Fighting the Stigma of Male Depression

Depression in men is underdiagnosed

Illustration by Brittany Inglese

Real men get the blues. Even worse, they can develop depression. Unlike the occasional bout of melancholy that we all experience from time to time, depression lingers, shading life throughout the day, nearly every day, for weeks or more at a time. It can affect sleep, appetite and the ability to concentrate while also stirring feelings of guilt or worthlessness and thoughts of suicide. “Major depression goes on for weeks, and it’s not just sadness — the person is pretty immobilized [and] has pervasive trouble functioning day to day,” says Stephen Naifeh, PhD, a clinical psychologist at Mill House Counseling Center in Dover.

Nearly a third of US men will go through a period of major depression in their lifetime, according to the American Psychological Association, but few will admit that they feel depressed. Women are reported to suffer from major depression two times more often than men. Compared to women, though, men are less likely to report feelings of depression, says Nashua-based clinical psychologist Carl G. Hindy, PhD, so depression is underdiagnosed in men compared to the female population.

Of the men in the US who do acknowledge their depression, only one in three will take medication for it, and only one in four will seek treatment from a doctor, Hindy says. These statistics reflect the stigma that continues to surround mental illness and treatment and the common reluctance in men to admit that they have depression, to talk about their feelings and to ask for help.

The problem is compounded by the fact that depression in men commonly does not reveal itself in ways we might expect. “It’s not like the guys are crying a lot or feeling sad,” says Naifeh. Instead, there might be anger, irritability, emptiness, joylessness and numbness, possibly masked by addictive behavior. Men often display anger rather than sadness, disappointment or distress, Naifeh says, because anger tends to be perceived as the more masculine — and therefore more socially acceptable — emotion. Many men also shy away from using the word “depressed” to describe themselves, Naifeh says, because they see it as a feminine emotion.

Men tend to suppress or hide their emotions to such a degree that they can lose touch with what they truly feel. It is not uncommon, Hindy says, for a male patient in diagnostic psychological sessions to deny that he is often irritable, has difficulty making decisions or frequently feels guilty. “But the man’s wife will be sitting there nodding, and she will say, ‘Oh, yes, he does do that,’” Hindy says. “Many men are not even aware that they are this way.”

Genetic history influences risk of depression, as does growing up with abuse or in an alcoholic or shame-based family that doesn’t permit boys to express their feelings, Naifeh says. Those who were part of a dysfunctional family or felt unloved and unsupported as children are particularly susceptible to depression as adults when faced with failure or rejection such as job loss. “We compare ourselves to others as well as to our own ideals and internal expectations,” Naifeh says. “When you fall short, if you’ve had a loving environment, you can bear it.”

As preventive measures, men should try to find a balance and engagement in meaningful work and deeply enjoyable activities, Naifeh says. Spirituality also helps many ward off or weather depression, he adds. “[But] the most natural antidepressant that exists for human beings is connection and loving relationships,” Naifeh says. “There is such vitality and self-esteem that comes from connection and close relationships. It helps people bear depression.” Men’s socialization, however, often does not prepare them for close relationships and friendships. “If you have to be self-reliant and deny vulnerability,” Naifeh says, “how do you deal with feelings and relationships? How you do say, ‘You’ve hurt my feelings?’ Men rarely say that to another guy,” and they generally feel embarrassed to bring it up.

Treatment for depression often involves psychotherapy, medication or a combination of the two. Although antidepressants tend to take effect more quickly than therapy — which can be particularly helpful in cases of severe depression — therapy’s positive influence “tends to last longer,” Hindy says, “and acts as both treatment and prevention in one, because we give [patients] tools they can use the rest of their lives.” Commonly, therapy raises patients’ awareness of their thoughts and how thoughts affect their feelings and teaches the patient how to modify harmful thoughts, Hindy adds.

But it can’t happen, of course, if the patient remains in denial. “Just to come in and get into treatment is an important first step,” Naifeh says. “Depression is very treatable.”

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