It’s hard enough to get a stubborn guy to recognize a physical symptom, set up a doctor appointment and show up at the clinic for a medical evaluation. It’s even tougher for men to determine whether a mood change is normal, or a possible sign of depression.

Depression-related illnesses strike about six million men in the United States. Men are less likely to be diagnosed with depression than woman, yet men are four times more likely to kill themselves. Society teaches men to control their emotions and to be physically tough. It’s this “macho” attitude that causes many men to let depression go untreated. Professor of Psychology at Clark University, Dr. Michael Addis, is a national expert on the subject and will be setting up the first-ever center on men and depression at Clark.

In an interview with Men and Health: It’s a Guy Thing, Addis, an author of over 60 books, says, “We’re probably under- diagnosing depression in men because, as you probably suspect, it’s an illness that’s highly stigmatized in men, so men are taught from a very young age by parents, peers and society to keep emotional vulnerability to themselves.” Addis says men are less likely than women to answer “yes” when asked if they are feeling sad, down, or feeling critical of themselves.

Symptoms of depression can take on different forms in men. Although there is no definitive study, Addis says, “For some men, and probably specifically for those men who adhere to more traditional gender roles… men who are more invested in controlling their emotions and handling problems on their own… those men are more likely to express depression in terms of anger, physical complaints and sometimes social withdrawal.” In general, men are more likely than women to keep their distress hidden from others. According to Addis, stress factors, such as divorce, unemployment, and loss of a loved one, and the reluctance of men to share these issues with others, may contribute to the increased incidence of suicide in men.

Outside forces, such as the sluggish economy, can contribute to the onset of depression. Says Addis, “Despite the progress of the women’s movement, which has come a long way towards re-defining women’s roles, men’s roles still heavily emphasize the bread winner. When that’s taken away, it’s not only an economic stress, it’s a psychological stress, because it essentially says to men, you’re no longer doing what you should be doing, so you fail twice. You don’t have a job and you’re not being appropriately masculine by bringing home the bread.” One of Addis’s students at Clark studied 60 recently-unemployed men in central Massachusetts. Addis says the study found, “the more traditionally masculine men were more likely to develop symptoms of depression then the less traditionally masculine ones.”

Depression can also strike members of the military. Addis says, “The suicide rate among returning veterans from Iraq and Afghanistan is soaring. It’s higher than it’s ever been and the incidence of depression and other problems (such as post-traumatic stress disorder and substance abuse) is very high as well.” Addis says this also relates to the psychology of men and masculinity, noting that while the military has made progress in raising depression awareness, there is still a long way to go.

In many cases, the family doctor can start a depression patient on the road to recovery. Addis says, “It’s very important that people find a primary care physician who is knowledgeable about mental health and open to treating mental health in the context of primary care,” adding that it’s the responsibility of both the patient and the doctor.

The Clark University professor offers words of encouragement for men who think they may be suffering from depression.  Addis says you’re not alone and there is absolutely no shame in getting help. Depression is a treatable illness. According to Addis, 75 percent or more of people who receive counseling or medication for depression are able to overcome it. Finally, don’t think you’re weak because of your feelings. “This is not a character flaw…no one chooses to be depressed.”