Depression in Men: Symptoms, Causes and Ways Out

Depression is a serious, common and treatable illness. In men it often shows up not as sadness but as irritability, anger, withdrawal, constant working or more alcohol. That is why it is recognised less often in men. This guide explains what depression is, how you recognise it, which causes come into question, what it does to your relationship, how the different schools of therapy understand it, and which ways out there are. For every topic you will find a detailed article.

Acute crisis? If you are thinking of taking your life, call the emergency number 112 or the Telefonseelsorge straight away: 0800 111 0 111 or 0800 111 0 222 (free, around the clock, in Germany).

What Depression Is

The Stiftung Deutsche Depressionshilfe (German Depression Foundation) describes depression as “a serious illness that affects thinking, feeling and acting” (Deutsche Depressionshilfe). The National Care Guideline (Nationale VersorgungsLeitlinie) speaks of “mental disorders characterised by a state of markedly low mood, loss of interest and reduced drive over a longer period” (NVL Unipolare Depression, p. 18).

The difference from a low mood matters: everyone has phases when everything looks grey. In a depression the symptoms persist almost daily for at least two weeks, and they noticeably limit work, relationship and everyday life. Depression is not a weakness of character. It can affect anyone, including men who look strong and successful from the outside.

Grief or Depression?

After the death of someone close, a separation or the loss of a job, deep sadness is normal. Grief is not an illness but a healthy reaction to a loss. It usually comes in waves and is tied to the loss: to memories, places, anniversaries. In between, moments of joy are possible too, and self-esteem usually stays intact. Grief is basically a farewell to something lost that mattered to you.

In depression it is different: the emptiness and heaviness lie on almost everything, joy is hardly possible, and feelings of guilt and worthlessness often come with it. In my personal experience you then have to “push” yourself extremely hard to meet the demands of everyday life. That produces anger and irritability. In addition, suppressed anger is not infrequently part of the mechanism.

Grief can, however, turn into depression, especially when the pain is not allowed to be felt. Many men simply carry on functioning after a loss. I can’t tell you how often I have heard: “First I had to manage the funeral, then there was possibly a dispute over the inheritance, then I had to be there for someone else’s grief.” The grief that gets no room stays in the body and can return years later.

Since the ICD-11, the WHO also recognises “prolonged grief disorder”: when grief is still so strong six months after the loss that it clearly impairs everyday life.

The Symptoms: Classic and Typically Male

The WHO describes three main symptoms:

1. low mood or inner emptiness
2. loss of interest and joy
3. lack of drive and quick exhaustion

In addition there are further symptoms such as sleep problems, difficulty concentrating, reduced self-esteem, feelings of guilt, changes in appetite, hopelessness and thoughts of death. “The diagnosis ‘depression’ is made when at least five symptoms are present for two weeks or longer. One of them must be a ‘main symptom’.” (Deutsche Depressionshilfe).

In my experience the sleep problems often come from the compulsion to distract oneself and a tendency to brood. The depressed person tries to escape his emotional state through excessive media consumption. Together with the tendency to think in a strained and worried way, this makes sleep extremely difficult.

In many men the symptoms look different. The Deutsche Depressionshilfe writes that, according to some studies, men show “untypical symptoms” more often: “irritable or aggressive behaviour and a greater tendency to reach for alcohol, cigarettes and other drugs”. Typical signs are:

• Irritability and anger: small things set you off, often in the family.
• Withdrawal: into work, the garage, the phone or sport.
• More work: standing still becomes unbearable.
• Numbing: alcohol, series, porn, gaming.
• Risk-taking: fast driving, extreme sports, risky decisions.
• Physical complaints: back, stomach, head, loss of libido.
• Inner emptiness instead of sadness: you function, but nothing touches you any more.

