Headaches, bouts of violent anger and working too hard... for 10 years Matt had no idea what was wrong with him - until he made this discovery. Now, he's warning men of the signs they can't afford to ignore

Matt Earl, a primary school teacher, was out with his colleagues one Friday night, when one of them made a comment that struck a raw nerve.

‘He said I needed to choose between being a family man or continuing my career as a teacher,’ Matt recalls. ‘It just set something off inside me. I felt myself boiling with rage. I’m not a violent man, but I was on the brink of punching him.’

A friend stepped in and took Matt home before the situation could escalate. This incident was pivotal, because it marked the moment Matt accepted he was experiencing a mental breakdown.

Matt, who was 38 at the time (he’s now 45), spent the rest of that weekend crying. His concerned wife Hayley suggested he take some time off. He agreed. But while Matt knew things weren’t right, like many men, he had no idea that his quick temper was actually a physical manifestation of depression.

In fact research shows that men frequently express their depression differently from women – as anger or physical pain, rather than ‘sadness’ – and as a result, they are not being identified or treated, sometimes with tragic consequences.

Matt, who lives in Gloucester with Hayley, 46, and their two children aged 11 and 16, now believes he spent ten years in denial that he was suffering from depression.

‘I was irritable and sound-sensitive, which was strange for me as I used to play instruments and have the radio on all day,’ he recalls.

‘I also found I couldn’t run any more – something I loved doing. I just didn’t have the energy or motivation.

‘And I kept losing my temper at home and sometimes at school too. If someone accidentally broke a plate at home, I’d totally overreact. I didn’t feel sad and didn’t realise that a lack of energy, an inability to get out of bed and irritability could also be signs.’

He also had frequent headaches and other niggling physical problems.

In 2008, a landmark review on male depression, titled Big Boys Don’t Cry, led by psychologist Peter Branney (then at Leeds Metropolitan University), looked at how depression manifests in men and why it is often under-diagnosed or misunderstood.

Published in the journal Advances in Psychiatric Treatment, it identified behaviours that are more common in men, such as avoidance (overworking or socialising to distract themselves), self-medicating with alcohol or drugs, aggression and hostility.

The review also found men display unexplained physical symptoms including pain and slow movements and speech, which are often overlooked by clinicians.

Yet 17 years on from its publication, depression in men remains under-diagnosed and not always understood – with men still finding it hard to speak up.

Last year, a European review, Real Men Don’t Talk, published in SSM-Mental Health, showed that a large proportion of men don’t share their mental distress with anyone. What’s more, persistent low-grade depression directly increases the likelihood for men not to disclose their mental distress and also makes them more isolated and withdrawn, so they don’t have anyone to confide in.

According to Dr Adarsh Dharendra, a consultant psychiatrist at the Priory Group, who also works with the NHS Crisis Service in Wiltshire, ‘it’s easier for men to say they’re having headaches than to admit they are struggling mentally’.

This is something Matt can identify with. For years before his breakdown, he experienced symptoms such as migraines, neck pain, and lumps behind his ears. He also now recognises he experienced feelings of inadequacy.

‘I felt I wasn’t good enough as a teacher, a husband or a father. Bit by bit, these thoughts started to overwhelm me and I withdrew from friendships and probably wasn’t a great husband or father.

‘But I buried my head in the sand that anything was wrong with me mentally and only visited a doctor because of my physical symptoms.’

Indeed, when Matt went to his GP seven months before his breakdown, he laughed it off when the doctor suggested they could be down to depression and anxiety. ‘I was still in denial,’ he says.

‘In clinical practice, I often see men minimising their distress or presenting in therapy only when a crisis has already erupted, commonly through relationship breakdowns or workplace burnout,’ says psychotherapist Anthony Davis, an accredited member of the British Association for Counselling and Psychotherapy (BACP).

He says men often experience what is termed ‘male-typical depression’ because their experiences are shaped by masculine social norms, which discourage emotional openness.

‘Consequently,’ he says, ‘men’s distress may be misinterpreted as behavioural issues or personality traits, rather than symptoms of mental ill health.’

This is why, in 2023, the BACP launched its RAISE campaign, encouraging practitioners, loved ones and colleagues to recognise the diverse ways distress can show up in men so they can act before a crisis point.

The mnemonic - R – Risk-taking, A – Anger, I – Isolation, S – Substance abuse, E – Exhaustion - is designed to alert people to common signs of depression in men.

Dr Dharendra says that men often come to his clinics with anger management issues, outbursts, or irritability, rather than feelings of sadness or hopelessness. ‘They may even deny being depressed because mental illness is still seen as a sign of weakness by many men.’

He recounts the example of a patient in his 40s who’d suffered a series of major life events, including bereavement and the end of his long-term relationship. ‘He was spending hours gardening, struggling at work, and his family noticed out-of-character behaviour, like the fact he was snapping at them, being very sarcastic, neglecting self-care and misusing alcohol,’ he recalls.

‘But he denied he was struggling emotionally. After a major outburst, he left his home and nobody could contact him.

‘The police eventually found him sitting by a riverbank and when they approached, he jumped in the river.

‘It was only at that point he got the help he needed from specialist mental health services. If he hadn’t tried to soldier on, he could have been helped much earlier.’

The cost to men of not seeking help is significant, and sometimes deadly. Men account for three quarters of suicides in England and Wales. There were 5,656 suicides registered in England in 2023 (the latest figures available), with the male suicide rate 17.1 per 100,000 people, compared to the female rate of 5.6 per 100,000. In Wales, the male suicide rate was 22 per 100,000, compared to the female rate of 6.3 per 100,000.

