When depression in men doesn’t look like sadness

A man may not say: “I feel depressed.”

He may say that he is tired. He may work longer hours, stop answering calls, drink more often, become impatient with his family or complain of persistent headaches, body pain and sleeplessness. He may drive recklessly, withdraw from friends or become unusually angry over small frustrations.

He may say: ‘Ngiyaphila,’ even when he is not. To the people around him, he may simply appear difficult, distant or disrespectful. However, beneath the anger, silence or restlessness may be a quieter and more dangerous reality: Depression.

For many people, depression has a familiar image. It is associated with crying, sadness, loss of motivation and staying in bed. These are real and important signs. The DSM-5-TR, the diagnostic guide used by mental health professionals, describes depression through symptoms such as persistent low mood, loss of interest or pleasure, sleep and appetite changes, fatigue, poor concentration, feelings of guilt or worthlessness, slowed or agitated movement and thoughts of death or suicide.

Yet, the way depression is experienced, expressed and recognised is not always the same.

The diagnosis is the same, but the presentation can differ

Men do not have a separate form of depression in the DSM-5-TR. A proper diagnosis still requires a thorough clinical assessment and cannot be made from anger, alcohol use or withdrawal alone.

Nonetheless, some men struggle to describe sadness directly. Instead of saying: “I feel hopeless,” they may say: “I am under pressure.” Instead of reporting emotional pain, they may focus on financial stress, conflict at home, physical exhaustion or frustration at work.

For some men, depression becomes visible through irritability, emotional numbness, increased alcohol or substance use, risk-taking, overworking, social isolation or sudden anger. Furthermore, loss of interest may not look like lying in bed all day. It can look like a man who continues going to work, but has disconnected emotionally from his children, partner, friends and community.

He is physically present, but psychologically absent.

This matters because many men have been taught that emotional openness is weakness. The familiar message, indvodza ayikhali, meaning ‘a man does not cry,’ may be passed down with good intentions. However, when men are taught to suppress vulnerability, they may learn to convert sadness into silence, fear into anger and helplessness into excessive control.

Consequently, depression may be missed until it has already damaged relationships, work performance, physical health and personal safety.

Depression can be expressed differently across people

It is important not to replace one stereotype with another. Not all men with depression become angry or use substances. Many men present with the more familiar symptoms of sadness, tearfulness, hopelessness and loss of interest. Similarly, women can experience irritability, substance misuse, emotional withdrawal and risk-taking behaviour.

Research often finds that women are more likely to report internal emotional symptoms such as sadness, changes in sleep and appetite or feelings of guilt. Men, on the other hand, may more often express distress through externalising behaviours such as anger, aggression, substance use or dangerous behaviour.

Moreover, these patterns are not only about biology. They are shaped by culture, family expectations, social class, trauma, employment pressure, relationship experiences and what people believe they are allowed to feel. These are patterns, not rules.

A man who has spent his life being praised for being strong may not recognise emotional distress until it reaches a crisis point. He may believe that seeking support means he has failed as a provider, father, partner or son. In reality, recognising distress is not weakness. It is insight.

When society misses the signs

When a depressed man is labelled as lazy, aggressive, stubborn or irresponsible without anyone asking what has changed beneath the surface, society loses an opportunity for early intervention. Families may respond with criticism rather than concern. Workplaces may discipline declining performance without considering distress. Communities may praise emotional silence as strength. Additionally, some men use alcohol, gambling, unsafe sexual behaviour or reckless driving to escape feelings they cannot name.  This does not mean depression excuses harmful behaviour. Violence, intimidation and abuse must never be normalised or explained away as ‘just depression.’