Depression in men

Bangladesh need 34 off the last three overs, and Rehan, 13, is on his feet in the sitting room in Gazipur, shouting the score. His father, Mizan, 45, a production manager at a garment factory, comes in from a fourteen-hour day with a buyer’s audit next week. “Turn that off. Now.” The television goes dark. Rehan goes to his room.

Mizan’s wife, Parveen, has stopped counting how many cigarettes he smokes on the balcony. At her brother’s house on Friday, the brother-in-law tries a joke: “Dulabhai, even the umpire doesn’t get shouted at like that.” Everyone laughs except Mizan. Later, when Parveen asks if he is sad, he looks at her as if she has asked something foolish. “I’m not sad. I’m just angry all the time.”

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding depression in men

Depression is diagnosed by persistent low mood or loss of interest, with changes in sleep, energy, concentration and self-worth. Many men describe it differently: irritability, anger, feeling numb, working longer, drinking or smoking more, driving recklessly, or physical complaints such as headaches and poor sleep. These are easy to read as stress or temper. A systematic review of 37 studies found that holding to traditional ideas of manhood shapes how men express depression, whether they seek help, and how they cope with it.

How common is depression in men?

In the US National Comorbidity Survey Replication, a national survey, men reported more anger attacks, aggression, substance misuse and risk-taking than women. When these symptoms were added to the usual signs on a combined research scale, men and women met that scale’s criteria for depression in equal proportions, 30.6% of men and 33.3% of women. It is a measure built for the survey, so read it as a comparison between men and women, not as how many men are depressed today. The evidence comes from the United States; we have not found a comparable Bangladeshi study.

Signs and symptoms of depression in men

• Irritability or anger out of proportion, often at home
• Working longer hours, or being unable to switch off
• More alcohol, cigarettes, or risky driving
• Withdrawing from family, friends or things once enjoyed
• Poor sleep, constant tiredness, headaches or stomach problems
• Talk of being a burden, or of not wanting to go on

Treatment for depression in men

A psychiatrist first takes the complaint seriously in the words it comes in, then asks about mood, sleep, alcohol and other substances, physical health and any thoughts of suicide. Physical causes are checked. Depression in men is treated with the same approaches as in women: talking therapies such as cognitive behavioural therapy, medication, or both, and a network meta-analysis of 101 trials in adults with depression found the combination worked better than either alone. The review on masculinity suggests that tailoring how care is offered, practical and focused on problems and goals, may help more men take it up.

What getting better can look like

In Mizan’s house, it might be an evening when Rehan shouts the score and his father shouts with him, a balcony with fewer cigarettes, and one honest conversation with Parveen that does not end in a slammed door.

Common questions about depression in men

What are the signs of depression in men?

Besides low mood, men with depression often show irritability, anger, working too much, drinking or smoking more, risk-taking, and physical complaints like poor sleep and headaches. In a large US survey, including these symptoms made depression as common in men as in women. A doctor can assess whether these changes are depression.

Why do men not seek help for depression?

Research suggests that ideas about being strong and self-reliant make many men less likely to name what they feel or to ask for help. They may see anger or tiredness as stress rather than illness. Asking for help is a practical step, and depression is treatable.

When to see a psychiatrist

If anger, drinking or withdrawal has been building for weeks, and family are tiptoeing around it, it is worth seeing a doctor. If you or someone you love talks about suicide or is at risk, call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Martin et al., JAMA Psychiatry, 2013 (PMID 23986338)
• Seidler et al., Clinical Psychology Review, 2016 (PMID 27664823)
• Cuijpers et al., World Psychiatry, 2020 (PMID 31922679)