By Dr Bradley Powell, Clinical Psychologist and Co-founder of Regal Private Therapy Practice, Harley Street, LondonContent note: This article discusses suicide. If you need support right now, call Samaritans free, day or night, on 116 123. If a life is at risk, call 999.
November is Men's Health Awareness Month, and International Men's Day falls on 19 November. Every year the conversation turns to moustaches and helping men to open up; I’m only good at the latter.
In my work as a Clinical Psychologist, the men I think about most are often the ones nobody would think to worry about. They turn up to work, they’re the funny one in the group chat, and they never miss a match. However, on the inside, they are running on empty.
There is a phrase for this that more and more people in the UK are searching for: high-functioning depression.
So what is it? And why are men often so good at hiding it, and most importantly what can you do if you recognise it in yourself or in someone you care about.
What masking depression looks like
In October 2023, Norwich City Football Club released a short film for World Mental Health Day, made with Samaritans.
The film follows two friends at Carrow Road across a season. One is withdrawn, quiet and visibly weighed down. The other is animated and chatty, the life of the stand. In the final scene, the quiet friend sits alone and lays his scarf over the empty seat beside him. The closing message is simple: sometimes the signs are harder to spot.
It’s had just shy of 300 million views since it was published on YouTube, and in its launch week it prompted more than 7,500 messages to Samaritans. I think it landed because so many of us recognised someone in it. From a clinical point of view, it is one of the clearest portrayals of masking I have seen, showing the world a version of yourself that hides what you are really feeling.
What is high-functioning depression?
High-functioning depression is where someone continues to work, socialise and meet their responsibilities, all whilst feeling sad, fatigued, emotionally exhausted, difficulties enjoying their usual activities, amongst other symptoms. It is not a formal diagnosis, but it often overlaps with persistent depressive disorder (dysthymia) or with long-lasting symptoms that fall just below the threshold for a diagnosis of depression, but are still clinically meaningful.
You may also hear it called smiling depression. Bupa's analysis of UK search data found that searches for "high functioning depression" tripled in a single year, which tells me a lot of people are quietly asking whether this describes them.
When people with depression continue to function, their distress is often unnoticed or misattributed (BJPsych Bulletin, 2026). Loved ones might say, “You can’t be depressed because I saw you smiling” the individual might feel that they can’t show the sadness because they are worried what others will think, all of which compounds stigma and help seeking.
Delayed recognition carries real risks, including progression to major depression and suicidality. NICE's guidance on depression in adults also recognises that persistent symptoms below the diagnostic threshold still deserve assessment and treatment.
Just because you are functioning, doesn’t mean you are okay. If you notice something off it’s better to speak to someone sooner rather than later; the longer symptoms persist the harder they can be to treat.
But why are men so good at masking?
Nobody is born knowing how to mask. They learn it, and many men learn it early. Most guys growing up will have heard something to the effect of “man up” or “boys don’t cry”. In a 2023 YouGov survey, 60% of British men said they tend to keep their feelings to themselves, compared with 53% of women. This is all despite growing awareness of mental health, illustrating how harmful messages continue to persist despite campaigning efforts.
Depression can also look different in men. A large US study published in JAMA Psychiatry found that men were more likely than women to report anger attacks, aggression, substance use and risk-taking. When those symptoms were counted alongside the "classic" ones, men and women met the criteria for depression in roughly equal numbers (30.6% of men and 33.3% of women). If we only look for sadness and tears, we can miss a lot of men.
Men are also less likely to come forward for help. Men made up only around a third (32%) of referrals to NHS Talking Therapies in 2023 to 2024.
But the stakes are high. In 2024, the suicide rate for men in England and Wales was 17.6 per 100,000, compared with 5.7 for women, and men have accounted for around three-quarters of suicides since the mid-1990s. Suicide is preventable, and noticing early is one of the most powerful things any of us can do.
How do you tell if someone is hiding depression?
So how do you tell if someone is depressed but hiding it? There is no single giveaway, and none of these signs on its own means someone is depressed. What I look for is a pattern, and a change from what is normal for that person:
More irritability or a shorter fuse than usual, sometimes aimed at the people closest to them.
Drinking more, or leaning on other ways to switch off, such as gambling, gaming or endless scrolling.
Working longer and harder. Staying busy can be a very effective way of not feeling anything.
Taking more risks, whether that is driving, spending or picking fights.
