Signs of depression in men

Road rage. Angry outbursts. Irritability and agitation. Mood swings and anger in men can be concerning for everyone around them but may in fact be a sign of depression. And while these symptoms of depression in men may show up at any time in life, male depression peaks in midlife—perhaps due to a variety of factors unique to men between 40 and 50 that may affect their mental health, including health and physical changes, family and relationship stressors, and career and financial challenges. 

Do men and women have different symptoms of depression?

In women the symptoms of depression often include feelings of sadness, hopelessness and inadequacy along with excessive crying and physical symptoms of fatigue. While men and women share many of the same symptoms of depression, signs of midlife depression in men may also include:

• Aggression
• Irritability
• Increased risk taking
• Loss of control
• Sudden anger
• Use of alcohol/drugs
• Impaired work functioning
• Social withdrawal

While a man may certainly lose control or have an angry outburst totally unrelated to depression, and at any stage of life, showing these repeated signs of male depression may indicate a deeper problem. In some cases, anger may be driven by feelings of hurt, failure and shame, and may feel more acceptable as a "male" emotion. Eventually, this anger can also become a habit.

"Culturally, men are conditioned to be more aggressive, to focus on fighting things and not to talk about feelings, which may be seen as a sign of weakness," says Stephen Mechanick, MD, chairman of the Department of Psychiatry at Bryn Mawr Hospital, part of Main Line Health. "For some men it's easier to act out anger or manifest anger in some other way." Dr. Mechanick is quick to caution against generalizations, however, as he encounters many male patients who are insightful and thoughtful, and are able to easily express how they're feeling and why. Anger, he adds, "doesn't necessarily mean depression. Anger is a symptom of something, just like fever is a symptom of something. It's not always depression."

Why do men get depressed?

While some men are attuned to what may be causing anger and upset in their lives, others may not realize how stress is impacting their physical and emotional health or how environmental factors are having an effect on their behavior. There are any number of reasons why men may be depressed and angry, but these are some of the common causes of depression in men:

• Disappointments in life – By mid-life a man may be assessing his achievements and failures, in business endeavors as well as in relationships. While these things may be explored with healthy perspective, a man susceptible to depression may internalize loss, failure and grief around life's disappointments.
• Mortality – A man who is dealing with aging and illness in himself or his loved ones may be grappling with his own mortality and coming to terms with death as a fact of life, perhaps more realistically and more immediately than a younger man. Thoughts of sadness and loss may fuel feelings of anger and frustration.
• Financial stress – A man may feel burdened by the expectation to provide financially, especially if he has a family to support. Fear of not being able to meet obligations or dealing with the constant strain of not producing enough to cover expenses can be mentally and emotionally draining for a man of any age.
• Partner/relationship strife – Lack of fulfillment in a relationship is among the top most stressful things for a man and may lead to anger, aggression and other destructive behaviors. A relationship that brings out the worst in a man may erode his self-confidence and feelings of masculinity over time and can lead to deepening depression.
• Medications with depression side effect – A number of medications have depression as a possible side effect, including certain types of blood pressure meds, proton pump inhibitors (PPI) for acid reflux, and analgesics (pain relievers). Side effects are different for every person so one man may have no side effects at all while another may experience significant depression-related side effects.
• Health changes – While chronic conditions are not inevitable as we age, the probability of having a medical condition increases the older we get. Health challenges such as high blood pressure, high cholesterol, or diabetes, may trigger feelings of anxiety and concern, or fear of losing strength and masculinity. Erectile dysfunction may also contribute to these concerns.
• Behavior/lifestyle – Weight gain along with addiction issues, and lack of time or attention to well-being and physical exercise, can all lead to a depressed mood and associated symptoms, including anger and lashing out at others. This connection between lifestyle and depression isn't always obvious, especially if it's been going on for a long time.
• Hormonal changes – Male hormones such as testosterone and androgen naturally decline with age. While this change is very gradual and doesn't usually produce noticeable symptoms, dropping hormone levels may cause irritability and may also affect self-esteem and sex drive, among other things. The effects of low testosterone remains a controversial topic, however, and according to Dr. Mechanick is not usually the cause of depression or other emotional problems.

Treatment for depression in men

Treating depression begins with recognizing that there's a problem. Some men may experience symptoms of depression or recognize certain aspects of their lives are not working as well as they should, but may still be in denial about the need for depression treatment therapy. Other men may readily recognize that anger and irritability are a result of depression, or they may have experienced depression in the past and are better able to identify it.

"If these symptoms of depression are causing enough distress to themselves or to another party, it makes sense to seek some assistance," says Dr. Mechanick. Depending on the severity of the signs and symptoms of male depression, there are a number of depression treatment options available which may be prescribed individually or in combination. These include:

• Counseling – A skilled mental health professional, such as a psychologist or licensed clinical social worker, can support men with depression by helping them talk through what they're dealing with in life. Counseling can help men develop new skills and coping mechanisms for working through anger and other signs of male depression. Support groups may also be helpful for things that are common to a group of men, such as a bereavement support group or divorce support group.
• Medication – A psychiatrist is able to provide therapy combined with medication, such as an antidepressant with optimal benefits and fewest side effects. For men who are dealing with feelings of anxiety or panic attacks, an anti-anxiety medication may be prescribed along with new behaviors such as meditation and exercise.
• Inpatient or partial hospital psychiatric treatment – Some men with severe depression or whose safety or the safety of others is at risk, or who is unable to care for himself because of mental illness, may need extra care and oversight in a 24-hour inpatient psychiatric unit. Under clinical supervision, men with clinical depression can participate in group, individual and family counseling, receiving a variety of therapies as well as medication to help manage psychiatric illness with the goal of returning to normal functioning and life in his home and community. Partial hospital psychiatric programs provide intensive outpatient treatment without the need to stay overnight in a hospital.
• Drug and alcohol treatment – Depression and substance abuse often go hand in hand, with one fueling the other in an endless cycle of self-destructive thought and behavior. For men with mental health and addiction issues (dual diagnosis), getting help for addiction is critical. Removing the alcohol or drugs and recovering from substance abuse can help reveal underlying mental health issues made worse by substance use.

"We encourage people to seek help early while it's potentially easier to correct and when there has been less suffering," adds Dr. Mechanick. "You don't get a prize for suffering."

Next steps:

Make an appointment with Stephen Mechanick, MD
Learn more about behavioral health care at Main Line Health
Recognizing when "okay" isn't okay—suicide prevention and mental health