THERAPY FOR MEN

WHO ARE STILL

HOLDING IT

TOGETHER.

Depression in men often looks like irritability.

A 2013 study in JAMA Psychiatry analyzed a national survey of about 5,700 adults. Men were more likely than women to report anger attacks, irritability, substance use, and risk-taking. When the researchers counted those symptoms alongside the traditional ones, the long-reported gender gap in depression disappeared.

A checklist built around sadness and tearfulness can miss a man who's mostly angry, numb, or drinking more. Some of the signs worth paying attention to:

• A shorter fuse with the people you care about most
• Feeling numb, flat, or checked out
• More drinks, more screens, more hours at work
• Sleep that's off, or tired no matter how much you get
• Pulling away from friends, or realizing there's nobody you'd actually call
• Saying "I'm fine" so often it's automatic

The same expectations keep coming up.

Men are less likely than women to seek help for mental health concerns, and research on why keeps landing in the same place: be self-reliant, keep emotions in check, provide. In a 2020 interview study of men treated for depression, those internalized expectations shaped whether and when they reached out at all.

Some men in related research described getting help as taking action, the same instinct they'd bring to any problem worth solving. For a lot of men, that framing fits better.

Shame is what keeps it quiet.

Guilt is about something you did. Shame is about who you are, or who you're afraid you are. A 2011 meta-analysis in Psychological Bulletin pooled decades of research and found shame was more strongly tied to depressive symptoms than guilt was.

For a lot of men, shame attaches to the struggle itself. Needing help starts to feel like proof of failing at the job of being fine. A 2021 study of 258 men who screened positive for depression found that self-stigma, the private sense that needing help makes you weaker or less capable, was directly linked to a lower likelihood of seeking help. Self-reliance and emotional control fed that self-stigma.

Shame tends to lose some of its grip once it's said out loud to someone who doesn't flinch.

Fewer close friends, and less support from them.

The same survey found men were less likely than women to receive emotional support from the friends they did have. Isolation removes one of the main places people set things down, and it makes everything else heavier to carry.

New dads get depressed too.

A 2010 meta-analysis in JAMA, covering 43 studies and more than 28,000 fathers, found that about 10% of new and expectant fathers experienced depression. Rates were highest 3 to 6 months after the baby arrived, and fathers' depression tracked moderately with mothers'. The authors called for better screening of dads, who are rarely asked.

Clear structure, practical goals, and a real working relationship.

A 2018 review of how to engage men in psychological treatment pulled together recommendations from across the field. Recurring themes: explain how therapy works up front, set practical goals together, and use language that fits how men actually talk about their lives. Follow-up research with men in therapy found they valued being oriented to the process and receiving structured, goal-focused treatment.

Related: Anxiety  ·  Burnout & perfectionism