By 
Depression in men often does not look like the picture in the leaflet, and the gap between how it is described and how it presents is a large part of why it goes unrecognised, including by the man who has it.
In 2023 the US suicide rate was 22.8 per 100,000 among men and 5.9 among women: nearly four times higher. The rate is highest in men aged 75 and over, at 40.7. Men are diagnosed with depression less often than women and die from its worst outcome far more often, and one reason is that the presentation is frequently irritability, anger, withdrawal, risk-taking or drinking rather than visible sadness.
| US suicide rate, men (2023) | 22.8 per 100,000 |
|---|---|
| US suicide rate, women | 5.9 per 100,000 |
| Highest rate of any group | Men aged 75 and over, at 40.7 |
| How it commonly presents in men | Irritability, anger, withdrawal, risk-taking, increased drinking |
| How it less often presents | Visible sadness or tearfulness |
| Men receiving counselling or therapy | 10.9%, against 16.9% of women |
| Men taking mental health medication | 13.4%, against 24.9% of women |
| Contact with primary care in the year before death | About three in four |
How much worse is depression outcome in men?
More than 49,300 people died by suicide in the United States in 2023. Broken down by sex:
| Rate per 100,000 | |
|---|---|
| Men | 22.8 |
| Women | 5.9 |
| Men aged 75 and over | 40.7 |
Nearly four times the rate. And the highest-risk group is not the one most people would name. It is older men, a group almost entirely absent from public conversation about male mental health, which tends to focus on men in their twenties and thirties.
Set against that, men are diagnosed with depression less often than women. Both things cannot be straightforwardly true about the underlying illness. Something in between the illness and the diagnosis is going wrong.
What does depression look like in men?
The formal diagnostic criteria are the same regardless of sex: persistent low mood or loss of interest, plus changes in sleep, appetite, energy, concentration, and feelings of worthlessness or guilt.
But the presentation men actually bring to a consulting room is frequently different in emphasis:
- Irritability and anger rather than sadness, a short fuse, disproportionate reactions, a sense of being constantly annoyed
- Withdrawal: from friends, from a partner, into work or a screen
- Escalating alcohol or drug use, which is both a symptom and an accelerant
- Risk-taking: driving, money, physical risk, affairs
- Working more, not less, which reads as coping rather than as illness
- Loss of interest in things that used to matter, including sex
- Physical complaints with no clear cause
Notice how many of those are read by everyone involved, including the man: as character rather than illness. “He’s become difficult.” “He drinks too much.” “He’s never here.” Those are descriptions of a person, not a diagnosis, and that is precisely the problem.
Related: All mental health articles
Why does male depression get missed?
Several things stack.
The symptoms are socially legible as something else. Anger and drinking get responded to as behaviour to be managed rather than as signals to be investigated.
Men present later and less often. Lower rates of primary care contact mean fewer opportunities for anyone to ask.
Screening questions ask about sadness. A man who is not sad but is furious and exhausted can answer “no” honestly and screen negative.
The word carries baggage. “Depressed” is a word many men will not apply to themselves, while “burnt out”, “stressed”, or “not myself” are all acceptable, and all point at the same thing.
What are the physical symptoms?
Depression is not only a mood disorder, and the physical features are often what actually gets a man into a clinic.
Sleep disturbance, usually early-morning waking, sometimes sleeping far more than usual. Fatigue that rest does not fix. Appetite and weight change in either direction. Headaches, digestive complaints and unexplained aches. Difficulty concentrating and making decisions, which men often describe as their memory going.
Two of those overlap with things this site covers elsewhere, and the overlap matters. Fatigue and low mood are also the symptom list that the testosterone market sells to, and the trial designed specifically to test whether raising testosterone improves vitality came back negative. And poor sleep is worth investigating in its own right rather than being filed under stress.
How does depression affect sex?
Loss of interest in sex is a core feature of depression, not an incidental one. For many men it is the first thing they notice and the last thing they attribute correctly.
There is a second, more awkward layer. The most commonly prescribed treatments also cause sexual dysfunction: in 84.5% of men when researchers ask systematically. So a man can lose his libido to the illness, get treated, and lose it again to the treatment, and reasonably conclude that nothing helps.
That is a solvable problem rather than a reason to avoid treatment. Adding a PDE5 inhibitor, adding bupropion, or switching agent all have randomised evidence behind them. What does not work is stopping the antidepressant without telling anybody.
What should you actually do?
If this describes you. You do not have to use the word depression, and you do not have to have a theory about it. “I’ve not been myself for months, I’m angry all the time and I’m not sleeping” is a complete and useful thing to say to a doctor. Treatment for depression works, with therapy, with medication, and best of all with both, and the evidence for that is far stronger than for most of what this site covers. Exercise has its own trial evidence as well: what 218 trials found, and what they did not.
If this describes someone you know. Ask directly and specifically. “You’ve seemed angry for a while, are you all right?” gets further than a general enquiry, because it names what is actually visible.
If things are worse than that. If you are having thoughts of ending your life, that is a reason to talk to someone today rather than to wait and see. In the US, the 988 Suicide and Crisis Lifeline can be reached by calling or texting 988, at any hour. If you would rather not talk to a stranger, tell one person you know. The rate above is what happens when men do not.
Common questions about depression in men
What are the signs of depression in men?
Frequently not sadness. Irritability, anger, withdrawal from people, reckless behaviour and increased drinking are all on the authoritative warning lists and are routinely read by the people around a man as him being difficult rather than unwell. Physical complaints, fatigue and loss of interest are common, and sexual difficulty runs in both directions.
Why is male depression underdiagnosed?
Partly because the diagnostic criteria were built around a presentation that emphasises low mood. When researchers reanalysed a large American survey using a scale that included anger attacks, substance misuse and risk-taking, the male rate rose above the female rate, and the usual sex gap in depression prevalence disappeared entirely.
How much higher is male suicide?
In 2023 the US rate was 22.8 per 100,000 for men against 5.9 for women, close to four times higher. The highest rate of any age group is men aged 75 and over, at 40.7, which is a group almost entirely absent from public conversation about the subject.
Can depression cause erectile dysfunction?
Yes, and the relationship runs in both directions, which complicates it. Depression reduces desire and can impair erectile function directly, while erectile difficulty is itself a substantial cause of low mood. Antidepressants add a third layer, since sexual side effects are common with SSRIs.
What should a man do if he recognises this?
See a doctor and say the specific thing, rather than the symptom you find easiest to mention. Around three in four people who die by suicide had contact with primary care in the preceding year, mostly about something else. Making the appointment about this rather than about tiredness is a small change with a disproportionate effect.
Sources
- National Institute of Mental Health. Suicide statistics. NIMH
- Antidepressant-associated sexual dysfunction in outpatients. BMC Psychiatry, 2025. BMC Psychiatry
- Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of testosterone treatment in older men (The Testosterone Trials). New England Journal of Medicine, 2016. New England Journal of Medicine
This article is for information only and is not medical advice. It cannot account for your individual circumstances. If you are struggling with your mental health, please talk to a doctor or another qualified professional. In the US, the 988 Suicide and Crisis Lifeline is available by call or text at any time.