When Depression Doesn’t Look Like Depression

Fatigue. Feelings of worthlessness. Loss of interest. We recognize these as classic signs of depression.

But according to Terry Real, MSW, LICSW, these symptoms aren’t always the way men experience depression.

So how do we help clients when their depression doesn’t necessarily look like depression?

In this short video, Terry shares a two-pronged approach to help his clients find relief.

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40 Comments

  1. Joan says:

    Love the interview, a real treat…

  2. Yes, very interesting and recognisable .

  3. Mattilda Orson, MS, Counselor says:

    It may sound Like a big howl, butb concurrently, there is a reticence for men to admit how steeped it is time consumed. Being in therapy can exert the feeling of being depleted. The person-client can’t recognize and validate that the male of female therapist is here to help and not to discriminate. therapy may stay the same but there is a technical component….and ALL client-therapist isn’t trained to perform. I can see myself undertaking the no sweat taks to understand their struggle…such as workplace stress, functioning or not, and smoky days…but there will always a big gap in how the two genders differ how they work on inthe during therapeutic relationship and this is very adamant to change so soon.

  4. Dr kelly owen says:

    My experience over the past 22 years as a clinician is exactly this – depression in men manifests very differently. In my practice, Men referred for anger management, road rage, temper tantrums in the work place, substance abuse, insomnia and Extreme irritability have ALL responded very well to treatment for depression which included psychotherapy , exercise and medication.

  5. jane says:

    … and not only men…. perhaps better to say, ‘people’

  6. Hannah Sherebrin says:

    It is good that finally someone is talking about the specificity of Covert Depression. I have presented a paper on the subject at the American Art Therapy Association conference in 2015. I use Art Therapy as the 2 level approach. I am sure that you are also aware that medications work differently for males and females to alleviate depression
    I can send you the paper if you wish. I did not publish it beyond the presentation at the conference.

    • Zelda Kause says:

      I too recognize women and men present differently with depression, and respond differently to treatment. I would appreciate a copy of this paper!

  7. This was very helpful. I have seen this over and over in the field of addiction and domestic violence. Even though it was in the back of my mind that something else is going on, this video clarified it my mind. Thanks for the insight.

  8. Barbara Caspy says:

    Thanks Ruth and Terry! I very recently had a male client who has Bipolar Disorder and quite a few years ago stopped alcohol and drugs. However, he had a bad accident since then and so for many years has legitimately been on pain pills. He’s been wanting to get off them because he doesn’t like the side-effects. He’s now off the pain pills and realizes that he often did take more then prescribed, such that he was addicted in the same way he was to alcohol and street drugs. When he came to session last week, he was experiencing huge amounts of anxiety and some depression from many life traumas. So now his therapy really begins!

  9. Anne Stone says:

    Coming from the corporate world, this is incredibly important. As we ‘correct’ for culture and productivity we pull folks into this covert stance and it’s honestly a crisis.

  10. This matches my experience exactly!!!

    Great contribution. Men are great at hiding their depression, sometimes successfully for decades!

  11. Anna Leigh says:

    The male depression I’ve observed in my family and my fiancé is a bit more subtle even than the pattern being described in this video, in that the man is depressed, but isn’t acting it out in either the “female” mode (over- or under-eating, low energy, etc.) or the “male” one. They’re not drinking, drugging, or womanizing, they’re not rage-aholics, they just think there’s something wrong with them; they can’t get happy, and they have little passion or momentum for their lives. Continuing to get up in the morning and go to work seems more a function of duty, performed because these are “good men” (and they are). Perhaps this level of depression wouldn’t qualify as being chronic enough for treatment, but it’s very real to them, and to me.

  12. Joan says:

    It sounds better therapy to be in an isolated place than socializing, for men. It can be an open space and in group, but for individual therapy , cave men looked for pleasure in a safe and comfy secure place. I totally understand this part

  13. Laurie Guay says:

    I am curious to know if covert depression in men is linked to online reality simulation games such as Second Life? How does one address this when the person feels that it is a harmless form of entertainment, but in reality seems to be a form of escapism and avoidance of intimacy in real life relationships?

  14. Thanks. Really important as not everyone is overtly depressed.

  15. Tanning says:

    Johnathan, Thank you for your feedback. I would like to know how are their rating in self-esteem and are they judging themselves as outcasts? This is an interesting group…

  16. Jonathan says:

    Excellent interview. I have always suspected that the studies that indicate that women suffer depression at greater rates than men may be questionable. Aboriginal Australian men and women have similar levels of depression because Aboriginal men are culturally allowed to be in touch with their feelings and express them.

  17. Tanning says:

    Very interesting video, thank you. Terry’s involvement shows something can be done and is to be done …

  18. Tanning says:

    Are women more prone to depression than men ? I am under the impression it is more difficult for men to recognize that side of the character – for the most. But for other people this is a characteristic that is no different or may be alike and kind of appreciated in certain culture. Am not saying covert or overt behavior here but only how they accept the image of how the are looked upon. Some behaviors are more acceptable to men than to women and vice versa well, accepted .

  19. I and two other therapists, one individual and one couple’s therapists, totally missed my husband’s depression. He retired at 62 years old and became an angry “dry drunk” the day he retired. ( At that time he had 17 years of sobriety without a relapse.) He died suddenly on a ski slope doing what he loved three and one half years later of a heart issue. (He never relapsed.)
    In retrospect I believe he was depressed and fearful of dying, but could not admit it.
    Now I ask male clients, who I suspect are depressed, two questions. What are you afraid of that you are afraid to admit? What do you feel helpless about and don’t want to admit it?

    • Tracy says:

      Very helpful questions. Thank you for sharing them and your story.

