The mental health issue men never talk about

Picture the worst person you can imagine whispering horrifying things in your ear. Now picture yourself believing every single world—so much so, that you start isolating yourself from other people.

That’s what depression feels like, says 32-year-old Joel Robison.

In 2015, nearly 5 percent of men reported experiencing at least one major depressive episode in the past year, according to the National Institute of Mental Health.

But many therapists don’t think this number even puts a dent into how many men actually deal with depression.

“Men are diagnosed about half as frequently as women with depression—but that’s still a lot,” says Ronald Levant, Ed.D., cofounder of the Society for the Psychological Study of Men and Masculinity. “It is the most frequently diagnosed mental illness by a long shot and there are still a lot of men who suffer with it.”

What is depression?

Clinical depression isn’t a brief bout of sadness—it’s a crippling mental illness with severe symptoms that can interfere with every part of your life, says Fred Rabinowitz, Ph.D., a professor of psychology at California’s University of Redlands.

It can take many different forms, but depression is usually characterized by persistent feelings of sadness and worthlessness, a lack of appetite and energy, insomnia, an inability to concentrate, or suicidal thoughts, according to the Diagnostic and Statistical Manual Of Mental Disorders.

These feelings don’t go away in just a few days, or even weeks—that’s how Robison knew something wasn’t right.

“I slowly started to abandon hobbies and interests—things that once brought happiness or were my favorite—I now lacked the energy to enjoy them,” he says. “I wasn’t sleeping, I wasn’t eating, I was irritable and difficult and those are all very different than who I am when I’m not feeling depressed.”

Why does this happen? You could become depressed if it runs in your family, after you experience a traumatic or stressful event, or your brain could be low in feel-good chemicals like dopamine and serotonin—or it could also be a combination of the three, according to the National Institute of Mental Health.

No matter the cause, the feelings unleashed afterward can become unbearable.

What does depression feel like?

For Robison, those feelings came in waves and he could usually sense them coming.

“It feels heavy,” he says. “It literally makes my muscles and body feel weighted. I feel sluggish and low energy. I’m a marathon and ultra marathon runner and can run for hours without stopping, but when I’m depressed, I feel as though lifting a coffee mug drains all the energy out of my body.”

Twenty-nine-year-old Joshua Beharry, who first started dealing with depression at age 22, also felt a lack of energy, partially due to the severe insomnia he developed—but what really got to him was the “uncontrollable and overpowering sadness.”

“Depression had made me incapable of feeling any positive emotions,” he says. “It was like a dog that was too sick to live. At some point, you have to put it down. I felt like I had to end my life, and because I didn’t believe I would ever be able to recover, that’s what I tried to do.”

Men are 3.5 times more likely to die by suicide than women, according to the American Foundation For Suicide Prevention, making it the 7th most common killer of men.

Twenty-two-year-old Adam Jaschen felt a loss of hope when he became depressed, too.

“I’ll never forget it,” Jaschen says. “You just want to be gone. It’s a very real and terrifying moment when you can imagine all the horrible impacts and still want it to end. The people closest to you don’t feel tangible or real, and it feels like the most immediate thoughts, no matter how twisted and self-indulgent, are more valid.”

(Of course, not all depressed people feel suicidal, but depression is the most common condition associated with suicide.)

Why don’t men talk about depression?

Men are often taught to suppress any expression of sadness during childhood, says Rabinowitz. So even though depression is very common among men, very few are willing to admit it.

Beharry didn’t talk about his depression for months because he saw it as a weakness. So instead, he tried to hide it: He pretended that he wasn’t sad or exhausted, that he was sleeping normally, and handling his stress okay.

“Male depression sometimes manifests through the ‘male code’ that says you cannot show weakness, sadness, or vulnerability,” he says.

Instead, many men become angry or irritable, throw themselves into work, cut themselves off from other people, or even develop drinking problems to deal with it. They see all of these behaviors as a socially acceptable way to get rid of bad feelings, says Levant.

“That’s why, in part, women are diagnosed with depression more than men,” says Rabinowitz. “Men don’t always fit the criteria.”

In fact, when University of Michigan researchers surveyed more than 5,600 men and women using symptoms more common in men as a basis for depression diagnosis, they found that 26 percent of men met the criteria compared to 22 percent of women—but when they used the traditional symptoms of depression, more women fit the criteria than men.

Changing this “masculine” mindset often requires therapy—but because many men fear talking about their depression in the first place, it often takes the encouragement of a partner, friend, or relative for a guy to actively seek treatment, says Levant.

What should you do if you think you’re depressed?

Here’s what you can do if you think you might need help:

Go to your doctor. He or she will be able to determine if something physical is causing your symptoms, like a medication with bad side effects, says Rabinowitz.

After Beharry made an appointment with his family doctor, she gave him a depression-screening test. Once she got the results, she prescribed him antidepressants and connected him with a psychiatrist so he could start therapy.

Research suggests a combination of medication and therapy is the best treatment for depression, says Rabinowitz, but everyone is different. Antidepressants can come with risky side effects like weight gain, insomnia, and sexual problems, so some people prefer to try just therapy first.

Find someone you can talk to. You have to open up and talk about what’s causing your depression, so you can start changing the way you think about and view life, says Rabinowitz. Sometimes, you might not even know what’s bothering you until you start treatment with a psychologist or psychiatrist.

After Robison started counseling, his therapist helped him find constructive ways to manage his depression without medication. Just having someone to talk to helped him greatly, he says.

You can also consider joining a men’s group, says Rabinowitz. While it sounds intimidating, it can be helpful if you feel lonely, since you’ll be surrounded by other guys going through the same thing. Click here to find one near you.