Where to start
There's no wrong door. Any of these is a good first step:
- Your primary care doctor. They can screen you, check for medical causes like low testosterone or thyroid problems, start medication, and refer you to therapy. Many people get their depression treatment entirely through primary care.
- A therapist directly. You usually don't need a referral.
- Your employer's EAP (employee assistance program), for a few free, confidential sessions and help finding ongoing care.
- The VA or a Vet Center if you've served. Vet Centers offer free counseling, often without needing VA health care enrollment.
If you're not sure how to bring it up, it can be as simple as this:
That's enough. Your doctor will take it from there.
Who's who
| Professional | What they do |
|---|---|
| Psychiatrist (MD/DO) | A medical doctor specializing in mental health. Diagnoses and prescribes medication. Some also provide therapy, but most focus on medication. |
| Psychiatric nurse practitioner | Prescribes and manages medication. Often easier to get an appointment with. |
| Psychologist (PhD/PsyD) | Provides therapy and psychological testing. Doesn't prescribe in most states. |
| Licensed therapist (LCSW, LPC, LMFT) | Provides therapy. Makes up most of the therapists in the U.S., and is often more affordable. |
| Primary care doctor | Screens, treats common depression and anxiety with medication, and refers. |
Types of therapy
Therapy isn't just lying on a couch talking about your childhood. The best-studied approaches are structured, practical, and time-limited, often 8–20 sessions. Many men find that appealing once they try it.
- ✓CBT (cognitive behavioral therapy): identifying and changing unhelpful thought patterns and behaviors, with homework between sessions. Strong evidence for depression, anxiety, panic, and insomnia (CBT-I).
- ✓Behavioral activation: rebuilding activity and routine to lift mood. Simple, and as effective as CBT for depression in trials.
- ✓Problem-solving therapy: structured steps for tackling concrete life problems. Good for stress and burnout.
- ✓ACT (acceptance and commitment therapy): learning to live with difficult thoughts and act on your values rather than fighting your mind.
- ✓Interpersonal therapy (IPT): focused on relationships, conflict, grief, and life transitions.
- ✓Trauma therapies (prolonged exposure, cognitive processing therapy, EMDR): first-line treatments for PTSD, widely available through the VA.
- ✓Couples therapy: if relationship strain is part of the picture.
For moderate to severe depression, combining therapy with medication tends to work better than either alone.
Finding a therapist
- Start with your insurance. Call the number on your card or search your plan's directory for in-network mental health providers.
- Use a directory, like Psychology Today's therapist finder, which lets you filter by insurance, specialty, approach, and whether they see men's issues specifically.
- Ask about approach. "Do you use CBT or other evidence-based methods? How would you approach something like what I'm dealing with?"
- Give it three or four sessions. Fit matters. If it isn't working, it's normal and fine to switch. Therapists expect it.
A note on therapy apps and platforms: online therapy can be convenient and effective, but review the privacy policy before signing up. In 2023 the FTC took action against one large therapy platform for sharing users' health information with advertisers.
What it costs
- With insurance: federal parity law generally requires most plans to cover mental health on terms comparable to physical health. Expect a copay or coinsurance per session, and check your deductible.
- Self-pay: often $100–$250+ per session, depending on location and credentials.
- Lower-cost options: sliding-scale therapists, community mental health centers, university training clinics (supervised trainees at reduced rates), and nonprofit networks that connect people with reduced-fee therapists.
- Free options: EAP sessions, Vet Centers and the VA for veterans, and some support groups. Call 988 for help finding local resources, not just in a crisis.
Antidepressants
Antidepressants are effective for moderate to severe depression and for many anxiety disorders. They're not "happy pills" and they don't change your personality. They help lift the floor so you can function and do the rest of the work.
| Type | Examples | Worth knowing |
|---|---|---|
| SSRIs | Sertraline, escitalopram, fluoxetine | Usually first-line for depression and anxiety. Sexual side effects are common. |
| SNRIs | Venlafaxine, duloxetine | Also first-line. Duloxetine can help with chronic pain. Similar sexual side effects. |
| Bupropion | Wellbutrin | Least likely to cause sexual side effects or weight gain. Can help with energy and quitting smoking. Not a primary anxiety treatment, and not for people with seizure risk. |
| Mirtazapine | Remeron | Helps with sleep and appetite. Weight gain is common. Fewer sexual side effects. |
What to expect
- It takes time. Some improvement often shows in 2–4 weeks, with the full effect at 6–8 weeks. Side effects often show up first and ease over the first few weeks.
