Depression Shows Up Differently in Men. Here are 5 Ways to Spot It and Help
I’m not being hyperbolic, or overdramatic, when I say a little part of me died when I read about the recent suicide of golfer Grayson Murray. I felt the same way after the suicides of Robin Williams, Anthony Bourdain, and Stephen “tWitch” Boss. As someone who has suffered from depression for most of my life (and suicidal ideation at certain moments), I feel a kinship with these men who could not get out from under the weight of their darkness.
As a health journalist, however, I worry about the larger issue. Men tend to hide signs of depression or other mental health issues, often out of stigma and shame. When we do exhibit symptoms, we don’t always recognize them for what they are (nor do our loved ones). Worse, if that’s possible, many of us don’t seem to know how to help, or what to say to better understand when a brother, husband, son, or friend is standing at the precipice.
With each of these suicides there’s been a flurry of headlines about men and mental health. A recent Golf Digest news story noted that “Murray’s death pushes the hard questions into the open,” adding, “It’s never been made real until now.” That is hardly the case—in 2022 about 70 percent of all suicides were men, according to KFF, a health policy non-profit. That’s about 40,000 men, making it very real indeed to their friends, families, and colleagues. One woman I know—a mother of two sons, sister of four brothers, and a friend to two men suffering from depression—told me, “I really want to know how it manifests differently in men than in women, so I can be more helpful.”
Therein lies the key: The symptoms of depression, which can be a driver to suicide, tend to be very different in men than in women. Women are more frequently diagnosed with depression than men are, based on classic symptoms including mood changes, eating disorders, anxiety, and irritability. Depression in men, however, may manifest itself as aggression, anger, changes in sexual performance, risky behaviors, and substance abuse. Multiple studies have confirmed that the stigma attached to depression in men prevents many of them from seeking help or admitting to feeling depressed. If they don’t ask for help, and nobody recognizes the signs, we end up with an epidemic of undiagnosed, untreated mental health issues.
Depression in men may get so little attention because it appears more common among women. A 2023 Gallup poll suggests that 23.8 percent of American women are currently suffering from depression, compared with only 11.4 percent of American men. Those are diagnosed cases. According to the National Institute of Mental Health, more than 6 million American men are known to have depression, with the actual number thought to be significantly higher. By the way, this is not just an American problem: A recent British study reported that 40 percent of men won’t talk to anyone about their mental health, including close friends, family members, or a medical professional.
“Men are socialized to minimize expression of emotional pain. It’s seen as weak or unmanly to cry, or admit to any sense of vulnerability or failure,” Richard A. Friedman, a psychiatrist at Weill Cornell Medicine specializing in depression, anxiety, and mood disorders, told me. Due to that stigma, men are more likely to externalize emotions, resulting in aggressive, impulsive, coercive, and risky behaviors.
Addressing the stigma and shame of mental health issues is central to making changes, and I have some personal experience with this. Nearly ten years ago I took a giant step in publicly disclosing my depression diagnosis and how debilitating it had become. I wrote an essay in The New York Times titled, “Opening Up About Depression.” In the column I reached back to my teen years when I created a “secret code” to record my darkish feelings in a daily journal, which I recognized as a heaviness in my head or a pervasive lethargy that sapped my hormone-driven teen self. Most days of the week I scribbled either A1 (for depression) or its first cousin, A2 (for anxiety) in my journal.
It was terrifying to come out in The Times like this, but keeping that secret had become even more challenging. By then, I knew secrets to be insidious, like a cancer that eats you alive. Did I feel exposed or vulnerable? Yes. Did I fear rejection? Yes. Did I feel I might be labeled as mentally ill or worse, nuts? You bet.
Did I help others? I believe so. Did it help me? Yes! Readers posted hundreds of supportive comments in response to that column. In particular, I felt seen by this one man, “Jackson,” who wrote as if describing my own experience:
“In one terrible year, a friend died suddenly, my son battled a mysterious andfrightening medical condition, and one of my parents was dying. Even with all those obvious reasons to be depressed I didn't recognize the classic symptoms: poor appetite, insomnia, and a sense of numbness, as if watching the world from afar.
The reality was that constant stress had seriously disrupted my biochemistry and overwhelmed my usual resilience. My therapist urged me to consider medication—along with intense counseling. I was too committed to ‘toughing it out’ but eventually I did and, as the therapist said, “ it turned down the volume" of my depression. Eventually it passed. If I am ever hit with another bout, I won't hesitate to seek help. Depression is as real an illness as cancer—and it can be as deadly.”
By the time I hit the mid-century mark, I’d confided my diagnosis privately to a few others. But it was my friend Erik’s death by suicide in 2015 that jumpstarted my own greater openness and The Times essay. Erik and I had had a lot in common: We’d both gone to Duke University, where we’d led closeted lives. We had sisters (and other family) who loved us and whom we loved in return. And we were gay. One hot summer day, Erik left work to eat lunch at home. From all accounts he retrieved the gun he’d bought some time before, went into his bathroom, and shot himself in the head.
(Suicide attempts among men are eight times more likely to involve a gun than attempts by women.)
Erik’s friends and family were shocked. Me, too. Only a few days before his death he had talked excitedly about buying a house, and his hopes for a promotion. I’d had no clue that he was at such risk. All these years later, I still recall what one of his friends told me after his passing: “You never know where depression lives.”
I’ve repeated that line quietly to myself many times since then. Some days, when I look in the mirror, I understand it even more personally. My face is often a mask, hiding the deeper stew of emotions within. If I can’t see me, how can I expect others to?
Here’s what haunts me about Erik’s death. Sure, he kept his pain to himself. But I’d never told Erik about the extent of my suffering, either. Like him, I was well practiced in camouflaging my illness, and as a high-functioning depressive I could hide my symptoms. I relied on medication and meditation, psychotherapy, sober weeks and months, healthy eating and regular exercise. I also knew that at times I had to go home, retreat from the world, because I’d become irritable or angry or aggressive—what I now know to be signs of depression in men.
What can we do? Here are five ways you can help:
No. 1: Learn more about the symptoms of depression and other mental health issues, especially as they apply to men. Don’t be surprised if you feel helpless. Information and resources will help you and them.
No. 2: Urge the men in your life to get help. Some men don’t even know that they’re depressed. Others may feel ashamed, thinking they can overcome it by sheer willpower. According to the Mayo Clinic, “depression seldom gets better without treatment and may get worse.”
No. 3: Explain why you’re worried. And offer to help find a trained—and affordable—mental health professional. You could even put together a list of questions for their first appointment or offer to take or accompany them to the visit.
No. 4: Be on the lookout for worsening signs of depression. For men, this may include increased drinking, deepening anger, or more frequent outbursts. Don’t forget that depression manifests differently. Pay attention. Ask questions.
No. 5: Learn and stay alert for the warning signs of suicide. If necessary, contact your friend’s doctor, therapist, friends or family. Reach out to a suicide hotline for additional resources. Call 911 or your local emergency number if your friend appears to be in crisis.
If you or someone you know is struggling or in crisis, help is available at the Suicide and Crisis Lifeline. Call or text 988 or chat 988lifeline.org
Steven Petrow is a contributing columnist with The Washington Post and the author of The Joy You Make, to be published by Maria Shriver’s book imprint, The Open Field, in September. He’s also written three books about modern manners and his TED Talk on civility has been viewed nearly two million times.
