work colleague. The simple act of talking to someone face to face can be an enormous help.
• Medication. Antidepressant medication may help relieve some symptoms of depression, but doesn’t cure the underlying problem, and is rarely a long-term solution. Medication also comes with side effects. Don't rely on a doctor who is not trained in mental health for guidance on medication, and always pursue healthy lifestyle changes and social support as well.

Lifestyle changes to treat depression in men

Lifestyle changes are extremely effective tools at treating depression in men. Even if you need other treatments as well, lifestyle changes can help lift depression and keep it from coming back.

• Exercise regularly. Regular exercise is a powerful way to fight depression in men. Not only does it boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just as antidepressants do. It also boosts self-esteem and helps to improve sleep. For maximum results, aim for 30 to 60 minutes of activity on most days.
• Eat well. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They'll get you going without the sugar crash. Deficiencies in B vitamins can trigger depression so take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs. Foods rich in certain omega-3 fats—such as salmon, walnuts, soybeans, and flaxseeds—can also give your mood a boost.
• Get enough sleep. When you don't get enough sleep, your depression symptoms can be worse. Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night.
• Reduce stress. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Set realistic goals and break them down into manageable tasks rather than burden yourself with huge objectives all at once. Figure out the things in your life that stress you out, such as work overload or unsupportive relationships, and make a plan to avoid them or minimize their impact.

Exercise as an Antidepressant for Men

Exercise can treat mild to moderate depression as effectively as antidepressant medication. Check with your doctor before starting a new exercise program, then follow these exercise tips:

• Exercise regularly and often. A 10-minute walk can improve your mood for two hours. The key to sustaining mood benefits is to exercise regularly. That may mean exercising vigorously for 30 minutes once a day as well as taking one or two short walks to keep your mood elevated throughout the whole day.
• Find activities that are at least moderately intense. Aerobic exercise undoubtedly has mental health benefits, but you don't always have to sweat strenuously to see results. Remember, even a few minutes of gentle activity are better than none at all.
• Choose exercises that are continuous and rhythmic. Walking, swimming, running, biking, rowing, and yoga are all good choices.
• Add a mind-body element to increase relaxation. If walking or running, for example, focus on each step—the sensation of your feet touching the ground, the rhythm of your breath, and the feeling of the wind against your face. If resistance training, focus on coordinating your breathing with your movements and note how your body feels as you raise and lower the weights.
• Make exercise social. Joining a class or exercising in a group can help keep you motivated and make exercise an enjoyable social activity. Try joining a running club or taking stationary bike classes at a gym or YMCA. If you like healthy competition, seek out tennis partners, join a soccer league, volleyball team, or pickup basketball game. Or find a workout buddy, and afterwards have a drink or watch a game together.

Social support to treat depression in men

Strong social networks reduce isolation, which can trigger or intensify bouts of depression.

• Let your family and friends help you. Accepting help and support is not a sign of weakness and it won’t mean you’re a burden to others. In fact, most friends will be flattered that you trust them enough to confide in them, and it will only strengthen your bond. Close relationships are vital to helping you get through this tough time.
• Participate in social activities, even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.

Building a social network to beat depression in men

More than just avoiding solitude, men need to find people they can really connect with, face-to-face. That doesn’t mean simply trading jokes with a coworker or chatting about sports with the guy sitting next to you in a bar. It means finding someone you feel comfortable sharing your feelings with, someone who’ll listen to you without judging you, or telling you how you should think or feel.
You may think that discussing your feelings isn’t very macho, but whether you’re aware of it or not, you’re already communicating your feelings to those around you; you’re just not using words. If you’re short-tempered, drinking more than usual, or punching holes in the wall, those closest to you will know something’s wrong. Choosing to talk about what you’re going through, instead, can actually help you feel better.
For many men—especially when they’re suffering from depression—reaching out to others can seem overwhelming. Close relationships don’t happen overnight, but there are steps you can take to help you connect with others and build a solid support network.