Depression in Numbers

Figure	Value	Source
Adults in Germany with depression in one year	8.2% (about 5.3 million)	Deutsche Depressionshilfe
Lifetime risk of developing depression	16–20%	NVL, p. 18
Medically diagnosed depression in the last 12 months	Women 9.7%, men 6.3%	RKI
Depression worldwide in adults	Women 6.2%, men 4.1%	WHO
Suicides in Germany 2023	about 10,300, of which 73% men	Federal Statistical Office
Share of suicides presumably due to depression	40–70%	NVL, p. 20
Suicide rate among depressed people	about 20 times higher than average	NVL, p. 20
Affective disorders in a steady partnership vs. without a close confidant	7.1% vs. 16.3%	NVL, p. 19
Affected people whose partnership was touched and who separated	45%	Survey by the Deutsche Depressionshilfe 2018, cited in the Tagesspiegel

The numbers show a mismatch: men receive the diagnosis less often but die far more often by suicide. Many experts see this as a sign that depression in men often goes unrecognised.

Causes: A Combination

The WHO describes depression as the result of a complex interplay of social, psychological and biological factors (WHO). In men I mainly encounter these eight factors on the way into depression.

Psychological: suppressed feelings. In my work I see almost the same pattern in men with depression: feelings are pushed away, especially anger, but also grief and fear. That costs strength, day after day. This is not only about feelings of today. Old feelings, too, which had no room earlier, for example from childhood, from a separation or a loss, do not disappear. They are stored in the body and carried along, often as tension, pressure or exhaustion (Singer, 2022). In certain situations they are then “triggered”: a critical remark from the boss or an argument with your partner sets off a reaction far stronger than the occasion, because the old feeling jumps in as well. Studies show that people who frequently suppress their feelings have more depressive symptoms (Gross & John, 2003). A typical example is the “nice guy” who does everything to please others. More on this: People Pleasing: When the Nice Guy Becomes Depressed.

Relationship patterns. We learn early how to conduct relationships: in the family, with father and mother. Many men have learned to adapt, avoid conflict or earn love through performance. These patterns repeat later in the partnership and at work: they give more than they get, say yes when they mean no, or withdraw instead of facing conflict. In the long run this produces resentment, emptiness and the feeling of not being seen. The National Care Guideline explicitly names the lack of a trusting relationship as a risk factor for depression (NVL, p. 19). More on this: People Pleasing and Depression and Partnership.

Sometimes there are also situations in which the depression stabilises a relationship. One person can then be the one who looks after the sick one, and this person and the relationship are better off for it. Or the depression is simply necessary in order not to face a fundamental incompatibility.

Lack of good social relationships. Many men have lost, over the years, the friendships they once had. Job, family and moving house pushed them out, and men talk less often about feelings. What is left is often only colleagues and the partner. Anyone who has nobody to be honest with carries everything alone: withdrawal, brooding and emptiness increase, and suppressed feelings stay suppressed. Depression reinforces this, because it makes you tired and indifferent, and contact with others breaks off further. Small steps help: taking up an old friendship again, telling one person honestly how you are, or finding a group in which other men also speak openly.

Work and exhaustion. Constant stress at work, conflicts with the boss, the fear of not managing everything. The guideline sees longer-term work overload as a risk for depression. More on this: Burnout or Depression? What Men Often Overlook.

Sometimes an illness is simply a way out of a job that you cannot just quit for financial reasons (see When Depression Serves a Purpose).

Life stages. In their mid-forties many men ask themselves whether that was all. The idea of simply carrying on like this forever becomes unbearable. Life seems like a narrowing, colourless tunnel of duties and functions. More on this: Midlife Crisis in Men: What the Crisis Is Trying to Tell You.

Season. For some, the depression returns every autumn. More on this: Winter Depression in Men.

Body. Thyroid, testosterone deficiency, sleep apnoea, medication and alcohol can trigger or reinforce depressive symptoms. The Deutsche Depressionshilfe therefore writes: “A medical examination is therefore indispensable.”

