For too many years, medical health professionals were missing the signs that women were suffering from heart attacks. While both men and women can suffer from chest pain during a heart attack, women are more likely to experience back or jaw pain, fatigue, and breathing difficulties instead of the expected pain in their chests. The same happened with strokes, autoimmune diseases, urinary tract infections, and many more physical ailments.

As a society, we have grown and learned a lot about atypical presentations of medical problems. Understanding these differences is essential for detecting the issues, tailoring effective interventions, and providing targeted support. However, if this has happened with physiological diagnoses, couldn’t it happen with mental health ones as well?

It’s time to shed some light on the differences men and women face when it comes to the diagnosis and treatment of major depressive disorder (MDD) to ensure everyone can get the treatment they need.

Depression Symptoms:

Both men and women can experience these core depressive symptoms:

● Tiredness, fatigue, or lethargy

● Feeling sad, down, or low

● Sleep difficulties, such as trouble falling or staying asleep or sleeping too much

● Feeling hopeless or empty

● Losing interest in or not getting pleasure from activities they used to enjoy

● Trouble concentrating

● Changes in appetite or weight

However, not everyone with depression will experience all of these symptoms, and some often experience other symptoms altogether.

Women Experience More Internalizing Symptoms

According to the Centers for Disease Control and Prevention, women are twice as likely to experience depression. These higher numbers for women are partly due to normal hormonal fluctuations and changes during puberty, monthly menstrual cycles, pregnancy, postpartum, and menopause. Life circumstances and culture can influence women’s risk for depression as well.

However, these inflated numbers could be because women more often report the typical depression symptoms than men. Women’s symptoms of depression tend to be more internalized and follow the core depression symptoms listed, such as sleep problems, excessive guilt, and feeling stressed, sad, and guilty.

The Difference in Men’s Symptoms

As we explained earlier, women are more likely to exhibit symptoms that are not as obvious to those around them. Men’s symptoms can be quite different and much more outward as a way to mask their true feelings of depression. Some common symptoms observed in men are:

● Inappropriate anger

● Risky behavior like significant alcohol intake, reckless driving

● “Escapist” behavior – staying overly busy to avoid dealing with true feelings

● Sexual dysfunction

● More frequently and easily irritable

Why the Differences in Symptoms are Worth Noting

In addition to the differences in symptoms of depression between men and women, so are their coping mechanisms. Some suggest that due to societal pressures that have been placed on men to always “toughen up” or that forwardly expressing their feelings makes them look weak, is a major reason why it is more common for women to verbalize and seek out help when they are experiencing depressive symptoms than men. It is more acceptable and expected.

In addition, the symptoms we mentioned above are not always leading a provider to think “major depression disorder (MDD),” which makes it much harder to diagnose and treat in a timely manner, if ever. The delay in diagnosis leads to delay in treatment which leads to worsening symptoms and quality of life. Often evaluations of depression focus on the physical and emotional symptoms of MDD such as fatigue, loss of interest in activities usually enjoyed, low energy, general loss of hope – but these miss the behavioral symptoms men often experience which can lead to a misdiagnosis.

Treatment Disparities

Given the difference in display of symptoms between men and women, research has shown that each prefers and reacts to different types of treatment as well. Because women tend to internalize their symptoms, treatment often involves implementing coping skills while men have more external symptoms and treatment might be more focused on controlling any destructive behaviors.

It’s not uncommon for both men and women’s depression to be resistant to antidepressant medication. The all too common “trial and error” process of trying to find the right antidepressant medication leads to people searching for alternative methods such as transcranial magnetic stimulation (TMS) for depression. TMS treatments for depression offer an avenue for those with depression that actually works on the areas of the brain that are hypoactive (not working hard enough).

Final Thoughts

We’re sure you have heard the saying, “you never know what someone is going through, so be kind,” and although this may seem like a cliche, it perfectly describes what we’ve just spoken about. Depression looks different on everyone. It will present differently on each individual person regardless of their gender, but patterns are obvious and research shows men and women do tend to exhibit different different types of symptoms (internalizing vs externalizing) and tend to reach and respond to different types of treatment. The seemingly lack of focus on behavioral symptoms in depression leads to a much more difficult journey for men to get diagnosed with MDD which could explain why they are four times more likely to commit suicide than women.

Ensuring an efficient treatment process for everyone requires a multifaceted approach that educates on the different ways depression shows up for people. There is also the bigger societal job of destigmatizing the shame around mental health for men and ensuring women are taken seriously when they cry for help. Developing tailored solutions and intentionally listening to each patient is a great start to bridging the gap in depression treatment.