It took me a long time to realize how extensive the influence of depression was in my life. That was partly because of a set of aggressive behaviors that I never associated with the illness. Researchers have singled out exactly these symptoms as typical of depressed men and very different from those experienced by women. 

A few years ago, a Johns Hopkins health bulletin published an interesting and helpful list that contrasted the depression symptoms of men and women. Here are a few of the key differences they identified:

• Women tend to feel sad and worthless, men angry and underappreciated.
• Women withdraw when hurt, men attack.
• Women feel anxious and scared, men suspicious and guarded.
• Women believe they can solve the problem by being better partners, men by being treated better by their partners.
• Women ask, am I lovable enough? Men ask, am I being loved enough?
• Women blame themselves, men blame others.

That last one really clicked: men blame others. Those words immediately brought to mind a long and painful period when I did exactly that and caused my wife a lot of pain. Rather than face the inner hurt as my own, I pushed the pain onto the people I was closest to. Blame led to outbursts of rage and verbal abuse and a terrible feeling that I might be getting out of control. It was some relief to learn that this behavior was another side of depression, but it hardly made up for the emotional damage I had caused.

The research has revealed a lot more about depression in men. Not knowing how to get better, men often turn to alcohol or drugs for relief. They also create escapist fantasies of finding a new partner or a new job, convinced that a fresh start in life will end their problems. Risk-taking can also increase. Men might seek out dangerous sports, drive recklessly or look for sex outside marriage. Both the cause and cure for unhappiness are out in the world, not within - yet there is no recovery out there for them to find.

These symptoms are so different from what we think of as depression that it’s hard to see the connection. The traditional criteria used in a diagnosis include prolonged periods of bleak and despairing mood, feelings of worthlessness, lack of mental focus, loss of energy, a tendency to isolate from contact with people - these and the rest of the criteria are all about passivity and inaction, not aggressive, action-oriented behavior. The contrast is a reminder of how complicated the phenomenon known as depression can be. Men don't imagine for a minute that depression may be their underlying problem. Denial comes easily when you can point to your wife or kids or job as the issue. The idea of treatment seems irrelevant or insulting.

But the anger and acting out aren’t the whole story of men’s depression, certainly not of mine. Men also experience depression in the more expectable ways, feeling so low and lacking in energy that it’s hard to get out of bed. They can be overwhelmed with shame and despair, live with shattered self-esteem and lose the ability to focus on their work. It’s hard to imagine that the two sets of symptoms could occur together. But that was exactly what happened to me.