In centuries past, depression was something you lived with. At the end of the twentieth century, sufferers of depression are able to take an active role in their own diagnosis and treatment.

But men, statistics now clearly show, tend, more than women, to avoid help. They also exhibit higher suicide rates.

For years, depression has been described as a “woman’s disease,” with “melancholy” the problem of females, as depicted in Victorian-era fiction.

While women are diagnosed with depression twice as often as men are, lately doctors are recognizing and bringing to light the patterns and problems of men who suffer the condition. Consensus is forming regarding what to do about it.

“I would wake up in the morning and remember who I was, and where I was, and just want to roll over and go back and be unconscious again,” recounts Brian Coopper, who suffers depression.

Coopper was diagnosed with clinical depression when he was in college. “There is a history of mental illness in my family. There’s a degree of shame and stigma and denial,” he says. “I had no hopes, no goals, no direction in my life.”

Coopper found it hard to admit he was in trouble, particularly since he was living with his parents. “You know that you’re in personal crisis and you don’t want people to know,” he says. “You hide it.”

Men may go undiagnosed because they often display different symptoms than women, reports Laurie Young, PhD, a psychotherapist with the (US) National Mental Health Association. “We don’t see it in the same kind of sad, weepy behavior that most of us think of as representative of depression,” says Young.

“With men, we would look more at irrational outbursts of anger, an inability to concentrate, a change in their sexual activity levels or interest, sleep disruption or sleeping too much, change in appetite,” she says.

People who live with depression experience life with a sense of despair, anger, lack of joy and diminishment in their ability to enjoy their lives, their children, and their work, says Young.

Coopper thinks most men share an expectation that they have to be strong at all times. “Deny it, be the perfect guy, strong man, no weaknesses, I can’t let my guard down: There’s a lot of frustration and angst about why this is happening to me,” he says.

Men find other ways to cope with the disease that set them apart, say experts. “I think men do sublimate their depression and we see that in masking of symptoms by using drugs and alcohol,” Young says. “High risk behaviors may be a way of conquering and moving beyond and above the kind of numbing down of life that can be part of depression.”

Depression can be deadly. It can double a man’s risk of heart disease, studies have repeatedly shown, including research recently completed at Ohio State University. And depression can disrupt sleep and sex life. Although women attempt it more often, statistics show that depressed men are 4 times more likely to die from suicide.

Whether more situational or more biochemical in origin, in addition to an expanding array of effective anti-depressants, talk therapy and counseling continues to be standard treatment for depression. “[Expressing feelings] is not seen as something that’s thought of as manly in our culture,” says Young. “The biggest barrier that we have for men is giving them permission to talk about what they are feeling and say that it’s OK, it’s a step towards health and not a sign of weakness.”

Public figures like Tipper Gore and newsman Mike Wallace have gone public with their testimonies of depression, in hopes of eradicating the shame. “It’s the labeling of depression that keeps people from seeking treatment, the stigma of mental illness,” says Young. “I think there are ways to talk to people: not confront it head on, but to talk about the kind of changes in behavior that people are seeing.”

Young urges people to seek evaluation–and doctors to encourage it–should they suspect something is not right. Basic, preliminary self-screening questionnaires are offered on the Internet.

Relying on maintenance-level medication and support groups, Brian Coopper says he has been successful in diminishing his depression for 6 years. “The camaraderie of being with other people who have been down the same road that you are going down, is so beneficial,” says Coopper.

Says Dr. Young, “When we have an ability to treat people with an 85 percent success rate in treatment, it’s criminal to keep people from access to treatments that can really help and change their lives.”