For two years, 44-year-old Samit (name changed) struggled with the feeling that ‘something was not justify’.It started with fatigue, headaches, and disturbed sleep, progressing to problems with concentration and memory as well as a declining interest in work, sex and hobbies coupled with decreasing self-worth. Formerly patient and understanding, he now regularly unleashed his temper on his wife and children. Formerly social and outgoing, he began to isolate himself and found a friend in alcohol and cigarettes. A corporate executive who used to love his work, he now summoned his willpower to get to a job he wanted to quit.

At home, his drinking habit led to further abuse of wife and children, pushing his relationship with them to the brink. His wife wanted a divorce. He sought psychiatric help as an attempt to save his life. He was diagnosed with depression.

Male depression – or depression in men – is a hidden epidemic. The reason this type of depression is often classified as male is that it frequently presents itself differently in men. And the reason it’s called a ‘hidden’ epidemic is that there is underreporting of this condition among men, as compared to women. Researchers think this is not just because men don’t recognize their depression but because men find it difficult to say what they feel. This problem with expression masks the symptoms, making it tougher for healthcare professionals to arrive at a diagnosis.

This difficulty with expression is thought to be rooted in sociocultural expectations of masculinity, no matter how toxic it may seem for the man trying to live up to them. Most of our male patients believe they are expected to always be strong and to be ‘men’, whatever that means. Most internalize this message more than they realize. And this might be killing them.

While women attempt suicide more often, men are four times more likely to die from it: 75-80% of suicides are by men. The reasons include under-recognition of depression, reluctance to seek help for fear of it being seen as a weakness, tendency to deny illness or self-treat symptoms with alcohol and other substances, and men using more lethal means than women.

One of the largest studies of depression suggests that while men and women have some common symptoms, the condition often manifests itself differently for them . It usually presents itself in men by way of a) irritability, hypersensitivity and angry outbursts; b) loss of interest in day-to-day activities; c) emotional withdrawal and numbness; d) trouble sleeping; e) aggression or violent or controlling behaviour; f) difficulties with concentration and memory; g) low libido and sexual dysfunction; h) physical/psychosomatic manifestations such as headaches, digestive issues and chronic pain; i) substance abuse or increase in smoking; and j) reckless behaviour like gambling, rash driving or unsafe sex.

Statistically, one out of every 10 men will develop major depression globally. In fact, recent research points to a higher figure. If you persistently experience any of these symptoms, speak to someone and seek help. Equally, if you see any of these symptoms in the men (or boys) in your lives, provide a safe, non-judgmental space for conversations. Untreated depression can not only trigger relationship/study/work-related issues but heart disease, hypertension, diabetes, cancer and even death by suicide.

Recognition is key, and it is important not to ignore signs. Treatment depends on severity.

Samit was eventually treated, and he restored his relationship with his wife and children. He got promoted within a year. And in a year-and-ahalf, he was able to stop his medication, putting the darkest period of his life behind him.

(Shamsah Sonawalla is consultant psychiatrist, Jaslok Hospital)