What looks and feels like depression to a woman may not to a man, which is why so many men in America are misdiagnosed or missed altogether.

However, considering that the rates of completed suicide of men are three to four times that of women, we need to educate ourselves about male depression and its unique symptoms. The following are 10 things you should know about male depression, compiled from Johns Hopkins Depression and Anxiety Bulletin and other sources.

1. Depression affects about 6 million American men and 12 million American women each year. But these numbers don’t tell the story of men, and older men, in particular.

2. Suicide in men peaks in the 20s and again in the 60s and 70s.

3. Many men experience “depression without sadness,” which makes it more challenging for primary care physicians to make the diagnosis of depression. Some of the symptoms of this kind of depression include severe anxiety, physical discomfort, sleep disorders, and diminished energy and self-confidence as some of its primary symptoms.

4. Men—more commonly than women—are likely to feel angry, irritable, and frustrated rather than sad when depressed.

5. Men tend to cope with depression differently than women. Instead of withdrawing from the world, men may act recklessly or develop a compulsive interest in work or a new hobby. Instead of crying, men may engage in violent behavior.

6. Men are more likely to abuse drugs and alcohol when in the midst of a depression, perhaps to find relief from the pain of depressive feelings. This can make it difficult to determine whether a problem is specifically alcohol-or-drug-related or whether it is primarily depression.

7. Men often report physical symptoms more often than women, such as headaches, joint pain, backaches, dizziness, chest pain, and digestive problems. However, they are often unaware that these symptom are linked to depression.

8. There may be genetic differences between depression in men and women. Five years ago, researchers from the University of Pittsburg identified 19 chromosomal regions linked to one form of major depression, but only three of them were significantly linked in both men and women. The other 16 were only linked in one sex.

9. A worrying recent trend is the increasing rate of suicide among younger men, a trend not seen among young women. The majority of these men have no asked for help before their deaths.

10. The higher suicide rate among men is a worldwide phenomenon. A few exceptions to the general rule exist, for example, among elderly women in Hungary and in some Asian countries. The reasons why men are more likely to kill themselves are complex, but risk factors include unemployment, social isolation, chronic illness, and certain occupations that have access to the means of suicide.

10 Things You Should Know About Male Depression