Every year, depression afflicts more that 11 million Americans, but men account for only 1 in 10 diagnosed cases.

Because of this, depression was once considered a “woman’s disease,” linked to hormones and premenstrual syndrome. Unfortunately, this lingering stereotype of depression being a female condition may prevent some men from recognizing its symptoms and seeking appropriate treatment. According to Therapist, Terrence Real, best-selling author of I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, “It’s not considered unwomanly to be emotional and vulnerable, but a real man would never be so ‘weak’ as to let his emotions get the best of him.” Real continues, “There’s a lot of shame involved, and this sets up what I call Compound Depression—a man gets depressed about being depressed.”

In reality, depression affects both men and women, disrupting relationships and interfering with work and daily activities. The symptoms of depression are similar for both men and women, but they tend to be expressed quite differently. The most common symptoms of depression include low selfesteem; suicidal thoughts; loss of interest in usually pleasurable activities; fatigue; changes in appetite; sleep disturbances; apathy; and sexual problems, including reduced sex drive.

There are several reasons why the symptoms of depression in men are not commonly recognized:

• Men tend to deny having problems because they are supposed to “be strong”
• American culture suggests that expressing emotion is largely a feminine trait. As a result, men who are depressed are more likely to talk about the physical symptoms of their depression, such as feeling tired, rather than those related to emotions
• Depression can affect sexual desire and performance. Men often are unwilling to admit to problems with their sexuality— mistakenly feeling that the problems are related to their manhood, when in fact they are caused by a medical problem such as depression
• The observable symptoms of male depression are not as well understood as those in women
• Men are less likely to show “typical” signs of depression, such as crying, sadness, loss of interest in previously enjoyable activities, or verbally expressing thoughts of suicide. Instead, men are more likely to keep their feelings hidden, but may become more irritable and aggressive

For these reasons, many men—as well as doctors and other health care professionals—fail to recognize the problem as depression. Some mental health care professionals suggest that if the symptoms of depression were expanded to include anger, blame, lashing out, and abuse of alcohol, more men might be diagnosed with depression and treated appropriately.

Regardless of what types of symptoms men experience, depression can have devastating consequences. The Centers for Disease Control and Prevention report that men in the U.S. are about four times more likely than women to commit suicide. A staggering 80 percent of all people who commit suicide in the U.S. are men! Although more women attempt suicide, more men are successful at actually ending their lives.

WHY is Depression Different in Men?
Understanding how men in our society are brought up to behave is particularly important in identifying and treating their depression. Depression in men often can be traced to cultural expectations: Men are supposed to be successful; they should restrain their emotions; they must be in control. These cultural expectations can mask some of the true symptoms of depression, forcing men to instead express aggression and anger, which is viewed as more acceptable male behavior.

In addition, men generally have a harder time dealing with the stigma of depression and may tend to deal with their symptoms with a ‘macho’ attitude or by drinking alcohol. This attitude still pervades many maledominated institutions, such as the military and athletics, where men are taught that “toughness” means putting up with physical pain, and where admitting to emotional distress is taboo. Rather than seek help, which means admitting to what they perceive as a weakness, men may be more likely to deal with their depression by drinking heavily or committing suicide.

Special Consideration … Bereavement
Men also tend to deal with the loss of a loved one differently than women. This also may be related to the belief that men must be strong in the face of adversity, and that showing emotion is a sign of weakness. Men tend to assume full responsibility for their bereavement and suppress their grief. Studies show that this suppression can increase the time it takes to grieve, and lead to complications, such as escalating anger, aggressiveness, and substance abuse. Physical symptoms may include increased cholesterol levels, ulcers, high blood pressure and pain.

Because they feel unable to openly express their feelings, many men deal with grief by taking on more activities—such as working overtime or going on business trips—to occupy their time. They may become involved in risktaking behavior, such as dangerous sports or compulsive sexual activity. Some addictive behaviors, such as alcohol or other drug abuse, can escalate as the result of suppressed grief.

Can Depression in Men be Treated?
More than 80 percent of people with depression—both men and women—can be treated successfully with one, or a combination, of the treatment methods listed below:

• Antidepressant medication specifi cally treats depression with generally positive results
• Counseling and psychotherapeutic work can be in a group or on an individual basis. In a group setting, it can be very therapeutic to see that there are many people experiencing the same things you are
• In some instances, for profound depression, Electroconvulsive Therapy (ECT) may be suggested

You can contact your family doctor or specialist mental health workers, such as psychiatrists, psychologists or social workers if you believe you are experiencing depression. Depression can be very successfully treated or certainly improved. “Depression is one of psychiatry’s great success stories, and study after study shows that 90 percent of men who receive help get significant relief,” encourages Real. “Unfortunately, somewhere between 60 to 80 percent of depressed men never get the treatment they need. And that is a heartbreaker.”