When you picture a crippling illness, your mind may jump to cancer, heart disease, or even Alzheimer’s. But as it turns out, the leading cause of ill health and disability worldwide is a condition that still continues to lurk under the radar.
According to the World Health Organization (WHO), more than 300 million people suffer from depression, a number that has risen by 18 percent between 2005 and 2015. What’s more, nearly half of those people don’t get treatment, largely due to the stigma surrounding mental illnesses.
Another reason? Many times, the telltale signs of depression are overlooked—and if you aren’t diagnosed, you can’t get treated.
That’s especially tricky for men, because they tend to show symptoms that aren’t typically what you would associate with depression, says John Greden, M.D., executive director of the University of Michigan Comprehensive Depression Center.
And that’s a problem, since receiving proper treatment is vital: Without it, depression can disable your ability to live a normal, healthy life—you may lose your job, ruin your marriage, or develop unhealthy habits like excessive drinking or smoking that can end up being fatal.
So as a testament to the WHO’s efforts in bringing awareness to depression on World Health Day, we’ve rounded up some of the most telling symptoms of depression in men. If you find yourself nodding along with them, make an appointment with your doctor. It might just be a lifesaver.
If you’ve ever gotten a flat tire the morning an important presentation is due, you know what it’s like to have a bad day—but that’s typical. Everyone has bad days and feels down from time to time.
But the mood you experience when you’re clinically depressed is different, says Dr. Greden.
For one, your sadness becomes more severe, because it’s combined with and can set off other crippling symptoms, like irritability, fatigue, loss of appetite, and even physical pain, he explains.
Plus, you “feel depressed” for a lot longer than just a day. When you get in a spat with your wife, you might feel down for the rest of the night, but you’ll likely wake up in the morning less peeved than before. Eventually you’ll talk it out and feel better.
But when you’re depressed, you feel weighed down by your negative mood for weeks, or even months, and it interferes with everything you do, says Dr. Greden
Depression can’t resolve overnight because it affects many complicated areas of your brain—including your amygdala, thalamus, and hippocampus—which play a combined role in keeping your mood stable by controlling your emotions, senses, and memory, according to Harvard Medical School.
#2: YOUR ANGER COMES OUT OF NOWHERE
Depression often manifests through a “male code” that scorns vulnerability. Due to this type of thinking, a lot of guys see the manifestations of depression as signs of weakness, says Dr. Greden.
So you become angry instead. You throw things. You yell. You try to hurt other people—physically and emotionally—as means of coping, he explains.
But depressive anger isn’t your typical pissed-off state. When you get mad, you can usually point to something as the cause of it. When you’re depressed, your outbursts may come out of nowhere, and are usually sparked by nothing other than the fact that you’re just angry, Dr. Greden explains.
“If there’s nothing appropriate that seems to set it off, like if you’re having a discussion at a dinner and all of a sudden you’re throwing silverware across the table and cursing, it’s not just an emotional reaction to something. It’s rooted inside,” Dr. Greden says.
A lot of men feel like they lose their masculinity when they admit they’re depressed, but “it’s real strength to be able to say ‘I’m not doing well and I need some help,’” he adds.
(These four strategies that help control your anger are a good place to start.)
#3: YOU END UP DOING A LOT OF STUPID THINGS
Recklessness is a lot more common in depressed men than women, says Dr. Greden. (To be fair, men do a lot of stupid, dangerous thingsin general.)
This, again, may be a byproduct of the “male code.” When you feel like you can’t express your emotions, you end up dealing with your depression in a way that may be a danger to yourself or other people, especially because you may not be thinking about the consequences at the time, he says.
For example, you may have the urge to drive your car down a residential street at 110 miles per hour just to prove that you can. You pick a fight with a guy a lot bigger than you. You prank your local police station. You get behind the wheel after you’ve been drinking. You may place one too many stupid bets at the casino. You tell your boss off at exactly the wrong time.
Consistently making bad judgment calls like the ones above is a sign that something is off, says Dr. Greden. What’s more, it may signal to a specific type of depression known as bipolar disorder, a mental condition characterized by alternating periods of high and low mood states.
#4: YOU START DEPENDING ON ALCOHOL OR OTHER SUBSTANCES
About 20 to 25 percent of men dealing with depression will suffer from a drinking problem, says Dr. Greden. That number triples if you’re dealing with bipolar disorder.
It’s no secret that booze makes you feel good: Alcohol ignites the dopamine pathways in your brain, a neurotransmitter that helps control your brain’s reward and pleasure centers—a signal that doesn’t work so well when you’re depressed, he explains.