The landmark Big Boys Don’t Cry report revealed clear disparities in diagnosis between men and women with depression. Statistically, for every woman diagnosed, only 0.4 men are, suggesting that men’s symptoms are missed or not recognised.

Dr Dharendra explains: ‘GPs may find it easier to diagnose depression in women, who generally openly discuss their emotions.’ As well as being more at risk of suicide, men are also over-represented when it comes to severe mental health conditions, such as psychosis or conditions needing inpatient care.

Peter Branney, co-author of Big Boys Don’t Cry and now associate professor at the University of Bradford, says one of the reasons for this is that mild or moderate depression in men may not be picked up early, allowing it to escalate into more serious mental health issues. This escalation is a phenomenon known as the ‘big build’ theory of depression.

‘When they’re struggling, men engage in behaviours that make things worse,’ explains Professor Branney. ‘They may act in ways that harm their relationships rather than drawing support from them. For example, they might avoid family connections, lash out at loved ones, or engage in destructive behaviours such as drinking too much.’

His research found that there are societal factors that increase the risk of depression in some men. ‘Unemployed men and those in manual jobs, or in very competitive workplaces, are at higher risk. These are environments that reward toughness and discourage emotional openness. Another group at higher risk are City workers, who typically work long hours under intense pressure.’

Depression is also particularly common in men during mid-life, he adds, ‘when it’s often linked to stress related to balancing work with family responsibilities and health challenges’.

Psychotherapist Anthony Davis says traditional masculine ideals, such as self-reliance and stoicism, can create internalised barriers to seeking help. ‘Men may fear being seen as weak or vulnerable,’ he says.

However the differences in the way men and women experience depression may also have biological roots. As Dr Dharendra explains: ‘Testosterone potentially amplifies irritability and emotional responses to stress.’

He also cites 2024 brain scan research, published in BMC Psychiatry, showing structural brain differences in individuals with major depressive disorder, which vary by their sex.

For example, it showed women with depression have a reduced ventrolateral prefrontal cortex area (VLPFC) – an area key to emotional regulation. However, men with depression differed in the volume of their dorsomedial prefrontal cortex (dmPFC) – an area which other research has linked to self-control and the ability to put things in perspective.

In 2008, when Big Boys Don’t Cry was first published, Professor Branney called for more awareness, tailored services, and campaigns to challenge stereotypes and help men address their mental health struggles.

Things are improving, he says, but the key point remains that ‘services should be practical and non-judgemental: men need to feel they can discuss their symptoms without fear of stigma or misunderstanding’.

When Matt went to the doctor seven months before his breakdown, he was prescribed antidepressants. He was reluctant to take them, sceptical as he was of the diagnosis – but did. However, the pills on their own weren’t enough to prevent his breakdown, he says, because he still wasn’t able to admit how he felt.

But by the time of his breakdown, he was thinking about suicide ‘often – trying to figure out ways that wouldn’t hurt my family too much,’ he admits.

‘I’d take drives, leave my phone behind so I couldn’t be tracked, but I always came back. My Christian faith played a huge role in that – as though I was being told, “You don’t want to do this”.’

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Following the altercation with his work colleague, Matt says he finally admitted how he felt about himself. He took six months off work and began talking therapy, including cognitive behavioural therapy (CBT), which he found transformative.

‘It took a few tries, but one-to-one therapy and CBT were incredibly helpful. CBT allowed me to contextualise feared events and consider what the outcomes and impact would be – rationalising the situations that caused my anxiety.’

Interestingly, Professor Branney’s research has found CBT is particularly effective in men because ‘it focuses on the here and now and is very practical’.

Another suggestion from Matt’s therapist, getting a dog, also brought unexpected joy in the form of Bryn, a Welsh Border Collie. ‘He gave me purpose, got me outside, and somehow seemed to understand how I was feeling. Walking him was and is really therapeutic.’

There are encouraging signs things are getting better for men’s mental health. ‘I’m seeing more young men, even teenagers, reaching out for help with emotional health issues, including eating disorders, which were previously seen as predominantly affecting women,’ says Dr Dharendra. He also highlights many initiatives that aim to foster conversations around men’s mental health, including public campaigns such as Movember, which raises awareness of men’s cancers and suicides, as well as MANUP and Men’s Minds Matter.

‘Community groups and peer support networks such as Men’s Sheds Association [where men meet to work together on repair tasks or odd jobs, while talking] also play a vital role in helping men connect with others,’ he adds.

Despite this, Dr Dharendra believes there is still much work to be done, particularly for men over 40, who he says often require tailored approaches to engage them in therapy as they struggle to open up.

He says he sometimes shares his own experiences to encourage patients to talk.

‘I might say, “I get anxious at work sometimes. How do you feel in similar situations?” It’s vital that we continue to break down barriers and encourage men to seek help before their struggles escalate.’

As for Matt, he is doing well. He decided to leave teaching and now works for an education software company. He still takes antidepressants – but says he has finally learned to talk openly about how he’s feeling.

‘If I’ve had a bad morning, I’ll say so to my wife and kids,’ he says. ‘I’ll apologise when I snap at them and explain why. It’s important for them to understand mental health and to know it’s OK to talk about it. I want other men to know it’s OK to talk about too.’

He adds: ‘I think of myself as a recovering depression sufferer. For me, it’s like an addiction – it never fully goes away, but I’ve learned to manage it. Too many men suffer in silence. Don’t let stigma stop you from getting the support you need.’

• For confidential help and support, call Samaritans on 116 123, visit samaritans.org