By Mary Elizabeth Dallas

Depression is often seen as a problem mainly affecting women. Ironically, that’s one of the reasons why the condition is underreported among men, according to Amit Anand, M.D., a professor of medicine at the Cleveland Clinic's Lerner College of Medicine and vice-chair of research at its Center for Behavioral Health.

Although women are 70 percent more likely than men to have depression, more than 6 million men in the United States struggle with the condition each year, according to the National Institute of Mental Health. However, several obstacles prevent many of them from seeking treatment, Anand says. These barriers to care not only affect how men with depression are diagnosed, he says, but also how they are treated.

Why Depression Is Underreported

Several factors contribute to depression often being unreported and undiagnosed in men. For starters, men who are depressed may not recognize their symptoms. “Women are far more likely to acknowledge that they have depression and seek help,” Anand says.

Also, symptoms of depression vary from person to person, and symptoms may not always be obvious, according to NIMH. Complicating matters is that, rather than showing such signs of depression as sadness and crying, men who are depressed often suppress their feelings, reports the National Alliance on Mental Illness.

Men and women also have different risk factors for depression that could affect whether they seek treatment, according to a study published in 2014 in the American Journal of Psychiatry. The factors most directly linked to depression among women are divorce, lack of parental or social support, and marriage troubles. For men, however, depression is more closely linked to drug abuse as well as financial, legal, and work-related stress, the researchers say. Their research suggests that men are less likely to seek medical attention if they attribute depression to career disappointment or failures. Rather than seek help, Anand says, men with depression are more likely to try to tough it out.

As Dean F. MacKinnon, M.D., an associate professor of psychiatry at the Johns Hopkins School of Medicine in Baltimore, says, "Men may be more likely to suffer in silence or try to self-medicate with alcohol or drugs."

Men may see their symptoms as a sign of weakness, he explains, likening the situation to the idea that men don't like asking for directions. “Men don't ask for direction because it makes them seem weak, but also they are afraid they won't get the right information,” MacKinnon says.

Men might also be worried about the social stigma associated with a diagnosis of depression, according to research published in Qualitative Health Research in 2014.

In addition, depression affects men differently than women, according to a study published in JAMA Psychiatry in 2013. Though women usually have traditional symptoms, such as feelings of sadness and worthlessness, the study found that men with depression were more likely to experience anger and irritability and to engage in risky behaviors. This suggests that if men are using traditional criteria to assess their symptoms, their depression could go unreported.

Why Treatment Is Critical

What sets men and women with depression apart can also make the condition more difficult to treat, Anand notes. Men with untreated depression can experience issues like anger, aggression, and substance abuse. Using drugs and alcohol to self-medicate, he says, can complicate treatment for depression.

Untreated depression among men can also have tragic consequences, he adds. "Women may talk about suicide more, but men may be more likely to complete suicide," Anand notes. “They may also use much more violent means of trying to commit suicide, like guns or hanging.” In fact, according to NAMI, men are four times more likely to die of suicide than women.

Most adults with depression improve with treatment, usually a combination of talk therapy and medication, Anand says. He notes, however, that it can be difficult to convince some men to try talk therapy.

Medication used to treat depression may also work differently in men and women. For instance, today the most commonly prescribed antidepressants, according to NIMH, are SSRIs -- selective serotonin reuptake inhibitors. Tricyclics, which are older antidepressants, are not used as often today because they come with more serious side effects, like drowsiness, dizziness, and weight gain. However, some research suggests that women respond better to SSRIs -- like fluoxetine and sertraline -- and that tricyclics, like imipramine, may be more effective for men, Anand says.

SSRIs may also cause more sexual side effects, which tend to bother men much more often than women, Anand adds. This could result in fewer men following through on treatment, he says.

If your doctor does recommend an SSRI, adjusting the dosage or switching from one SSRI to another can help alleviate unwanted side effects, according to NIMH.