Depression in men: 7 symptoms that do not look like sadness

You have been short with everyone for months. You sleep badly, you drink a bit more than you meant to, and at four in the morning you are staring at the ceiling. Nobody calls that depression. You least of all.

Yet this is how it starts for a lot of men. When researchers counted anger, substance use and risk-taking as symptoms, the familiar gap between the sexes almost vanished: 30.6% of men against 33.3% of women, a difference that was not significant (Martin and colleagues, 2013).

What strikes me about this topic is that almost every symptom list is written as though sadness is the starting point. For men it often is not. Below are seven signals that rarely look like sadness, followed by an honest section on what blood testing can and cannot do here. We sell blood tests, so read that second half twice.

How do you recognise depression in a man?

Often not by sadness. Men with depression report irritability, anger, alcohol or drug use and risk-taking relatively more often than women do. The familiar complaints sit alongside them: less pleasure, poor sleep, no energy, trouble concentrating. What counts is the combination, and above all how long it has been going on.

Thuisarts.nl, the Dutch GP information service, uses a simple rule of thumb: complaints present most of the day, nearly every day, for longer than two weeks.

Two weeks. Most men are well past that line before they say anything.

1. A short fuse instead of sadness

Irritability is one of the most commonly reported expressions in men. Not crying, but snapping. The colleague who types too slowly, the car that will not merge, your kid asking something for the third time.

There is even a separate term for the picture where restlessness and agitation dominate: agitated depression. You are not slow and withdrawn but tense and quick to react.

The treacherous part is that anger is more socially acceptable than sadness. A man who snaps is said to be having a bad day. A man who cries gets a question.

2. Drinking more than you planned to

In the Martin analysis, men scored higher on substance use as a symptom of depression. Two beers become four, and the hour you start creeps earlier.

Alcohol genuinely works in the short term: the tension drops, you fall asleep more easily. That is exactly the problem.

Its effect on sleep reverses in the second half of the night, and that second half is already fragile when your mood is low.

3. Physical complaints with no explanation

Back pain, headaches, a heavy feeling in the stomach, a neck that never loosens. Many men bring a physical complaint to the GP while the mood sits underneath it.

That is not attention seeking, and it is not a clever excuse either. Sustained stress and depression produce real physical symptoms, and those symptoms are often the only doorway a man finds acceptable.

If a complaint persists for months and investigation turns up nothing, mood is a reasonable question to put on the table.

4. Awake at four and not getting back to sleep

Waking early and not getting back down is a classic pattern. Not trouble falling asleep, but lying awake far too early, usually with a head that switches straight on.

Sleep and mood also push each other both ways. Poor sleep deepens low mood, and low mood disrupts sleep.

Poor sleep also lowers testosterone, which muddies the picture further. We wrote about that in poor sleep and your testosterone.

5. A libido that drops away

Reduced interest in sex belongs to the symptom pattern of depression, and for many men it is the first thing they notice. It is also the symptom most quickly blamed on something else: pressure, age, the relationship.

This is where the biggest confusion in the whole topic sits. Low energy, no interest and a low mood also appear on the list of low testosterone in men.

Take two men of 41, both with a testosterone of 16 nmol/l. Both comfortably inside the reference range. One trains three times a week and has no complaints at all. The other has been short-tempered for four months, sleeps badly and has lost interest in sex.

Same number, completely different story. So the number points at nothing here.

Which of the two it is cannot be seen from the outside. That is why there is a table further down.

6. Recklessness behind the wheel or on your account

Risk-taking was one of the symptoms that showed up more often in men in that same 2013 analysis. Driving harder than needed, spending money that is not there, a bet that does not stay a bet.

From the inside it does not feel like recklessness. It feels like feeling something.

That is the distinction that matters: behaviour that is not so much enjoyable as briefly effective at breaking the flatness.

7. Burying yourself in work and screens

Withdrawal in men often looks like productivity. Working later, taking the phone to bed, episodes until half past one.

From the outside that reads as commitment. From the inside it is usually avoidance.

A useful question: when did you last do something you did not have to perform at, and did you enjoy it?

Why is depression in men missed so often?

Because the symptoms we screen for mainly describe the female presentation, and because men seek help less often. Anger, drinking and working hard get read as character or as busyness. Once researchers do count those expressions, the difference in prevalence largely disappears.

That last point is the most underrated figure in this field. It does not suggest men are depressed more often than thought in absolute terms, but it does suggest we miss some of them by asking the wrong questions.

On top of that, the threshold for raising it is high. RIVM, the Dutch national institute for public health, has reported for years that suicide in the Netherlands occurs roughly two to three times as often in men as in women, while reported depression figures run the other way.

Those two numbers sit badly together. That alone is a reason to look wider than sadness in men.

Can a blood test show depression?

No. There is no blood value that confirms or rules out depression. Depression is established in a conversation, based on symptoms and how long they last. Blood testing plays a different role here: it can bring physical causes into view that produce similar complaints.

This is where it gets interesting, because nearly every health page overreaches at this exact point. The standard line is: get your thyroid, your B12 and your testosterone checked. The research is less certain.

Bode and colleagues pooled 25 studies covering 348,014 participants. They found an association between hypothyroidism and depression, but it sat mainly in women (OR 1.48) and not in men (OR 0.71).

For B12 the picture is comparable. Across 16 trials with 6,276 participants, supplementation did not improve depressive symptoms in people without advanced neurological disease (Markun and colleagues, 2021).

The honest summary: blood testing rules things out here, it points at nothing. That is still useful, because fatigue and flatness from an underactive thyroid or a B12 deficiency call for a very different approach than depression does.

It is simply not an answer to whether you are depressed.

If your main question is whether this is exhaustion or your mood, the difference between burnout and low testosterone takes you further. If you want the physical side ruled out, a fatigue blood test brings your thyroid, iron and B12 into view among others. What the result means is a conversation for your GP.

When should you get help straight away?

If you are thinking about suicide, do not wait for a result or an appointment. In the Netherlands, call 113 Zelfmoordpreventie on 0800-0113, free and available day and night, or chat via 113.nl. If there is immediate danger, call 112.

That is the only line in this piece with no nuance attached.

If you recognise several of the seven signals above and they have lasted longer than two weeks, book an appointment with your GP. You do not have to walk in with the word depression. You can start with: I have been short-tempered for months, I sleep badly and I have lost interest in everything.

That is enough. The rest is their job.

My own position after reading this research: the most useful step here is rarely a tube of blood. It is that one sentence at the GP, and it costs nothing but discomfort.

References

• Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry. 2013. PMID 23986338
• Bode H, Ivens B, Bschor T, Schwarzer G, Henssler J, Baethge C. Association of hypothyroidism and clinical depression: a systematic review and meta-analysis. JAMA Psychiatry. 2021. PMID 34524390
• Walther A, Breidenstein J, Miller R. Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA Psychiatry. 2019. PMID 30427999
• Markun S, Gravestock I, Jager L, Rosemann T, Pichierri G, Burgstaller JM. Effects of vitamin B12 supplementation on cognitive function, depressive symptoms, and fatigue: a systematic review, meta-analysis, and meta-regression. Nutrients. 2021. PMID 33809274
• Thuisarts.nl. Ik ben somber of depressief. 2025. thuisarts.nl
• RIVM. Figures on suicide and mental health. 2025. rivm.nl

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.