Present but absent. Still turning up, but quieter, less engaged, and leaving early.
Losing interest in things they used to love. Psychologists call this anhedonia, and it sits at the heart of many accounts of high-functioning depression.
Changes in sleep, energy or appetite, often explained away as stress.
Humour as deflection. Jokes that land a little too close to home, or a quick laugh that shuts the conversation down.
The automatic "I'm fine." One Mental Health Foundation survey found the average UK adult says "I'm fine" 14 times a week, but only 19% really mean it.
How to check in on a mate
You do not need to be an expert to help. These are the approaches I share with families and friends:
Pick your moment. Many men find it easier to talk side by side than face to face: on a walk, at the pub, in the car, or on the way to the match.
Ask twice. "How are you?" usually gets "fine." A gentle "No, really, how are you doing?" tells them you actually want to know.
Be specific. "You've seemed quieter the last few weeks", “ “I’m here if you want to chat”, is easier to respond to than "Are you depressed?"
Listen more than you fix. Resist jumping to advice, feeling heard is often the first step towards getting help.
Ask directly about suicide if you are worried. Saying the word can feel frightening, but research shows that asking someone about suicide does not put the idea into their head. It gives them permission to be honest.
Help them take the next step. Offer to sit with them while they call their GP or a helpline, and check in again a few days later.
If you are the one wearing the mask
If parts of this feel familiar, that is not weakness.
It usually means you have been carrying a lot, for a long time, without a break. Masking takes enormous energy, and it’s understandably exhausting. Often it makes life harder, if you don’t have the energy to mask, most people withdraw more. Try to let one of your friends know, which will remove the pressure to always be upbeat.
Depression responds well to treatment, and there are nationally recommended talking therapies such as cognitive behavioural therapy (CBT) for depression, including persistent symptoms. Your GP is a good first step, and in England you can also self-refer to NHS Talking Therapies by googling “self referral”.
At Regal Private Therapy Practice, our team of doctoral Clinical Psychologists and therapists works with men who look fine on the outside but are struggling underneath. We offer evidence-based therapies, including CBT and acceptance and commitment therapy (ACT), at a pace that suits you, and I also offer EMDR. Whatever route you choose, the most important step is telling someone.
Frequently asked questions
Is smiling depression real? "Smiling depression" is not a clinical diagnosis, but the experience it describes is very real: depressive symptoms hidden behind a cheerful or capable surface. Clinically, it often overlaps with persistent depressive disorder or with depressive symptoms that are being masked.
Can you be depressed and still function normally? Yes. Many people keep working and socialising while living with persistent low mood, exhaustion or emptiness. Being able to cope on the outside does not mean you are not struggling, and it does not mean you do not deserve support.
What does depression in men look like? Alongside low mood, depression in men can show up as irritability, anger, drinking more, risk-taking, overworking and withdrawing from friends. Because these signs do not always match the stereotype of depression, they are easy to miss.
Check in this November
The Norwich City film ends with a scarf on an empty seat. It is a hard image, but its message is hopeful: we can notice, we can ask, and we can act. This Men's Health Awareness Month, think of the friend who always seems fine and send the message. If that friend is you, let someone in.
Need support now? Call Samaritans free on 116 123, any time. In England, call NHS 111 and select the mental health option. If a life is at risk, call 999 or go to A&E.
References
Okereke PU, Umeh CV, Okereke WO, Ndayambaje E, Obetta CC, Uzor OF, Oduola OJ. High-functioning depression: a hidden burden demanding clinical recognition. BJPsych Bulletin. 2026;50:111-113.
Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry. 2013;70(10):1100-1106.
Joseph JF, Tural U, Joseph ND, et al. Understanding high-functioning depression in adults. Cureus. 2025;17(2):e78891.
National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022.
Office for National Statistics. Suicides in England and Wales: 2024 registrations. Published 3 October 2025.
NHS Digital. NHS Talking Therapies for anxiety and depression, annual report 2023-24, as cited in London Assembly Health Committee, Men's mental health in London.
YouGov. International Men's Day: 5 insights into British men's mental health. 17 November 2023.
Mental Health Foundation / OnePoll. "I'm Fine" survey.
Bupa UK. High-functioning depression: do you know the symptoms? 2025.
Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine. 2014;44(16):3361-3363.
Marketing Week. How Norwich City went global with its mental health message.
Samaritans. Media guidelines for reporting suicide (editorial standard followed, not cited in the text).
