context: While clinical depression was once considered a "woman's disease," more than 6 million men in the U. S. have depression each year. Unfortunately, the lingering image of depression as a female condition may keep men who are clinically depressed from recognizing the symptoms of depression and seeking treatment. Depression actually affects both sexes. It disrupts relationships and interferes with work and daily activities. The symptoms of depression in men are similar to the symptoms of depression in women. But men tend to express those symptoms differently. Common symptoms of depression include loss of interest in usually pleasurable activities, fatigue, changes in appetite, sleep disturbances, and apathy. In women, depression may be more likely to cause feelings of sadness and worthlessness. Depression in men, on the other hand, may be more likely to cause them to become withdrawn or to feel irritable, aggressive, or hostile. There are several reasons why the symptoms of clinical depression in men are not commonly recognized. For example, men tend to deny having problems because they are supposed to "be strong." And American culture suggests that expressing emotion is largely a feminine trait. As a result, men who are depressed are more likely to talk about the physical symptoms of their depression -- such as feeling tired --- rather than symptoms related to emotions. Yes. Depression in men can affect sexual desire and performance. Unfortunately, some antidepressants and other medications can do the same. Men often are unwilling to admit to problems with their sexuality. Many mistakenly feel that the problems are related to their manhood, when, in fact, they are caused by a medical problem such as clinical depression. Men are less likely to show more "typical" signs of depression such as sadness. Depression in men may cause them to keep their feelings hidden. Instead of expressing a depressed mood, they may seem more irritable and aggressive. For these reasons, many men -- as well as doctors and other health care professionals -- may fail to recognize the problem as depression. Depression in men can have devastating consequences. The CDC reports that men in the U. S. are three to four times likelier than women to commit suicide. A staggering 75% to 80% of all people who commit suicide in the U. S. are men. Though more women attempt suicide, more men complete the act of actually ending their lives. This may be due to the fact that men tend to use more lethal and violent methods for committing suicide, such as using a gun rather than taking an overdose of pills. Understanding how men in our society are brought up to behave is particularly important in identifying and treating their depression. Depression in men often can be traced to cultural expectations. Men are supposed to be successful. They should rein in their emotions. They must be in control. These cultural expectations can mask some of the true symptoms of depression. Instead, men may express aggression and anger -- seen as more acceptable "tough guy" behavior. Yes. And men generally have a hard time dealing with the stigma of depression. They are more likely to deal with their symptoms by drinking alcohol, abusing drugs, or pursuing other risky behavior. Many men avoid talking about depressed feelings to friends or family. Although depression is not a normal part of aging, senior men may have medical conditions such as heart disease, stroke, cancer, or other stressors that may contribute to depression. For example, there may be excessive losses (such as friends, physical health, spouses, income, meaningful work). Retirement is difficult for many men because they end up with no routine or set schedule to follow. These changes may increase the stress they feel, and a loss of self-esteem may contribute to depression. In addition, the death of family and friends, the onset of other health problems, and some medications can contribute to depression in men. More than 80% of people with depression -- both men and women -- can be treated successfully with antidepressant medication, psychotherapy, or a combination of both. If you are uncertain about whom to call for help with depression, check out the following list from the National Institute of Mental Health: Community mental health centers Employee assistance programs Family doctors Family service/social agencies Health maintenance organizations Hospital psychiatry departments and outpatient clinics Local medical or psychiatric societies Mental health specialists such as psychiatrists, psychologists, social workers, or mental health counselors Private clinics and facilities State hospital outpatient clinics University or medical school affiliated programs