Understanding depression: It doesn't look the same for everyone

Depression doesn’t look the same for everyone, and gender plays a role. Hormonal differences, societal expectations, and stress coping styles all contribute. Because symptoms vary, it’s important to recognize the signs in yourself and loved ones. Whether it’s mood changes, sleep issues, or withdrawal from activities, seeking support early makes a big difference.

World Mental Health Day is the perfect reminder to check in on your mind just like you do your body. Mental health matters! Whether you’re dealing with stress, anxiety, or depression, taking care of your emotional well-being is essential.

We at TOI spoke to Dr Shilpa Srinivasan, Consultant Psychiatrist, Psycho-Oncologist, VS Hospitals, Chennai and Dr Yayathee Subbarayalu, Consultant Psychotherapist, Rela Hospital, Chennai; Dr. Rohan- Consultant, Psychiatry, Regency Health, Kanpur on how depression differs in men and women and how to take care of mental health.

We often hear that depression affects everyone, but is it true that men and women experience and express it differently? How so?
Depression affects both men and women, but they often experience and express it differently, as explained by Dr. Shilpa Srinivasan and Dr. Yayathee Subbarayalu. While common symptoms like low mood, low energy, loss of interest, and sleep disturbances can occur in both genders, men are more likely to externalize their struggles through anger outbursts, aggression, substance use, or risk-taking behaviors, whereas women tend to internalize symptoms, focusing on sadness, guilt, hopelessness, and self-criticism.

According to Dr. Subbarayalu, women are nearly twice as likely as men to be diagnosed with depression, particularly after puberty, and hormonal changes during menstruation, pregnancy, postpartum, and menopause can increase vulnerability. Dr. Srinivasan adds that men may mask emotional symptoms, partly due to testosterone and societal pressures to appear strong and self-reliant, which contributes to underdiagnosis and their higher suicide rates — three to four times greater than women.

Social and cultural factors also play a role: women often juggle stressors like caregiving, poverty, or abuse, while men face expectations to suppress emotions, limiting help-seeking. Understanding these differences, as highlighted by Dr. Srinivasan and Dr. Subbarayalu, is crucial for early recognition, support, and effective treatment, ensuring that depression doesn’t go unnoticed in either gender.

How do these gender roles impact the way depression is experienced or diagnosed?
Dr. Rohan: Social expectations deeply influence how men and women experience and express depression. Men learn early that being “strong” means staying silent. There is pressure to appear resilient, and a boy grows into a man who feels the same pain inside, but suppresses feelings of sadness or vulnerability, leading to what’s known as “masked depression.” Instead of openly expressing emotional pain, men may show signs through irritability, anger, withdrawal, or even substance use, symptoms that are often overlooked or mistaken for personality traits rather than indicators of mental distress.

Women, on the other hand, are expected to “stay nurturing” and emotionally available. While this makes it more socially acceptable for women to talk about their feelings, it also creates a double burden. They are allowed to cry, but only just enough and at the right time. Sometimes it is diagnosed late or dismissed with a simple “you’ll be fine” instead of real help. Their emotional distress is sometimes trivialized as being “too sensitive” or dismissed as hormonal fluctuations. This not only undermines their experiences but can delay proper diagnosis and treatment.

These ingrained gender roles shape not just individual coping mechanisms but also how depression is recognized and addressed in society. Men’s struggles often go unnoticed, while women’s are minimized or misinterpreted. Breaking these stereotypes is crucial — emotional expression should be seen as human, not gendered. Only then can mental health conversations become truly inclusive and empathetic.

Many cope with depression through risky behavior or substance use rather than seeking therapy. How can we break this stigma and encourage emotional openness?
Dr. Rohan: Depression often hides behind a mask of strength or indifference. Many people deal with it by turning to risky behaviors or using substances instead of asking for help. This happens because there is still a lot of misunderstanding about mental health and a strong stigma around showing emotions. Many believe that asking for help means they are weak, while harmful habits are seen as just phases that will pass.

To change this, we need to treat mental health as seriously as physical health. Doctors, teachers, and community leaders should start open conversations about depression. It is important to show that seeking therapy is a sign of strength and awareness, not failure. Early support and talking openly in schools, workplaces, and homes can make a big difference.

Adding mental health checks during regular doctor visits can help people get used to discussing their feelings. The media and public figures also have a role in changing how we think about mental health. When people see that being vulnerable is okay, more will feel safe to ask for help. Healing starts when we accept that mental health problems are real, treatable, and deserve kindness, not judgment.

World Mental Health Day is about awareness and empathy. What can families and partners do to better recognize depression in their loved ones, regardless of gender?
Dr Shilpa Srinivasan: On World Mental Health Day, awareness should begin at home. Families and partners can play a powerful role in identifying depression early, regardless of gender. Understanding depression doesn’t always require medical training; it often starts with empathy and attentiveness. Subtle changes such as no interest in activities, irritation, lack of interest in conversations, disrupted sleep, or loss of appetite can be red flags. Loved ones should approach these changes with kindness rather than criticism, creating a safe space for honest conversations.

Dr Yayathee Subbarayalu: As we celebrate World Mental Health Day, families and partners have an important role in early recognition. Paying attention to subtle behavioural shifts can make all the difference. Noticing when a person becomes unusually quiet, withdrawn, irritable, or restless is key. Offering a nonjudgmental space to talk is more effective than trying to “fix” the problem. Asking gentle questions, showing consistent support, and encouraging professional help can guide someone out of silence and toward healing.

Finally, if you could give one piece of advice to men and one to women struggling silently with depression, what would you say to each?
Dr Yayathee Subbarayalu: For men, your emotions are not a threat to your strength. Talking about them is a powerful act of courage. Suppression doesn’t make pain disappear, it will only increase it. For women, you do not have to carry the weight of the world alone. Seeking help is not selfish, it is a step toward reclaiming your well-being. Depression may express itself differently across genders, but the path to healing begins the same way for everyone with connection, and the courage to speak.

Dr Shilpa Srinivasan: For men struggling in silence, it is strength but it’s not about suppressing pain it’s about having the courage to share it. Reaching out is an act of strength, not weakness. For women, your emotions are not a burden, and seeking help is not a sign of failure. Depression is a medical condition and not personal failure. Whether through professional therapy, or trusted loved ones, speaking up is the first and most powerful step toward healing.