What Depression in Men Really Looks Like

"When we think of clinical depression, we usually think of sadness, anxiety, poor motivation, the "blahs," guilt, and negativity. These all have the negative inclination that characterizes depression. We may also think of women as they are subject to depression more often than men. Depression in adult men is frequently quite different. As an example: A man who is usually calm and even tempered, becomes irritable, prone to anger, criticism, disparaging remarks and cynicism. He does not show emotions such as sadness, pessimism and guilt."

"The cause of this different presentation of depression in men is subject to debate. Is it genetics and testosterone? Family upbringing of boys? Or our culture's expectation of men? The answer seems to be that all these factors contribute. We do not know exactly what percentage of men present differently from traditional sadness symptoms. But studies and experience place it anywhere from 30% to a clear majority."

"Some research literature discusses the observation that rather than experience the core feelings of depression men often indulge in escape behaviors such as risk-taking, substance abuse, or acting out (such as extramarital affairs). These are the behavioral manifestations of feeling states like irritability and anger, which they then act out. Although this does happen, I did not see it in my practice. This may reflect negative biases about men more than the clinical reality."

Clinical depression in men often presents with irritability, anger, criticism, cynicism, and acting out instead of classical sadness, guilt, or pessimism. Such presentations can worsen existing anger-laden traits or emerge in previously even-tempered men. Causes include genetics, testosterone, childhood upbringing, and cultural expectations, and multiple factors commonly contribute. Prevalence of atypical male presentations is uncertain, estimated from about 30% to a majority, partly because many men avoid treatment. Some research links male depression to escape behaviors such as risk-taking, substance abuse, or affairs, though clinical observations may vary. Experienced clinicians or close associates can often recognize these patterns.

Read at Psychology Today