    • Fatima .S says:

      My brother Acts the same way by not recognizing the depression and getting help. His panic become intensive and is caused by loss, abandonment by our mother, and now is mortified to the point he is careless about his wife who encourages him to stop smoking, drinking and seeking out rewarding pleasures…I myself can see his falling but it has to come from the man, he is, to get what will be good for him. This comes from my opinion, as a woman.But there is not much to do when this comes from his being raised without a father as a good model. He has no children and doesn’twant any and that makes it hard for the couple. He is letting himself going back to the hole and has no idea this isn’t aaway. I am thankful there is now a focus on men in therapy or who seeks therapy, if not, within the family circle. Thank you for sharing, Lynn.

    • Kerima says:

      Very helpful questions. Thank you.

  20. Mary Gayle Selfridge R.N.,Ph.D says:

    In my practice I have found this to be true. Men often present with addictive behaviors and once those are addressed ,the depression comes out. Often men have agitated depressive episodes more than women. Anger is expressed more than sadness. I found this video to be helpful .Thank you both

  21. Bente says:

    Linked in what way ??
    I’ve heard it is linked to hormonal imbalance (from SOME kind of stress…) – e.g. LOW testosterone and HIGHER ESTROGENE in men ?? THAT makes them emotionally imbalanced ?? (It is not normal for men to be more angry, is it ??? Like it shouldn’t be for women either…) Or… ?

    • Bente says:

      Oh, I’m sorry, this was meant as a reply for Sherry…

  22. Yannick says:

    tHIS IS my personal observation in my work to see women. bUT my impression is very blurred because it takes more time for a man to confide and for a woman to be comfortably well to say what they really want to say in a session..i have been come to the conclusion there is a projection of their problem to what the reality is. the depression is under covering many difficulties in cultural, gender and age that create Obstacles and barriers to therapeutic rapport

  23. Beatriz says:

    I agree with others that women also will self medicate instead of “owning” their depressive symptoms. Do you find that certain cultures tend to have more covert vs overt depression? Do you think the level of stigma is different within certain cultures?

  24. Mike says:

    I agree about how anger is underneath all of the emotions. Sadness that one can be defective and not up to the task of being a human, likely to be perfectly fine, can be a big demand. So the amount of anger that the world outside is putting on a person to be not depressed by what one is going through can be very roughly said, too tough for anyone. Group support that I have helped to facilitate has shown to be a great help to men to open up and to see how others can be empathic rather than rejecting or shameful. Or at least that what has appeared to me sofar

  25. Barb says:

    Isn’t it the being depressed in cause and not being a one “or not” one ? a diagnosis such as depression or else like cptsd is just another after another that it is hard to admit to self that one isn’t “good enough? Well, at least there is hope

  26. Sherry says:

    Wondering if another sign of covert depression is chronic anger. Chronic anger (not speaking of physically violent behavior here) that doesn’t need much provocation to appear seems to be more common and more acceptable among men, probably because it’s percieved to be so closely linked to testosterone.

    • Kerima says:

      I think that anger can help pull someone enough out of depression to function somewhat, rather than curl up and not get out of bed. So I see some degree of anger as energizing and helpful, possibly a helpful reframe? I would love to see comments on this!

  27. Priscilla A Jones says:

    I particularly like the coinage of the terms covert and overt depression. In my professional and personal experience, I have seen this in both men and women, equally. I would be curious to know how you would tease out the covert depression vs bipolar 2?

  28. premi says:

    This is a very important observation, however it does not belong just to men and it was a bit of a blunder the way he stated that it is easier and more socially acceptable for women to express depression. It could have been stated more clearly so as not lump all women together and all men together. It’s all a matter of circumstance. There are many, many women who cannot afford to be or show depression. They may be surviving abuse, survival issues around finances or parenting, or have addiction issues, or a variety of other issues.

  29. Eduardo says:

    Tanks for your insight on covert depression and how to treat it before dealing with overt depression,

    Jep

  30. daisy says:

    Is it about gender?

    We’re all humans who like to be treated as humans?
    Womanly or unwomanly is avoiding the basic truth that mostly, we all like not to be considered as something unimportant.

    First and foremost, I think we need to think a bit more about people?
    We might treat others and be treated better when we think of ourselves in the same way we think about US?

    Fatuous response perhaps but important, I feel.

  31. Thank you for this.
    What I have observed is that this is true about Z’evastrong women do as well.

  32. Aspasia Holley says:

    This was insightful and very helpful, thank you. I had honestly never considered this perspective to understand the behavior of womanizing or self medicating. Facinating and profound. One a side note… Ruth that color on you is absolutely breathtaking. I know it’s off subject but, I felt it worth acknowledging.

  33. Women cry. Men rage. Women are raped and killed. Men make excuses and go numb. How convenient. Women are coming forward to call the whole thing off. It is long overdue that men suffer depression. Let them get ECT and Meds. Women are recovering and evolving. Even in the world of psychology it is the Ogdens, Baders. Poole Hellers, And countless others whose names may not be known who are coming forward. In oneself is the whole world. WE ARE ALl the WORLD. So we have to change. We need RADICAL change. This means ROOT change. We need to stop Thought and meaningless words. We need to be REAL. We need to be WHOLE and end this gender divisiveness, and every other divisiveness. We need humility and accountability. It takes energy and seriousness.

  34. jen says:

    It is not true that it is unwomanly to hide depression. The same stigma exists because people see it and want to avoid it for fear of bringing themselves down. I’ve seen it and seem other women talk about it.

    The problem is that we have layers that influence layers and getting to the root of something that keeps growing new roots is tricky. People, families, institutioons, countries, and leaderrs all experience this. Thus shark eat shark behaviour.

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