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Introduction: Depression strikes about 20 million American adults each year. Twice as many women as men suffer from it, according to government figures. But some experts believe that the wide gap in numbers between the sexes may be misleading. New research from the National Institute of Mental Health, for example, suggests that depression in men often goes unrecognized. Is that because men are more reluctant to seek help? Or because depression symptoms are different in men? Many clinicians and researchers think it's a combination of both. Laurie Udesky files this report.

Laurie Udesky: One morning in 1994, writer Andrew Solomon awoke and could not move. He thought he must have had a stroke.

Solomon: I felt that I was completely paralyzed. I kept staring at the telephone and thinking I should call someone. But I couldn't bring myself to reach out and pick up the phone. It was too difficult. It was too overwhelming and it was too frightening, and after lying there for four and a half hours and staring at the phone, someone called and I said something terrible has happened to me. I really need help.

Udesky: But it wasn't a stroke. Solomon's paralysis followed months of gradually deepening depression.

Solomon: I had been feeling perfectly all right, then I began to feel a little bit tired all the time. And then everything began to seem difficult. I felt like eating a meal -- the idea that you had to cut your food up, and get it on to a fork, and lift it to your mouth and chew it and swallow it -- it all began to seem like more than I could tolerate.

Udesky: Solomon's slide into depression -- and his exhaustive study into the causes and treatment of it -- gave rise to his evocative book on the subject, The Noonday Demon: An Atlas of Depression. He traces the beginnings of his own illness as a delayed reaction to his mother's death years earlier. Solomon thinks that men who experience depression, as he has, feel as though they're becoming invisible.

Solomon: I think a great deal of what goes wrong in the male-dominated world comes out of people who are depressed, and who feel that despair and who get the feeling, which is endemic to depression, that they're disappearing, that they're vanishing, and that their masculinity is profoundly compromised. I think for me there were certain ways that I responded that were specific to my being male, a certain amount of closing down, that I did more readily, disconnecting from the emotional world, possibly having less of a connection to the emotional world in the first place.

Udesky: To psychotherapist Terrence Real, author of a groundbreaking book on male depression called, I Don't Want to Talk About It, the emotional disconnection that Solomon refers to is at the core of male depression.

Terrence Real: When women are depressed, 99 out of 100 times you're dealing with people who have lost their voice. With depressed men the issue isn't that so much, it's disconnection, and that goes right to the way we raise boys, the way we turn boys into men is through disconnection. We pull them away from their mothers, we now think far too early. We teach them to disconnect from their feelings, disconnect from their vulnerabilities, and to be honest, disconnect from caring all that much about others. And when I deal with a depressed man, I am always dealing with a guy who is cut off.

Udesky: Men who are cut off, says Real, may not even realize they are depressed. Rather than expressing sadness, men who are depressed may appear unusually angry and unreasonable.

Real: When men are distressed, we tend to externalize. They reach out. They get into action, and for years that was one of the favorite explanations about why men are quote unquote, protected from depression. Well, many of the things that men move toward, like drink, or compulsive behavior or rage are not good. I don't think that they protect men from being depressed. I just think they protect men from feeling depressed. And they don't work all that well. And even when they do work, they come at a very high cost to their lives.

Udesky: If you had asked an ironworker we'll call Joe what was bothering him 18 months ago, he never would have told you he was depressed.

Ironworker: I got short tempered, I got highly agitated and irritable at little things and everyone would say things like, "What's wrong with you?" And I'd say "Nothing." You'd blame it on every other thing than what it really was, because you're supposed to be macho and you're supposed to be a guy. You know you don't get depressed. You don't even recognize it.

(Ambient sound from construction site)

Udesky: This is the familiar sound of a building site, not unlike the one where Joe works with his fellow union members of Local 580.

Ironworker: Basically we do a variety of things, anything from a staircase to the facing of a building, like take the World Trade Center, the whole outside aluminum facing was done by 580.

Udesky: Ironically, his local was among the rescue workers clearing away the debris from the towers they had helped build, and searching for signs of life. That was the trigger for Joe's depression.

Ironworker: Before 9/11, I lost a brother. I lost my mother. In stride you take it, that's part of life. My other brother was a fireman and on 9/11, he went down in the north tower. And basically, I went there hoping that he wouldn't have been one of the victims, much less one of the 340 firemen who died. I come to realize that he was. It's... I don't know how you want me to put this. You know, I didn't know that I was depressed or think that I was depressed at all. I stopped giving a crap about anything. It didn't matter.

Udesky: Joe, however, sought help for his depression -- although it wasn't his idea.

Ironworker: In my case, it was my wife saying, "Either you go get help or we're going to have to separate. Because I was that out of hand."

Udesky: Joe saw a psychiatrist who prescribed antidepressants, and they've taken off the edge. It's allowed him, he says, to be more involved in life again. He still has good days and bad days. But he says that other men who may be depressed could save themselves a lot of wasted time if they look at the larger picture.

Ironworker: Basically you've got to look at yourself and say, hey, is this what I want for the rest of my life? Is this how I'm going to be? If people start leaving you and getting away from you because you're that unstable, that's a pretty good clue that you need to do something. So it's recognizing that you've got the problem, and then realizing that there are steps to take. And you've got to feel comfortable with who you're dealing with. I think that's a big thing. It doesn't mean you're off your rocker or you're a nut job.

Udesky: Andrew Solomon finds that talk therapy and medication help him feel better. But he wishes he hadn't resisted taking antidepressants for as long as he did.

Solomon: I think that people somehow think that if you just sit it out, that's brave and heroic. But actually, you don't get those years back, and you don't get the relationships back that you've destroyed, and you don't get the professional opportunities that you've missed back. People don't recognize; men don't recognize how much they lose.

Udesky: Because men are less likely to recognize that they're depressed -- and because depressed men are four times more likely than women to kill themselves -- the National Institute of Mental Health is starting a campaign to encourage men to seek treatment for this insidious disease. Solomon, for one, thinks this outreach comes none too soon.

Solomon: If you start dealing with the depression when it sets in, turning it around is much easier than it will be if you wait until it becomes desperate. I wish that I had dealt with my depression sooner. I don't think I needed to go to the depths that I went to.

Udesky: For Consumer Health Interactive Radio in San Francisco, I'm Laurie Udesky.

First published September 23, 2003
Last updated February 19, 2008
Copyright © 2003 Consumer Health Interactive