Loss of meaning. Anyone who lives without a goal loses drive and joy in the long run. One line of thought about depression is that it forces us to ask the question “Why?” and to answer it. If a human being is only a body walking around on a rock in space, satisfying various needs on the way to death, emptiness quickly sets in. Why am I doing all this? More on this in the section Meaning and Spirituality.

When Depression Serves a Purpose

As hard as depression is: sometimes it also serves a purpose. Psychoanalysis speaks of “secondary gain from illness” (Krankheitsgewinn). This does not mean that someone wants to be ill or is faking it. It means that the illness unconsciously solves something that could not be solved any other way. Sigmund Freud distinguished here between the primary gain, the inner relief from an unbearable conflict, and the secondary gain, the advantages in everyday life (Freud, 1916–17).

In men this can look like this, for example: the exhaustion finally permits the withdrawal he would never otherwise have allowed himself. Expectations at work and in the family drop. A conflict, a separation or a difficult decision does not have to be tackled. And he receives care and attention that he could never have asked for.

I have also treated people in rehab for whom the illness is the “best solution”. They have to be ill so as not to have to go back to work. At the same time they cannot simply quit for financial reasons. Disproportionately often these were civil servants, by the way.

Recognising this is not a reproach but often a key. Behind the gain there is usually a need or a feeling that had no room: the no that was never said, the anger at the boss, the wish for rest. If this need finds another way, the depression loses part of its purpose. Systemic therapy, too, asks which function a symptom has in the family or partnership (see the table further down).

Depression and Partnership

A depression never affects only one person. The National Care Guideline states that it also burdens relatives: “Family and partner relationships often suffer.” (NVL, p. 20) In a survey by the Deutsche Depressionshilfe, 84% of those affected said they had withdrawn from social relationships during the depression. For one in two this affected the partnership, and 45% of these separated (Tagesspiegel).

Typical in men: the withdrawal looks like disinterest, and the irritability hits the partner in particular. The lack of emotional resonance is unbearable and feels like being abandoned. Many women take this personally, although it mostly has to do with the illness. Not infrequently she provokes him in order to get him to engage at all. At the same time, a trusting relationship protects: people in a steady partnership develop affective disorders markedly less often (7.1% compared with 16.3% without a close confidant, NVL, p. 19).

More for partners: Depressed partner and you can’t go on: what helps you and him now and the Partner Test.

Depression in Fathers

Around the birth of a child, most people think of the mother. But fathers can become depressed too. A review found signs of depression in about 10% of fathers in the period from pregnancy to the child’s first year, most often three to six months after the birth. If the mother is depressed, the father’s risk rises as well (Paulson & Bazemore, 2010).

Problems: the feeling of not being good enough as partner and father, lack of sleep, money worries and the feeling of suddenly coming second in the relationship. Many fathers are ashamed of this, because it “should actually be a happy time”.

How Schools of Therapy Explain Depression

There is no single explanation for depression. Every major school of therapy has its own picture of how it arises, and from this follows its way out. For many men it is helpful to know that these differences exist.

Approach	How depression is understood	Where the work starts
Psychodynamic / psychoanalytic	Result of losses and unresolved inner conflicts; Freud saw depression as anger turned inward (“Mourning and Melancholia”, 1917)	unconscious patterns, relationship experiences from childhood and family
Behavioural	Loss of positive reinforcement (Lewinsohn) and “learned helplessness” (Seligman): anyone who experiences being unable to change anything gives up	activities, daily routine, new experiences of effectiveness
Cognitive	negative thought patterns about oneself, the world and the future, the “cognitive triad” according to Aaron Beck	recognising, testing and changing thoughts
Systemic	Depression as part of a relationship pattern in family, partnership or work that serves a function	relationships, roles, communication in the system
Interpersonal	Triggers in relationships: grief, role conflicts, life transitions, isolation	current relationship problems
Humanistic / emotion-focused	blocked or warded-off feelings and needs; the person does not live in harmony with himself (Rogers, Greenberg)	perceiving, allowing and expressing feelings
Biological / psychiatric	changes in brain metabolism, stress hormones, hereditary predisposition	medication, sleep, light, exercise

In practice these views overlap.

