Headaches, anger and exhaustion: One man’s decade-long depression and the warning signs often missed in men

Matt Earl thought he was just stressed and overworked until a violent outburst at a work night out forced him to confront a decade of mounting symptoms that he now recognises as depression.

Earl, 45, said the incident — when a colleague’s remark about choosing family over a teaching career left him "boiling with rage" — marked the point he accepted he was having a mental health crisis. He spent the following weekend crying, took six months off work and later began cognitive behavioural therapy; he remains on antidepressants and now speaks publicly about how male depression can present as anger and physical complaints rather than overt sadness.

Earl, who lives in Gloucester with his wife and two children, told reporters he experienced irritability, increased sound sensitivity, frequent headaches, migraines, neck pain and persistent fatigue for years. He recalled losing the ability to run, losing motivation and snapping at family and pupils — behaviours he said he dismissed until a GP suggested depression seven months before his breakdown. "I was still in denial," Earl said, adding that he had worried about being seen as weak.

Researchers and clinicians say Earl’s experience fits a documented pattern in which men express depression with anger, risk-taking, isolation, substance misuse and physical symptoms, and are therefore less likely to be recognised and treated. A 2008 review led by psychologist Peter Branney, published in Advances in Psychiatric Treatment and widely known as Big Boys Don’t Cry, identified avoidance, self-medication, aggression and unexplained physical complaints as more common presentations among men.

More recent work has reinforced the gap in identification. A European review published in 2023, Real Men Don’t Talk, found a substantial number of men do not share mental distress and that persistent low-grade depression increases isolation and decreases disclosure. Public health statistics underscore the stakes: men accounted for about three-quarters of registered suicides in England and Wales in 2023, with a male suicide rate of 17.1 per 100,000 in England and 22 per 100,000 in Wales, compared with female rates of 5.6 and 6.3 per 100,000 respectively.

"It’s easier for men to say they’re having headaches than to admit they are struggling mentally," said Dr. Adarsh Dharendra, a consultant psychiatrist at the Priory Group who also works with the NHS Crisis Service in Wiltshire. He and other clinicians caution that traditional masculine norms — including expectations of stoicism and self-reliance — can shape how men communicate distress and delay help-seeking.

Psychotherapist Anthony Davis, an accredited member of the British Association for Counselling and Psychotherapy (BACP), said clinicians often see men minimise their feelings or present only after a crisis such as relationship breakdown or workplace burnout. "Men often experience what is termed ‘male-typical depression’ because their experiences are shaped by masculine social norms," Davis said. "As a result, men’s distress may be misinterpreted as behavioural issues or personality traits, rather than symptoms of mental ill health."

To improve recognition, the BACP launched its RAISE campaign in 2023, a mnemonic designed to highlight common male presentations: Risk-taking, Anger, Isolation, Substance abuse and Exhaustion. Professor Peter Branney, now an associate professor at the University of Bradford and co-author of Big Boys Don’t Cry, said the failure to identify milder forms of depression in men can allow conditions to escalate — a pattern he describes as a "big build" leading to more severe illness and overrepresentation of men among those requiring inpatient care.

Branney’s work and clinicians point to social and occupational factors that elevate risk. Unemployed men, men in manual jobs, highly competitive workplaces and some City roles often reward toughness and discourage emotional openness. Mid-life, when pressures around work, family and health converge, is another period of heightened vulnerability.

Biological differences may also contribute to divergent presentations. Dr. Dharendra cited research suggesting testosterone can amplify irritability and referenced a 2024 brain-scan study in BMC Psychiatry that reported differing patterns of structural brain change in men and women with major depressive disorder. The study found reduced ventrolateral prefrontal cortex area in women and differences in dorsomedial prefrontal cortex volume in men — regions linked to emotional regulation and perspective-taking respectively.

Earl told reporters that he initially resisted medication and downplayed the GP’s suggestion that his headaches and fatigue might be linked to anxiety and depression. He said he had thought often about suicide during his worst periods but was repeatedly held back by his faith and ultimately by seeking help after the workplace incident. He described cognitive behavioural therapy as "transformative," saying it helped him reframe feared events and address the practical problems that fuelled his anxiety.

Therapists and researchers have noted that practical, present-focused therapies such as CBT can resonate with men. In Earl’s case, an early suggestion from his therapist to get a dog produced tangible benefits: a Welsh border collie named Bryn, whose walks gave Earl routine and time outside.

There are signs of improved engagement among younger men, clinicians say, and a growing number of public campaigns and community groups aimed at fostering conversations about male mental health. Initiatives mentioned by Dr. Dharendra include Movember, MANUP and Men’s Minds Matter, as well as grassroots gatherings such as Men’s Sheds, where men work together and talk in informal settings. Still, clinicians emphasise more work is needed to tailor services for men, particularly those over 40 who may struggle to open up.

Earl, who left teaching and now works in educational technology, said he has learned to talk about his feelings with his wife and children, acknowledging bad days and apologising when he snaps. He described his condition as chronic and manageable rather than curable: "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."

Clinicians encourage friends, family and primary care practitioners to recognise non-traditional signs of depression in men and to offer practical, nonjudgmental support and referral options. For confidential help and support, Samaritans can be contacted at 116 123 or online at samaritans.org.