- The first one might not be the right one. Many people need a dose change or a switch. That's normal, not failure.
- Stay on it for at least 6–12 months after you feel better to reduce the risk of relapse.
- Don't stop suddenly. Stopping abruptly can cause discontinuation symptoms (dizziness, irritability, "brain zaps"). Taper with your prescriber.
- Under 25? Antidepressants carry an FDA warning about a small increase in suicidal thoughts early in treatment for young people. Close follow-up in the first weeks matters.
- Alcohol worsens depression and interacts with many medications. Cut back.
Sexual side effects
This is one of the most common reasons men stop antidepressants, often without telling their doctor. SSRIs and SNRIs can reduce libido, delay ejaculation, or make erections harder. Depression itself also causes sexual problems, so it isn't always the medication.
There are real fixes. Raise it with your prescriber:
- ✓Adjusting the dose.
- ✓Switching to bupropion or mirtazapine, which have lower rates of sexual side effects.
- ✓Adding bupropion to your current medication.
- ✓Adding an ED medication like sildenafil or tadalafil, which is generally safe alongside most antidepressants.
Don't just quit. There's almost always an option that works for both your mood and your sex life.
Anxiety medications
- SSRIs and SNRIs are first-line for ongoing anxiety.
- Buspirone: a non-addictive option for generalized anxiety.
- Hydroxyzine: a non-addictive antihistamine sometimes used as needed.
- Propranolol: a beta blocker sometimes used before presentations or other performance situations to blunt the physical symptoms (racing heart, shaking).
- Benzodiazepines (alprazolam, lorazepam, clonazepam): work fast, but carry a real risk of dependence and withdrawal, and are dangerous with alcohol or opioids. Best for short-term or occasional use only.
When first treatments don't work
About a third of people with depression don't respond fully to their first couple of treatments. That's called treatment-resistant depression, and there are good options:
Medication changes & combinations Established
Switching drug classes, or adding a second medication (another antidepressant, a low-dose atypical antipsychotic, or lithium), often helps. A psychiatrist is valuable at this stage.
TMS (transcranial magnetic stimulation) FDA-cleared
Magnetic pulses stimulate mood-regulating areas of the brain. It's typically done as daily outpatient sessions over several weeks, with no anesthesia, and you can drive yourself home. Newer accelerated protocols compress treatment into days. It's generally well tolerated and often covered by insurance after other treatments have failed.
Esketamine (Spravato) FDA-approved
A nasal spray related to ketamine, approved for treatment-resistant depression and for depression with suicidal thoughts. It's given only in certified clinics, with a couple of hours of monitoring afterward, and it often works faster than standard antidepressants.
ECT (electroconvulsive therapy) Established
Modern ECT is done under general anesthesia and is the most effective treatment for severe depression, especially when there's psychosis or severe suicidal risk. Short-term memory side effects are its main downside. It looks nothing like the old movie portrayals.
IV ketamine clinics Situational
IV ketamine is used off-label and has reasonable evidence for rapid, short-term relief, but clinics vary widely in screening and follow-up, and it isn't usually covered by insurance. The FDA has warned about the risks of compounded ketamine taken at home without monitoring. If you consider it, choose a clinic that works with your psychiatrist or therapist.
Psychedelic-assisted therapy Not yet approved
Psilocybin therapy is showing promise in clinical trials but isn't FDA-approved. The FDA declined to approve MDMA-assisted therapy for PTSD in 2024. A few states run regulated programs. Using psychedelics on your own carries real risks, especially with a personal or family history of psychosis or bipolar disorder, and with some medications.
What about testosterone?
For men with genuinely low testosterone, TRT may modestly improve mood and energy, and restoring normal levels is a reasonable part of treatment. But studies don't show a meaningful antidepressant effect in men with normal levels, and TRT isn't a replacement for depression treatment. If you have depression and low testosterone, treating both usually works best.
Be wary of any clinic that offers testosterone as a fix for low mood without a proper diagnosis, or without asking about your mental health history. Read the testosterone guide →