My view: I understand depression above all as suppressed emotion. I am a pragmatist; in practice this view has simply brought the best results. My first client was a hypochondriac. In the clinic I treated him for 3 months, twice a week, according to Carl Rogers: without any success. So I tried out many approaches. This puts me close to the psychodynamic idea of anger turned inward and to the emotion-focused approaches. In my work the aim is to make suppressed feelings perceptible and changeable again, among other things with the Sedona Method. Its effect is felt immediately: even during the exercise clients notice how a feeling becomes lighter and dissolves. So the method does not only promise an effect at some point in the future; you can check it in the moment yourself.

Meaning and Spirituality

Many men who come to me have “achieved everything”: job, family, house. And yet they ask themselves: what is it all for? Behind a depression there is often not only exhaustion but a loss of meaning. Life feels like a programme you work through without knowing why.

For many, personal goals are enough as meaning: things like training for a marathon give drive, also because they create experiences of success. Today I managed 30 km for the first time. In 2 months the marathon is on. The downside of such goals is that people often fall into a vacuum once they are achieved. The midlife crisis is closely connected with this. Often these were basically only “dopaminergic”, too personal goals. Such goals are also sometimes used as compensation. A very successful client of mine worked feverishly towards sales targets and then bought himself a Porsche Panamera. During that time he called me and was thrilled. Then he fell into a hole. The chase after the goal had in fact disguised that he felt crushed by the responsibility for the growing number of employees. The whole time he would actually much rather have played World of Warcraft.

Fulfilling personal values is more sustainable. But you first have to define them clearly and work out what they mean in practice.

Existential psychotherapy takes these questions seriously. The American psychiatrist Irvin D. Yalom describes four givens that every human being has to deal with: death, freedom and with it responsibility for one’s own life, fundamental loneliness, and the meaning we have to give ourselves (Yalom, 1980). Anyone who avoids these questions, for example through constant work or numbing, often loses vitality. Viktor Frankl, the founder of logotherapy, already saw in the loss of meaning a source of psychological suffering and in finding meaning a source of strength, even under the most severe conditions (Frankl, 1946).

For some men this search also has a spiritual dimension: the question of connectedness, of something greater than one’s own ego, of forgiveness and inner peace. In my work I actively turn to these questions, without presupposing any particular worldview. One source I work with myself is “A Course in Miracles”. More on this on the page My Method. I am also very familiar with Eastern approaches such as Buddhism.

Voluntary giving from personal abundance is, in my experience, the most reliable source of meaning. Everyone has something to give, even if those affected often see this too little. Sometimes it is a matter of directing the focus to this in therapy. I have already invited wealthy clients to conferences on effective altruism.

Assessment and Diagnosis

1. Self-test: The Depression Self-Test for Men gives a first impression in about three minutes, based on the WHO criteria.
2. GP practice: conversation, physical examination, blood tests. Physical causes are also ruled out here.
3. Specialist or psychotherapeutic assessment: if needed, in psychiatry, psychotherapy or psychosomatics.

Prepare for the appointment: write down since when you have felt like this, bring your medication and say openly how you are really doing, even when it is about anger or alcohol.

Ways Out

• Medical treatment: The Stiftung Deutsche Depressionshilfe stresses: “With medical and psychotherapeutic help, depression is highly treatable.” (Deutsche Depressionshilfe) The medical standard is described by the National Care Guideline Unipolar Depression (in German). Never stop medication without consulting your doctor.
• Psychotherapy and support: depending on the approach, with the emphases from the table above.
• My approach: allowing feelings again instead of pushing them away. What this looks like in concrete terms: The Sedona Method and my own way out of depression.
• What you can do yourself: talk about it, intensify contact with friends, exercise and daylight, regular sleep, no alcohol. The WHO names exactly these points as self-help (WHO).

