The Hidden Signs of Male Depression

Men’s mental health has been getting some spotlight recently, but are we any better at detecting and intervening when it comes to depression in guys?

Depression is not a homogenous experience, especially when it comes to gender. While rates of undiagnosed depression in males are not readily available, many sources (e.g., Mayo Clinic, n.d.; Call et al., 2015; Shi et al., 2021; Swetlitz, 2021) point out that depression is different in men and likely underdiagnosed.

Contributing factors

It’s no secret that males are usually socialized to show toughness, and therefore, it’s no surprise that machismo plays a big role in the lack of help-seeking (e.g., Berke et al., 2023; Pennsylvania Psychiatric Institute, 2025). Regardless, if male depression looks different, it’s harder to recognize by providers, people close to the male, or even the man themselves, making them less likely to encourage or initiate treatment. Adding urgency to better identifying depression in males is that suicide, highly correlated to depression, has much higher rates in males (Shi et al., 2021; Cui & Fiske, 2021).

Next, the Diagnostic and Statistical Manual of Mental Disorders (DSM, American Psychiatric Association, 2013), arguably the most-utilized diagnostic reference, provides a Gender-Related Diagnostic Issue subsection for most conditions. However, for depression, despite decades of researchers telling us otherwise, it is noted “…there are not clear differences between genders in symptoms…”

Thus, if a male doesn’t present or report the typical sad, crying, guilt-ridden, non-motivated, anhedonic, appetite-and-sleep-disturbed picture, there’s a good chance depression will go undetected. That said, Shi et al. (2021) had it right when they wrote, “…it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria…”

For depression, a “his and hers” list of symptom presentations, or expanded discussion on gender differences in presentation, could be helpful.

Keys to detecting male depression

While the above might sound like better identifying male depression is a cryptic clinical adventure, fear not! Here’s what researchers have long told us about the differences in male depression:

1. There’s a good chance emotional turmoil will be masked, especially by substance use (e.g., Ogrodniczuk & Oliffe, 2011). This may well be a product of male socialization, it being better to drown emotions than admit to psychological “weakness.”
2. The bad mood, or dysphoria, of depression in men tends to have an angry, irritable, or even aggressive or hostile nature to it (e.g., Winkler et al., 2005; MacDonald et al., 2020).
3. Increased sexual activity may seem a strange bedfellow to depression, but, as I noted in “An Unusual, Overlooked Sign of Depression,” relationship experts have written about how infidelity can evolve as a remedy for depression. Pursuing sexual partners can make one feel desirable, which is an antidote to poor self-esteem, and excited, as if they’re coming back alive. Further, someone pursuing an affair is more apt to take care of themselves for appearance’s sake, and may take to exercise and better self-care, which in themselves may be antidotes to depression or at least help further conceal it.
4. Risky behavior, which is often sensation-seeking, like stealing, gambling, and fighting, is also associated with male depression. Researchers such as Cross et al. (2011) note that men tend to be more sensation-seeking than females, and it’s easy to see how this may naturally be put to use, providing excitement in an otherwise bland internal landscape.
5. Argumentativeness may also be present, if for no other reason than being chronically irritable or angry naturally lends itself to squabbling or worse.
6. Lastly, some researchers tell us that males saying they’re feeling “stressed” often turn out to be depressed.

Putting it all together

Providers should remember that depression in men can present differently from the standard DSM picture. Chances are, the irritable or angry mood and argumentativeness, especially towards the people close to them, may be the first thing observed or complained about.

After ruling out reactions to substances and medical-related causes, like endocrinological complications, and if no mania is present, the emergence of such a mood or demeanor shift should be investigated for not only the five other above possible signs of male depression, but also the more standard depressive symptoms. Remember, these male-centric standout symptoms can overshadow or mask the more typical symptoms, especially if substance abuse is occurring. Asking the patient and people close to them about any increase in substance use during this period will be helpful.

Once depression is suspected, it is vital not to forget to evaluate the person’s cognition and explore the thoughts in their mind. Depressed people can experience “brain fog” with symptoms like delayed cognition and memory. As for what is lurking in the mind’s shadows, chances are themes of inadequacy, guilt, and shame will surface.

Providers are cautioned not to ask about thought material by saying, “Have you been feeling guilty lately?” This is because the guy might sense that saying “yes” could suggest they’re depressed, and this is something they’re defending against. Rather, having a general conversation about what’s been happening and their thoughts about it can reveal the negativity frequently associated with depression, Also, asking what kind of thoughts are associated with their bad mood can helpful, too; “When you’re having an irritable kind of day, what sort of thoughts are running through your mind?”

Lastly, administering a Personality Assessment Inventory (PAI) can also be useful. The PAI measures numerous items, so it is not obvious that this tool is assessing depression, which could lead to dishonesty in answers. Plus, it has built-in scales to track if they’re trying to make themselves look better or worse. Coupled with observation and interview, the PAI can help diagnose depression with confidence. In turn, it could provide more convincing or objective proof that the man is depressed, which can help in encouraging treatment. While the Beck Depression Inventory (BDI) is a good tool, the name of the instrument alone, coupled with questions about levels of sadness and other obviously depressive symptoms, might spur the man to be dishonest.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student.

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