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Depression in Men: Why Accessing Therapy Can Feel So Difficult

  • Aug 3
  • 7 min read

Depression does not always announce itself as sadness. It may begin with sleep that no longer restores you, a shorter temper, less patience with the children, or the feeling that work is the only part of life you still know how to do. You may be functioning, earning, parenting and

answering messages while privately feeling that you have withdrawn from your own life.


A solitary man walks towards a narrow opening filled with light, symbolising depression in men and the difficulty of accessing therapy.
Finding a way into therapy can feel uncertain, particularly when distress has been carried alone for a long time.

This can happen to anyone. There is no exclusively male form of depression and no single reason why a man may find therapy difficult to approach. Gender can matter, though. It may shape which feelings seem permissible, how distress is expressed and what a person imagines will happen if he is no longer able to cope alone.


Depression Can Look Like a Life Becoming Smaller


Some men recognise depression because they feel low, hopeless or close to tears. Others do not feel sad in any obvious way. They notice that they are irritated by ordinary demands, staying later at work, drinking more, avoiding friends or losing interest in sex, hobbies and family life. There may be headaches, physical tension, exhaustion or an uncomfortable restlessness that never quite settles.


Anger can sometimes sit near depression, but anger is not proof of it and depression does not excuse frightening or harmful behaviour. It may, however, be the feeling a person can reach when grief, fear, shame or helplessness feel less bearable. A man who has learned to act rather than speak may experience distress first through what he does: withdrawing, overworking, taking risks or becoming difficult to reach.


None of these responses belong only to men. Women can become angry and men can become openly sad. The point is not to create another stereotype. It is to notice that depression may be missed when we are only looking for one familiar picture of it.


What Is Gendered, and What Is Simply Human?


The familiar claim that men do not seek help needs some care. The 2023/24 Adult Psychiatric Morbidity Survey found that common mental health conditions were reported more often by women than men. Among people who did have significant symptoms, however, men and women were now receiving treatment at broadly similar rates. This is an important correction to an older and rather shaming story that men simply refuse help.

At the same time, the consequences of distress are not evenly distributed. In 2024, the registered suicide rate for men in England and Wales was just over three times the rate for women. Statistics cannot tell us what any individual man feels, but they do tell us that the question of how men become visible to services remains serious.

Three black gender symbols representing feminine, mixed-gender and masculine identities, separated by vertical lines.
Gender can shape how depression is expressed and understood, but it does not tell the whole story.

Gender may influence how suffering is recognised. It does not explain the suffering by itself. Depression can follow bereavement, trauma, childhood neglect, financial pressure, racism, illness, loneliness, unemployment, relationship breakdown or years of feeling responsible for everybody else. These are human experiences. What gender can alter is the position a person feels expected to take in relation to them.


“Men Need to Open Up” Is Not Enough


There is more public encouragement for men to talk about mental health than there used to be. That is welcome, but the instruction to “open up” can become another demand. A man who has spent years keeping himself together may not know what to say, or may only have words for the practical problem and not yet for the feeling underneath it.


He may also have good reasons for caution. Perhaps vulnerability was mocked in his family. Perhaps a previous disclosure was used against him. He may fear being pitied, managed or treated as less capable. Some men are comfortable offering support but feel ashamed when they need anything in return.


Therapy should not require a performance of emotional fluency. Silence, uncertainty and even suspicion can be part of the beginning. The work is not to reward a man for saying the right mental-health words. It is to understand what has made speaking, needing or depending upon another person feel dangerous.


Depression in men: Fatherhood, Rejection and Being Seen as a Threat


For some men, depression becomes especially acute around fatherhood, separation or the loss of ordinary contact with their children. A father may have built much of his identity around providing, protecting and being present. If that position is suddenly reduced to scheduled contact, financial arrangements or conflict with a former partner, the loss can reach into every part of life. It is not only the relationship that has ended. A daily version of fatherhood, and sometimes a whole sense of usefulness, may have gone with it.