Antidepressants. Doctors prescribe antidepressants mainly for moderate and severe depression. It often takes about three to four weeks until a change is noticeable. Those who benefit should keep taking the medication for at least six months after improvement, because the risk of relapse is otherwise high. Common side effects of some antidepressants are nausea, restlessness, sleep problems and sexual dysfunction. Men rarely bring up the latter. Tell your doctor; there are often alternatives. Never change the dose on your own and do not stop antidepressants without consulting your doctor (Barmer, in German).

When It Becomes Urgent

Get help immediately if you are thinking about suicide, see no way out or no longer feel safe. Call the emergency number 112 or the Telefonseelsorge: 0800 111 0 111 or 0800 111 0 222, free and around the clock (in Germany). The Info-Telefon Depression of the Deutsche Depressionshilfe can be reached on 0800 33 44 533.

As a partner: always take statements about suicide seriously and bring in help. You don’t have to carry this alone.

How to Find Help in Germany

Many men don’t know where to start. These routes exist:

1. GP practice: the simplest first step. Physical causes are also clarified here, and if needed you get a referral, for example to psychiatry.
2. Psychotherapeutic consultation (Sprechstunde): you can contact a psychotherapist with a statutory insurance licence directly, without a referral. The consultation clarifies whether and which treatment makes sense (Federal Ministry of Health, in German).
3. Appointment service 116117: if you can’t find an appointment, the appointment service of the Association of Statutory Health Insurance Physicians must arrange an appointment for the consultation within four weeks, by phone on 116117, online or via app. If acute treatment is needed, the waiting time for it should not exceed two weeks.
4. Bridging the wait: many people wait several months for a regular therapy place. Ask in the consultation about acute treatment (up to 24 sessions) or about a group.
5. Acute crisis: psychiatric clinics have an emergency department that is reachable around the clock. In danger to life: emergency number 112.

Private support with me: My sessions are private and are not paid for by statutory health insurance. You don’t need a referral or an application for them. Some private health insurers or supplementary policies reimburse part of the cost; ask your insurer. The first session is free: Book a trial session.

Frequently Asked Questions

How does depression show in men?

Often less as sadness and more as irritability, anger, withdrawal, exhaustion, more work or more alcohol. Physical complaints and an inner emptiness often come with it. Many men keep functioning outwardly while they hardly feel anything inside.

Are men less often depressed than women?

Men receive the diagnosis about half as often as women. Many experts assume, however, that depression in men is overlooked more often, because it shows differently and men seek help less often. The high suicide rate among men points that way.

What is the most common cause of depression?

There is rarely just one cause. Usually psychological strain, life circumstances and physical factors act together. In men I see, in my work, suppressed feelings, constant stress at work and relationship conflicts especially often. Physical causes should always be ruled out by a doctor.

Can anger be a sign of depression?

Yes. In men, irritability and outbursts of anger are among the most common signs. Especially when the anger is new, is directed at people close to him and comes with exhaustion or withdrawal, an assessment is worthwhile.

Which therapy is the right one?

That depends on you: on the severity of the depression, your experiences and which approach suits you. The schools of therapy explain depression differently (see above). What matters is that you feel understood. A trial session helps to find that out.

When should I see a doctor?

If low mood, emptiness, irritability or exhaustion last longer than two weeks and affect your everyday life. Get help immediately if you are thinking about suicide: emergency number 112 or the Telefonseelsorge on 0800 111 0 111.

