When the exhaustion goes deeper
Depression in men is often overlooked – by society, by those around them, and not infrequently by the men themselves. While women tend to talk about sadness or withdrawal, men often exhibit different symptoms: irritability, exhaustion, aggression, or excessive achievement orientation.
These "atypical" symptoms often lead to depression in men being diagnosed late or not at all. However, depression is more than just a bad mood; it affects brain metabolism , hormone balance , and physical performance , and can impair overall quality of life in the long term.
What is depression?
Depression is a serious mental illness characterized by persistent low mood, loss of interest, lack of motivation, and physical symptoms . It is characterized by an imbalance in brain metabolism, particularly in the neurotransmitters serotonin, norepinephrine, and dopamine .
Typical symptoms of depression:
- Persistent depression
- Loss of interest, joylessness
- Exhaustion despite sufficient sleep
- Sleep disorders (difficulty falling asleep or staying asleep)
- Difficulties concentrating and making decisions
- Self-doubt, guilt
- Thoughts of death or suicide
‼️ If you are having thoughts of harming yourself, please seek help immediately. You can contact the telephone counselling service anonymously and free of charge:
📞 0800 111 0 111
📞 0800 111 0 222
🌐 www.telefonseelsorge.de (also chat and email counselling)
For those affected outside of Germany:
Switzerland : Helpline – 📞 143 – www.143.ch
Austria : Telephone counselling service – 📞 142 – www.telefonseelsorge.at
How does depression manifest itself in men?
In men, depression often manifests differently than in women, being more emotionally withdrawn, more physical, and often with a tendency towards overcompensation.
Male-specific symptoms:
- Irritability, impatience, tantrums
- Cynicism, social withdrawal
- Increased need for control or perfection
- Excessive workaholism
- Increased alcohol or drug consumption
- Loss of libido and erection problems
- Physical complaints without a medical cause (e.g., back pain, stomach problems)
Many men develop so-called masked depression , in which psychological symptoms are replaced by physical ones. This often makes diagnosis more difficult.
What factors contribute to depression in men?
Depression arises from an interplay of various factors – biological, psychological, and social. In men, the following often play a role:
- Chronic stress (professional, family, financial)
- Hormonal imbalance (e.g. testosterone deficiency, excess cortisol)
- Unresolved emotional burdens
- Physical illnesses (e.g. thyroid, sleep apnea, diabetes)
- Performance pressure or fear of failure
- Loneliness despite outward success
Many men tend to suppress their emotions and don't seek help as long as they are still "functioning." This increases the risk of chronic conditions or suicidal crises.
What role do hormones play in depressive moods?
Especially in middle-aged men, depression can be linked to a testosterone deficiency . Declining testosterone levels have a number of negative effects, including:
- Mood
- drive
- Muscle power
- Sleep
- libido
Additionally, cortisol levels often rise during periods of stress, disrupting the serotonin and dopamine balance in the brain. The result: a double hormonal burden that can exacerbate or trigger depression.
Hormonal markers that should be checked:
- Free and total testosterone
- SHBG (Sex Hormone-Binding Globulin)
- DHEA and DHEA-S
- Cortisol (especially daily profile)
- Thyroid hormones (TSH, fT3, fT4)
- Vitamin D, magnesium and omega-3
How is depression diagnosed?
The diagnosis is made through a detailed consultation with a doctor or psychotherapist. Common tools used include:
- Clinical Interview
- Questionnaires (e.g. Beck Depression Inventory, PHQ-9)
- Blood tests to investigate hormonal or physical causes
- Exclusion of other diseases (e.g. thyroid, sleep disorders, infections)
Especially with men, it is important to specifically ask about irritability, sleep problems, loss of libido or withdrawal - classic signs of depressive symptoms in men.
How is depression treated in men?
Treatment is always individualized and depends on the extent, causes, and accompanying illnesses. It can include psychotherapeutic, pharmacological, and hormonal measures.
1. Psychotherapy
- Cognitive behavioral therapy
- Psychotherapy based on depth psychology
- Male-oriented therapy formats (e.g., emotional labor, role conflicts)
2. Medications
- Antidepressants (e.g., SSRIs, SNRIs) - only under medical supervision
- Adaptogens (e.g. Rhodiola, Ashwagandha - for mild cases)
- Herbal remedies (e.g. St. John's wort - not for severe depression)
3. Hormone and micronutrient optimization
- Testosterone replacement therapy (in cases of proven deficiency)
- Supplementation with vitamin D, omega-3, magnesium, zinc
- Cortisol levels balanced through stress management
4. Lifestyle changes
- Structured daily routine
- Regular exercise (strength and endurance training)
- Regular sleep
- Digital detox, mindfulness, social environment
What should men keep in mind?
Depression is not a sign of weakness, but a biologically real illness that can be treated. Men who take their symptoms seriously, open up, and seek help benefit from a high probability of recovery.
The important thing is: the earlier depression is recognized, the better the chances of a full recovery – physically, hormonally, and psychologically.
Conclusion
Depression in men often presents differently than expected. It manifests itself through irritability, physical symptoms, decreased performance, or social withdrawal, and therefore frequently goes undetected for too long. Recognizing the warning signs allows for early intervention.
The combination of psychological support, hormonal diagnostics and targeted therapy can sustainably improve the quality of life, even after a long period of suffering.
If you have any problems or simply need someone to listen, you can contact the telephone counselling service at any time, free of charge and anonymously.
📞 0800 111 0 111
📞 0800 111 0 222
🌐 www.telefonseelsorge.de (also chat and email counselling)
Contact points outside of Germany:
Switzerland : Helpline – 📞 143 – www.143.ch
Austria : Telephone counselling service – 📞 142 – www.telefonseelsorge.at