There is also a difficult atmosphere around how men are spoken about. Harmful male violence, coercion and entitlement are real and must never be minimised. Yet public discussion can sometimes move too quickly from challenging those behaviours to imagining male anger, authority or ambition as inherently aggressive or power-hungry. Some men come to feel morally suspect before they have spoken.


This can create a painful bind. If a man is angry about rejection, he may fear that the anger itself will be taken as evidence that he is dangerous. If he says nothing, his withdrawal may deepen. If he speaks only in the language of injustice, the grief and humiliation beneath it can remain untouched.


Psychotherapy does not have to choose between accountability and compassion. It can take a man’s pain seriously without endorsing every account he gives of a conflict. It can also recognise paternal rejection as a genuine emotional loss, rather than dismissing it as wounded pride.


Masculinity Does Not Belong to One Culture


There is no culturally neutral way to be a man. Ideas about duty, authority, privacy, faith, family loyalty and emotional expression vary between communities and generations. For one man, speaking to a therapist may feel like betraying family privacy. For another, depression may be understood through the body, through spiritual struggle, or simply as pressure and tiredness rather than a mental health condition.

A man wearing a red striped garment stands beneath trees, looking thoughtfully into the distance.
Ideas about masculinity, responsibility and emotional expression are shaped by culture, family and community.

Race, migration, class, sexuality and religion can also affect whether a service feels trustworthy. UK research continues to find unequal access to mental health treatment for people from Black, Asian and other minoritised ethnic groups. This cannot be explained by “stigma” within communities alone. Previous experiences of racism, fear of being misunderstood, services built around unfamiliar assumptions, cost, language and a lack of culturally thoughtful care all matter.


A therapist cannot know every culture from the inside. What matters is whether they can remain curious, recognise their own assumptions and allow culture to be part of the psychological story without turning it into the whole story. You can read more about my approach to Intercultural Therapy Online UK: https://www.archibaldpsychotherapy.co.uk/intercultural-therapy-online-uk.


Access Means More Than a Service Existing


A therapy service may technically be available and still feel inaccessible. Waiting lists, cost, working hours, repeated assessments and uncertainty about what therapy involves can all prevent someone beginning. A man who supports a family may regard an hour spent in therapy as indulgent. Someone in a small community may worry about privacy. A person who has had to prove his competence at work may find it difficult to become a patient or client.


Online psychotherapy can remove travel and widen the choice of therapist. It can also feel less exposing than entering a clinic. It is not automatically easier, and it requires privacy, reliable technology and enough emotional space after the session. Still, for some men it makes regular attendance possible around work, caring and family commitments.

If you are uncertain about the difference between psychotherapy and other forms of help, Can Psychotherapy Help Me?: https://www.archibaldpsychotherapy.co.uk/can-psychotherapy-help-me explains what the work can and cannot offer.


What Psychodynamic Psychotherapy May Offer


Psychodynamic psychotherapy is interested in symptoms, but it also asks what may be happening underneath them. Why has criticism become unbearable? Why does needing another person bring shame? Why does success provide relief for only a few hours? Why does a disagreement now feel like abandonment?


These questions are not a way of blaming childhood for everything. Current realities matter, including money, discrimination, work, family conflict and physical health. Earlier experiences may matter as well, especially when the same feelings or relationships keep returning.


The therapeutic relationship becomes part of this enquiry. How it feels to be listened to, to disagree, to depend on a regular appointment or to imagine being judged can tell us something about relationships elsewhere. This is considered slowly and without requiring you to become a different sort of man.



Beginning Without Having to Be Certain


You do not need a diagnosis, a crisis or a polished explanation before contacting a therapist. It may be enough to notice that your life has narrowed, that people close to you are worried, or that keeping everything contained is taking more effort than it used to.


Therapy is not right for everyone, and psychotherapy is not an emergency service. If you feel you may act on thoughts of suicide or cannot keep yourself safe, seek immediate help through emergency or urgent mental health services where you are.


If you would like to think about whether online psychodynamic psychotherapy may be appropriate, I offer a free 20-minute introductory consultation. There is no obligation to continue. You can make contact here: https://www.archibaldpsychotherapy.co.uk/contact.


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