Sources

1. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), AWMF: Nationale VersorgungsLeitlinie Unipolare Depression, Langfassung, Version 3.2 (2022). AWMF-Register-Nr. nvl-005. https://www.leitlinien.de/themen/depression
2. Stiftung Deutsche Depressionshilfe und Suizidprävention: Was ist eine Depression? https://www.deutsche-depressionshilfe.de/wissen/was-ist-eine-depression
3. World Health Organization (WHO): Depressive disorder (depression), Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/depression
4. Thom, J., Kuhnert, R., Born, S. & Hapke, U. (2017). 12-Monats-Prävalenz der selbstberichteten ärztlich diagnostizierten Depression in Deutschland. Journal of Health Monitoring, Robert Koch-Institut. https://edoc.rki.de/handle/176904/2787
5. Statistisches Bundesamt (2024): Jeder 100. Todesfall in Deutschland ist ein Suizid. Pressemitteilung N046. https://www.destatis.de/DE/Presse/Pressemitteilungen/2024/09/PD24_N046_23211.html
6. Koch, M. (2024): „Ich stehe hilflos daneben“: Ist der Partner depressiv, leidet auch die Liebe. Der Tagesspiegel, 22.01.2024. https://www.tagesspiegel.de/gesellschaft/ich-stehe-hilflos-daneben-ist-der-partner-depressiv-leidet-auch-die-liebe-11025805.html
7. Gross, J. J. & John, O. P. (2003). Individual differences in two emotion regulation processes. Journal of Personality and Social Psychology, 85(2), 348–362.
8. Freud, S. (1917). Trauer und Melancholie. Internationale Zeitschrift für ärztliche Psychoanalyse, 4(6), 288–301.
9. Beck, A. T. (1967). Depression: Clinical, Experimental, and Theoretical Aspects. Harper & Row.
10. Seligman, M. E. P. (1975). Helplessness: On Depression, Development, and Death. Freeman.
11. Greenberg, L. S. & Watson, J. C. (2006). Emotion-Focused Therapy for Depression. American Psychological Association.
12. Yalom, I. D. (1980). Existential Psychotherapy. Basic Books.
13. Frankl, V. E. (1946). …trotzdem Ja zum Leben sagen. Ein Psychologe erlebt das Konzentrationslager. Wien: Verlag für Jugend und Volk.
14. Freud, S. (1916–17). Vorlesungen zur Einführung in die Psychoanalyse. Leipzig, Wien: Hugo Heller.
15. Paulson, J. F. & Bazemore, S. D. (2010). Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression: A Meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605
16. Ramchandani, P., Stein, A., Evans, J. & O’Connor, T. G. (2005). Paternal depression in the postnatal period and child development: a prospective population study. The Lancet, 365(9478), 2201–2205.
17. World Health Organization (WHO): ICD-11, 6B42 Prolonged grief disorder. https://icd.who.int
18. Bundesministerium für Gesundheit: Psychotherapeutische Sprechstunde. https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/psychotherapeutische-sprechstunde
19. Barmer: Antidepressiva: Wirkung, Nebenwirkungen und Absetzen. https://www.barmer.de/gesundheit-verstehen/psyche/depression/antidepressiva-1253270
20. Singer, M. A. (2022). Living Untethered: Beyond the Human Predicament. Oakland: New Harbinger / Sounds True.

Acute crisis? Emergency number 112 or Telefonseelsorge 0800 111 0 111 / 0800 111 0 222.

The Next Step

If you recognise yourself in this guide: the free Depression Self-Test for Men shows you in a few minutes where you stand. After that you can get to know me in a free trial session, at my practice in Berlin-Schöneberg or online.

All Articles and Tests at a Glance

• Depression Self-Test for Men
  Ten questions based on the WHO criteria, about three minutes.
• Partner Test: Is my partner depressed?
  For partners who are worried.
• People Pleasing: When the Nice Guy Becomes Depressed
  Why pleasing everyone can lead to exhaustion.
• Burnout or Depression? What Men Often Overlook
  How to tell the difference.
• Winter Depression in Men
  When the depression returns every autumn.
• Midlife Crisis in Men: What the Crisis Is Trying to Tell You
  Why midlife calls so much into question and when depression is behind it.
• Depression in Men: What Partners Need to Know
  For partners and relatives.
• The Sedona Method: How Letting Go Can Help with Depression
  Feeling and releasing emotions, with an effect you notice straight away.
• Podcast: Feeling as the Path to Abundance
  To listen to.
• About me: my own way out of depression
  Who is behind this site.