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Depression: The Hidden Epidemic

Why male depression stays hidden.

Depression is often considered a "female disease," since affected women reportedly outnumber men by four to one. Yet male depression may be more rampant than we realize.

Many men try to hide their condition, thinking it unmanly to act moody. And it works: National studies suggest that doctors miss the diagnosis in men a full 70% of the time. But male depression also stays hidden because men tend to express depression differently than women do.

Research shows that women usually internalize distress, while men externalize it. Depressed women are more likely to talk about their problem and reach out for help; depressed men often have less tolerance for internal pain and turn to some action or substance for relief. Male depression isn't as obvious as the defenses men use to run from it. I call this "covert depression." It has three major symptoms. First, men attempt to escape pain by overusing alcohol or drugs, working excessively or seeking extramarital affairs. They go into isolation, withdrawing from loved ones. And they may lash out, becoming irritable or violent.

The causes of depression differ in men and women, as well. While depressed women often feel disempowered, depressed men feel disconnected, from their needs and from others. This begins in childhood, as society teaches boys early on to pull away from their mothers, their emotions and their vulnerabilities.

Reconnection is key. Treatment first requires resolving the violent or self-medicating behaviors—the affair, the drinking, the workaholism—so that the underlying condition can be grappled with. But the ultimate cure lies in reestablishing connection. The ideal of male stoicism and the ensuing isolation lie at the root of male depression. Intimacy is its most lasting solution.