Once you get addicted to the good feelings a couple of beers produce, it’s hard to stop that cycle of self-medication. But alcohol is a lousy antidepressant, says Dr. Greden—it often magnifies many of your symptoms, like your lack of sleep and anger. Plus, too much of it can hurt your muscles, heart, and other parts of your body.
But that’s not the only substance that you may latch on to.
“We have an opioid crisis going on in our country right now, and it’s often linked with depression,” explains Dr. Greden.
People with depression tend to feel more physical pain, too. That’s because neurotransmitters that affect your mood, like serotonin and norepinephrine, also play a part in pain regulation, research shows. Deregulation of those neurotransmitters can cause joint pain, back pain, and headaches.
So your doctor may prescribe painkillers to alleviate your discomfort, Dr. Greden says. But once you start taking those drugs consistently, it’s hard to wean yourself off of them, because your body quickly becomes dependent on the chemicals they produce in your brain, he says.
And you might become mentally hooked as a way to self-medicate your down mood, too, since opioids produce a feeling of euphoria, according to the American Addiction Centers.
#5: YOU FEEL EXHAUSTED
Can’t fall asleep? Having trouble staying awake the next day? Sleep disturbances are one of the earliest and most common features of depression, says Dr. Greden. In fact, three quarters of depressed patients have symptoms of insomnia, according to a review published in Dialogues in Clinical Neuroscience.
You may have trouble falling asleep, wake up in the middle of the night, or wake up really early in the morning before your alarm goes off, says Dr. Greden.
Blame it on rumination, or your tendency to think deeply about things: When you can’t sleep, you tend to focus on all of the bad things going on in your life. This is particularly common in people who wake up really in the morning and have trouble falling back asleep, he explains. (Here are five ways you can sleep better every night.)
When you have a million terrible thoughts running through your mind, your brain keeps you awake, which can lead to excessive fatigue throughout your day. This might make your other symptoms, like irritability and lack of appetite, even worse.
Those thoughts tend to snowball, too. When you start thinking about all of the terrible things in your life, you might eventually just starting questioning your purpose, and that’s when dangerous, suicidal thoughts might come into play, says Dr. Greden.
#6: YOU START PUSHING PEOPLE AWAY
Depressed people have a negative view of themselves, the world, and their future. If you suffer from it, you feel like you have nothing to look forward to, and tend to forget about all of the positive parts of your life, like your relationships with other people, says Dr. Greden.
That means you might start isolating yourself from your family and friends. You’ll withdraw into your own little bubble, because you actually lose your ability to feel and anticipate pleasure and happiness when you’re depressed, says Dr. Greden.
But your loved ones will be the first people to notice your change in mood. Because lots of men refuse to admit they need to get help in the first place, they put up a wall and push people away instead of listening to their concerns. Your anger may even tell you to blame them for your problems.
That takes a toll on the way you interact with those you care about: In fact, one 2011 study found that people who suffer from depressive symptoms in their teens actually experience more conflicts within their romantic relationships as they grow up than teens who didn’t deal with the disorder.
#7: YOUR SEX DRIVE TANKS
You might assume that sex would boost your mood, but that’s not always the case when you’re depressed, says Dr. Greden. Studies show that up 75 percent of depressed patients experience low libido, according to Stanford University research.
A decreased sex drive is one of the earliest signs of depression, especially in young guys. It’s not uncommon for men to go to the doctor thinking they have a serious condition, like cancer, without realizing that a mental health disorder may be to blame, says Dr. Greden.
That’s because depression can impair parts of your limbic system, an area of your brain that controls appetite, sleep, energy, and your sex drive, he explains.
Plus, taking certain antidepressants to treat your depression can sink your libido, too: Selective serotonin reuptake inhibitors (SSRIs), which include Prozac and Lexapro, can delay ejaculation and may even lower your testosterone. Research shows that this causes sexual dysfunction in up to three quarters of people who take them. (Here are four more medications that can ruin your sex life.)
WHAT TO DO IF YOU THINK YOU HAVE DEPRESSION
When combined, the side effects of depression can be fatal. Men are 3.5 times more likely to die by suicide than women, according to the American Foundation For Suicide Prevention, making it the seventh most common killer of men. And sadly, a majority of people that have committed suicide were dealing with some form of depression at the time, says Dr. Greden.
But with the proper treatment, recovery is possible. Most people go through therapy or take medication to treat their depression, but research actually suggests that a combination of both is the best route for many people, as we’ve reported in the past.
But everyone is different, so talk to your doctor about what may work best for you. While they can prescribe antidepressants if necessary, most guys prefer to try just therapy first. (Here’s how you can find a therapist.) Joining a men’s group can also help. It may sound like a lot a first, but it surrounds you with other guys going through the same thing, which can be helpful if you feel like you don’t have anyone to talk to. Find one near you here.