For generations, men have been taught that being “tough” means keeping emotions to themselves. Admitting to depression or anxiety is often seen as a weakness.
“That’s tied to the stigma around mental illness,” said Lokesh R. Shahani, MD, MPH, a psychiatrist at UT Physicians Interventional Psychiatry Clinic and chief medical officer for the UTHealth Houston Behavioral Sciences Campus. “Men don’t report depression or anxiety as commonly.”
Even so, one of pop culture’s most recognizable tough guys, Tony Soprano, was also one of the first characters on television to show a man in therapy in the late 1990s.
How stigma shows up in real life
According to the CDC, nearly 80% of individuals who die by suicide are men. That means suicide rates are about four times higher among men than women.
When men don’t address their mental health—especially those who are middle-aged or older men—they may fall into one of three behavioral patterns, Shahani said.
- Acting out/ externalizing: irritability, anger, relationship conflict; road rage is also linked to untreated mental health conditions.
- Withdrawal: isolating from family and friends rather than expressing emotions
- Self-medication: turning to alcohol and substance use for relief
When mental health is neglected, it can also take a toll on physical health.
“Untreated depression and anxiety can lead to hormonal imbalance,” said Shahani, an associate professor at McGovern Medical School at UTHealth Houston. “That contributes to a weak immune system, more obesity, and sleep problems. Chronic stress has always been associated as a risk factor for cardiovascular disease.”
Misconceptions about treatment
Shahani identified two persistent misconceptions that can keep men from seeking psychiatric care, even when they’ve moved past the initial stigma.
Misconception 1: The “zombie” fear
A common concern Shahani hears in clinic is the fear of “feeling like a zombie,” referring to the possible side effects such as emotional numbness or extreme fatigue when starting antidepressants.
“We’re now in the 2020s, almost five decades after Prozac was first introduced,” Shahani said. “We have much better medications and provide personalized care. We don’t give the same medication to everyone.”
Misconception 2: Medications are forever
Another concern is the fear of becoming dependent on medication and not being able to stop. Shahani said not all patients need to take medications for life. With professional guidance, patients can take medications for a few months to a year and then be safely taper off.
First steps for men who aren’t ready
Shahani also reframed psychiatric care as part of overall healthcare: Think about addressing your mental health with a professional the same way you would your physical health with a family physician.
He also pointed to evidence-based apps as a starting point. These tools provide real-time feedback on negative thoughts or behaviors. FDA-approved mental health apps are medical-grade, software-based treatments clinically proven to target specific psychiatric disorders. They require a prescription from a healthcare provider to unlock and use.
“People often feel embarrassed admitting their weaknesses in front of a person, but the same person might not feel as stigmatized doing it with a nonhuman,” he said.
Therapy also looks different for everyone, and patients don’t have to open up all at once.
“Admitting that you’re embarrassed or want to go slow—these are things we totally understand as psychologists and psychiatrists,” Shahani said. “It happens with many patients, not just a few.”
When to seek help
It may be time to see a mental health professional if you notice symptoms such as sleep disturbances, changes in appetite, persistent fatigue, or chronic pain. If everyday emotions start to interfere with your day-to-day life, it may be time to reach out. Symptoms lasting two weeks or more, could be an indicator of psychiatric illness.
“I always refer my patients to the Pixar movie, ‘Inside Out,’” Shahani said. “Sadness, anger, worry, jealousy—these are all normal human emotions, and we all experience them. It would actually be unusual not to.”