• Join a support group for depression. Being with others who are facing the same problems can help reduce your sense of isolation and remove the stigma you may feel. It can also be inspiring to share experiences.
• Volunteering can be a great way to help others while also expanding your social network.
• Meet new people with a common interest by taking a class, joining a club, or enrolling in a special interest group that meets on a regular basis.
• Walk a dog. It’s good exercise for you and a great way to meet people. If you can’t adopt your own, ask a friend or neighbor to borrow their dog.
• Invite someone to a ballgame, movie, or concert. There are plenty of other people who feel just as awkward about reaching out and making new friends as you do. Be the one to break the ice.
• Call or email an old buddy. Even if you’ve retreated from relationships that were once important to you, make the effort to reconnect.
• Confide in a counselor, coach, or clergy member.
• Be a good listener. To develop a solid friendship with someone, be prepared to listen and support them just as you want them to listen and support you.

More tips for fighting depression in men

• Challenge negative thoughts. Make a note of every negative thought you have and what triggered it. For each negative, write down something positive. For example, “My boss hates me. He gave me this difficult report to complete” could be replaced with, “My boss must have a lot of faith in me to give me so much responsibility.”
• Postpone making important decisions. If possible, avoid making life-changing decisions before your depressed mood has lifted. It’s hard for a man to be objective when suffering from depression. Discuss potential changes with someone whose opinion you trust before changing careers, moving home, or getting divorced, for example.
• Don’t expect your mood to improve instantly. Feeling better takes time. You’ll likely begin to feel a little better each day. Many men recovering from depression notice improvements in sleep patterns and appetite before improvements in mood.

Helping a male relative or loved one with depression

It often takes a wife, partner, or other family member to recognize a man’s symptoms of depression. Even if a man suspects he’s depressed, he may be ashamed that he’s unable to cope on his own and only seek help when pressured to do so by a loved one.

Talking to a man about depression

The first step is to let him know that depression is common among men and is no way a negative reflection on his manhood. Many men don’t exhibit typical depressive symptoms—but rather anger and reckless behavior—so you may want to avoid using the word "depression" and try describing his behavior as "stressed" or "overly tired." It could help him to open up.

• Point out how his behavior has changed, without being critical. For example, "You always seem get stomach pains before work," or "You haven't played racquetball for months."
• Suggest a general check-up with a physician. He may be less resistant to seeing a family doctor than a mental health professional at first. A regular doctor can rule out medical causes of depression and then make a referral to someone trained in mental health for therapy or medication. Sometimes, this "professional" opinion makes all the difference for a man.
• Offer to help him find a mental health provider and go with him on the first visit.Some men are resistant to talking to a stranger about their feelings, so try to remove roadblocks to him seeking help.
• Encourage him to make a list of symptoms to discuss. Help him focus on his feelings as well as physical ailments, and to be honest about his use of alcohol and drugs.

How to offer support to a man with depression

Supporting a man with depression requires understanding, patience, affection, and encouragement.

• Engage him in conversation and listen carefully. Do not disparage the feelings he expresses, but do point out realities and offer hope.
• Do not ignore remarks about suicide. Call the National Suicide Prevention Lifeline at 1-800-273-8255 or find a suicide helpline outside the U.S. at Befrienders Worldwide.
• Invite him for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused.
• Encourage participation in activities that once gave pleasure, such as hobbies, sports, or cultural activities, but do not push him to undertake too much too soon. He needs diversion and company, but too many demands can increase his feelings of failure.
• Do not accuse him of faking his feelings, or expect him 'to snap out of it.'Instead, keep reassuring him that, with time and help, he will feel better.
• You may need to monitor whether he is taking prescribed medication or attending therapy sessions. Encourage him to follow orders about the use of alcohol if he’s prescribed antidepressants.
• Remember, you can’t "fix" someone else’s depression. You’re not to blame for your loved one’s depression or responsible for his happiness. Ultimately, recovery is in his hands.

Adapted from: National Institute of Mental Health