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He Feels, She Feels: How Depression Signs Differ in Men and Women

He Feels, She Feels: How Depression Signs Differ in Men and Women

Symptoms in men can be easy to miss.

It’s commonly thought that depression affects women more than men. According to the World Health Organization, depression is about 70 percent more common in women. Case closed? Not so fast.

“Other studies suggest we’re missing diagnoses in men,” says psychiatrist Frank Pavlovcic III, DO, outpatient clinical director at Saint Joseph Mercy Health System in Michigan. "When studies take a look at alternative symptoms and when you catch men experiencing these, the rate looks more similar." A 2013 JAMA Psychiatry study suggests the rates are nearly identical: 30.6 percent of men met the criteria for depression, as did 33.3 percent of women. So where’s the disconnect? Why might men be underdiagnosed for depression?

Social stigma
Is there a stigma around men and depression? “The short answer is yes,” says Pavlovcic. “Studies suggest that men with depression are perceived more negatively by both men and women than women with depression. Some of these studies suggest that men are also perceived as more dangerous, and that they need to pull themselves together.”

Many societal norms say that men should be the strong, silent types—hard working, protective and able to shrug off emotional turmoil. “It varies from culture to culture, but western expectations are that men are tough,” says Pavlovcic.

A 2016 study in Community Mental Health Journal of about 900 Canadians found that more than one-third of respondents who had no direct experience with depression or suicide viewed men with depression as unpredictable. And, more than 56 percent of men with direct experience of depression or suicide said they’d be embarrassed to get help for depression, compared to less than 40 percent of women.

That’s dangerous, says Pavlovcic, because of the connection between depression and suicide. “Men are three to four times more likely than women to commit suicide, and between 75 and 80 percent of people who commit suicide are men.” 

Symptoms in men are easy to miss
Another reason it’s hard to diagnose men with depression is that they often have non-traditional symptoms. “There is a constellation of symptoms that is generally associated with depression: sleep disturbances, low energy, apathy, anhedonia (inability to feel pleasure),” says Pavlovcic. And while men do experience these, they're more likely than women to experience alternative symptoms, including anger, alcohol and drug abuse, and risk-taking behavior.

“Even though men complain about things like irritability and impulsivity, that wouldn’t necessarily drive a healthcare provider toward a diagnosis of depression,” Pavlovcic says. “If you ask a man if he’s been feeling depressed, he might say no, he’s been angry, and it’s easy to miss that. Women are more likely to report feeling classic symptoms of depression.”

Getting help
Although men and women often express different symptoms, the causes of depression are similar in both sexes. “Depression is generally a combination of genetic factors and one or more environmental factors such as poor resilience, possibly a baseline negative temprament, trauma, seasonal sensitivity, medication and medical issues,” says Pavlovcic. There is one exception, though. “In women, hormone fluctuation during menopause or pregnancy can also contribute to depression.”

As difficult as it is for mental health professionals to diagnose people—especially men—with depression, it can be even more difficult for the person him or herself to see that something’s wrong. It’s all about looking for patterns, says Pavlovcic.

“Individuals often miss the forest for the trees,” he says. “You’re not just down because you’ve had a bad day, you’re stuck down. Sometimes it takes a lot to recognize persistent patterns.” Pavlovcic adds that family and friends are often in a better position to recognize when something is off.

While their symptoms may be different, there’s not much difference between men and women when it comes to treatment. “Studies show men and women with depression respond similarly to the standard treatments of medication and therapy,” says Pavlovcic. But, he adds, it’s important to start treatment as soon as you realize there’s a problem. “It’s best to treat depression early,” he says. “If you wait to get treatment it can get worse.”

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