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Why Depression in Men May Be Underdiagnosed

Published on May 05, 2016
Medically reviewed by Daniel Karlin, MD, MA

More than 6 million men suffer from depression each year in the United States, yet the disease tends to be underdiagnosed in men. There are a number of reasons for this, but it may be because men can experience a different set of depression signs and symptoms than women.

Currently, women are diagnosed with depression twice as often as men, and most research on the topic focuses on why women are at greater risk for developing the disorder. The problem may be compounded by the notion that men are said to be reluctant to talk about how they are feeling, and so they may not recognize, acknowledge, or seek help for depression.

Different Symptoms in Men

According to The National Alliance on Mental Illness (NAMI), men seem to be less likely to show “typical” signs of depression, though this observation is not yet well understood. Still, the NAMI defines typical depression signs as crying, sadness, loss of interest in previously enjoyable activities, and verbally expressing thoughts of suicide. However, an analysis by the National Comorbidity Survey Replication, a nationally represented mental health survey, found that men report higher rates of anger attacks/aggression, substance abuse and risk-taking compared with women.

NAMI and HelpGuide, a trusted not-for-profit organization for mental illness and well-being, indicate that depressed men are more likely to experience the following symptoms as well:

  • Exhaustion.
  • Sleeplessness.
  • Irritability.
  • Physical pain.
  • Loss of interest in work.

NAMI suggests that because men may feel shame or try to “tough it out” on their own, they may also self-medicate with drugs or alcohol. Unfortunately, healthcare professionals may miss the opportunity to diagnose depression accurately in men. For some men, by the time clinical depression is diagnosed, the condition has gone undiagnosed for years and can be severe.

Causes and Treatment of Depression

Regardless of gender, depression may be caused by a combination of three factors:

  • Genes—A family history of depression increases a person’s likelihood of being diagnosed with depression.
  • Hormones—Brain chemistry can be affected by hormones that control mood and emotions.
  • Stress—External factors (e.g., finances, relationships, losing a loved one) can affect mood and lead to depression.

According to NAMI, 80% to 90% of all persons (men and women) diagnosed with major depression can be treated effectively with antidepressants and psychotherapy. Additionally, peer support and attention to lifestyle, including diet, exercise, and smoking cessation, have been shown to result in better physical and mental health. In some non-responsive or other cases, electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) may be used.

Seeking Help

If you think you may have atypical signs or symptoms of depression, speak with a doctor or a licensed mental health professional. If you know someone who may be depressed, be supportive, listen carefully, and encourage treatment. Never ignore thoughts or mentions of suicide. In such a case, the Suicide Prevention Lifeline is an important resource to turn to for help: 1-800-273-TALK (8255).

[1] [2] [3] [4] [5] [6] [7] [8]


  • 1. National Institute of Mental Health. Depression in men. Accessed December 18, 2015.
  • 2. Mayo Clinic Staff. Male depression: Understanding the issues. Accessed December 18, 2015.
  • 3. Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: Analysis of the national comorbidity survey replication. JAMA Psychiatry. October 2013; 70(10): 1100-1106.
  • 4. National Institute of Mental Health. Men and depression. Accessed December 18, 2015.
  • 5. National Alliance on Mental Health. Men and depression fact sheet. Accessed December 18, 2015.
  • 6. Robinson L, Smith M, Segal J. Depression in men: Why it’s hard to recognize and what helps. Accessed December 18, 2015.
  • 7. Men’s Health. Why your doc is likely to miss it if you’re depressed. Accessed December 18, 2015.
  • 8. National Institute of Mental Health. Men and depression. Accessed December 18, 2015.
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