Irritability, apathy, "nothing brings joy": men's mood after 40

You snap at the people close to you over small things. Work that used to grip you has become a burden. You want to shut yourself off and have a drink in the evening "to take the edge off". Many men wouldn't call this "sadness" — and that's exactly why it so often goes unnoticed.

What male depression looks like

In men, depression often hides. Instead of tears and gloom it looks like this:

• irritability, a short temper, outbursts of anger;
• escaping into work or alcohol;
• risky behaviour;
• physical complaints — aches, stomach trouble, "no energy";
• loss of interest and desire.

Men say "I'm not okay" less often and seek help less often. So this state gets put down to character, tiredness or "low testosterone". And depression is treatable.

Testosterone, sleep and the thyroid

Low mood overlaps strongly with short sleep and apnea, functionally low testosterone and, less often, the thyroid. These are worth checking with a doctor. But there's no need to prescribe yourself testosterone "for mood": if your level is normal, the hormone doesn't fix mood.

What helps

Movement. Regular aerobic and strength exercise is one of the strongest ways to lift mood without medicines.

Sleep. Get up at the same time all seven days. If you snore with pauses and feel sleepy during the day — get checked for apnea.

People. Loneliness is a real risk factor, especially for men. Meeting a friend, a phone call, a shared project work better than you'd think.

Daylight. Getting outside, especially in the morning.

Less alcohol. It depresses mood by itself and wrecks sleep. "Unwinding" with it means making tomorrow harder.

Slow breathing. About six breaths a minute for five minutes. The tension eases within minutes.

Psychotherapy, including cognitive behavioural therapy, is the core of help if mood is getting in the way of life. It's not "mood supplements".

If you take tablets for the prostate or for hair loss

Finasteride and dutasteride carry a signal of lowered mood, more often in the first months. Don't stop them on your own, but if your mood has changed for good on these tablets — tell your doctor right away.

When to get help — right away

• Any thoughts of harming yourself, or that "it would be better not to live", — get help from a professional or a crisis line right away. This is not something to wait out.
• Low mood, irritability or loss of interest almost every day for more than two weeks — see a doctor within the next few days.

What to try this week

• Three 20–30 minute walks in daylight.
• One meeting or call with someone you haven't spoken to in a long time.
• A week without evening alcohol.

This is general information, not a prescription. Tests and treatment are chosen by a doctor.