About 30% of men are depressed -- the same as women -- when diagnosed under new criteria. 
 
 Men's gambling may be a sign of depression, a new study suggests. (Photo: Ron Agnir, AP) Story Highlights Traditional symptoms of depression are sadness, loss of sleep, lack of interest in usual activites 
 
 While women may manifest these symptoms, many men won't admit to crying or feeling helpless 
 
 In men, depression may manifest as anger, aggression, taking risks or abusing drugs 
 
 A new study finds that depression may be far more common in men than previously estimated. 
 
 Women traditionally have been diagnosed with depression about twice as often as men, with about 20% of women becoming depressed at some point in their lives. 
 
 In the past decade, however, some researchers have suggested that they simply weren't asking the right questions when talking to men. While women may show their depression through symptoms such as crying or trouble sleeping, depression in men may manifest as anger, aggression, substance abuse or risk taking, such as gambling or womanizing, says lead author Lisa Martin, an assistant professor at the University of Michigan in Dearborn. 
 
 When researchers factored in those types of symptoms, they found that about 30% of both men and women had been depressed at some point in their lives, according to a study published Wednesday in JAMA Psychiatry. 
 
 Researchers at the University of Michigan based their study on of 3,310 women and 2,382 men. The analysis is the first to look at gender differences in depression rates in a large national sample, Martin says. 
 
 Not all experts accept that depression manifests differently in men and women, says Peter Kramer, a clinical professor at Brown University not involved in the new study. 
 
 The notion of gender differences in depression symptoms is still a new idea, says Kramer, who describes Martin's findings as preliminary. 
 
 Rates of bipolar disorder — in which people may cycle back and forth between depression and mania — are similar between men and women. But rates of many other conditions vary by gender, Kramer says. Autism and attention-deficit hyperactivity disorder are much more common among men, for example, while eating disorders are more common among women. 
 
 Yet Martin says that changing the criteria for diagnosing depression could lead to more men getting help. 
 
 "If we can get men who have depression to recognize it in themselves and get treatment, that is really significant," Martin says. 
 
 Depressed men are typically much less likely to be treated than depressed women, Martin says, partly because some men see asking for help as a sign of weakness. 
 
 Martin says clinicians tell her that men are not as likely to walk into their offices of their own free will; Instead, doctors say that men often seek treatment only because "they've been given ultimatums by their wives or their employers," who threaten to divorce or fire them unless the men change their behavior. 
 
 Mental and substance use disorders were the leading cause of non-fatal illness in the world in 2010, according to an analysis published Wednesday in The Lancet. 
 
 Mental and substance use disorders were responsible for more of the global burden of death and illness than HIV/ AIDS and tuberculosis, diabetes, or car accidents, according to the study. 
 
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 Depression can look very different in men and women. And many of its hallmarks — rage, risk-taking, substance abuse and even workaholism — can hide in plain sight. 
 
 Now researchers say that when these symptoms are factored into a diagnosis, the long-standing disparity between depression rates in men and women disappears. 
 
 That conclusion overturns long-accepted statistics indicating that, over their lifetimes, women are 70% more likely to have major depression than men. In fact, when its symptoms are properly recognized in men, major depression may be even more common in men than in women, according to a study published Wednesday by the journal JAMA Psychiatry. 
 
 The findings help unravel a mystery that has long puzzled mental health authorities: If men are so much less likely than women to be depressed, why are they four times more likely to commit suicide? 
 
 "When it comes to depression in men, to some extent we have blinders on," said Dr. Andrew Leuchter, a psychiatrist who studies depression at UCLA. "We have not been asking about and taking into account a range of symptoms that may be gender-specific." 
 
 Health policy researchers from the University of Michigan and Vanderbilt University set out to test the feasibility of two new checklists that might diagnose depression in men as well as women with greater accuracy. 
 
 In addition to familiar depression symptoms such as sadness, difficulty sleeping, feelings of guilt or worthlessness and loss of interest in pleasurable activities, the researchers expanded the list to include anger attacks, aggression or irritability, substance abuse, risk-taking behavior and hyperactivity. They devised two scales — one designed to be gender-neutral and one tuned toward the way the disease manifests itself in men. 
 
 The researchers tested these diagnostic criteria in a group of nearly 5,700 American adults who had been interviewed as part of a long-term study of mental health organized by researchers at Harvard Medical School; 41% of the participants were men. 
 
 The results of the analysis were striking. 
 
 When assessed using the "gender inclusive depression scale" that included widely recognized depressive symptoms such as sadness and hopelessness as well as symptoms commonly seen in men, 30.6% of men and 33.3% of women were found to have experienced a depressive episode at some point in their lives. In research terms, that gap between men and women was so narrow it may have been a statistical fluke. 
 
 And when the subjects were evaluated with the "male symptoms scale," 26.3% of men and 21.9% of women were said to have experienced a major depressive episode in their lifetimes. That difference was large enough that it could not be due to chance, the researchers reported. 
 
 "Everything we think we know about depression is a reflection of how we defined it to begin with," Leuchter said. 
 
 That bias, he added, may have fostered the perception that depression is predominantly a "woman's disease" — and that men don't need treatment for emotional suffering. 
 
 Sigmund Freud, the father of psychiatry, portrayed depression as rage turned inward. But for many men today, depression's rage appears not so much directed at oneself as it is spat outward — at spouses, co-workers and friends. 
 
 While women may not feel shame in acknowledging their sadness and sagging self-esteem, mental health experts find that depressed men often respond to such feelings with actions that look like their opposite: They bluster and bully. They throw themselves into harm's way. They numb themselves with sex, drugs and endless workdays. 
 
 If the emotional pain of many men is to be understood for what it is, depression's definition should be expanded to include these "externalizing" symptoms — the opposite of "internalizing" symptoms that have long defined depression, some mental health professionals argue. 
 
 "These findings could lead to important changes in the way depression is conceptualized and measured," the study authors concluded. 
 
 If psychiatrists update their official diagnostic criteria to reflect these gender differences, that would be only a first step, Leuchter said. 
 
 Doctors, including primary care physicians who now diagnose most depression, would have to be educated to look for an expanded set of symptoms, he said. Researchers would not only need to understand how seemingly separate diseases such as substance abuse and depression relate to each other, they would also need to assess whether the treatments currently available — antidepressants and talk therapy — would help men with these symptoms, he said. 
 
 For men as well as women, the checklists now in wide use to diagnose depression may fail to capture the experience and language of the emotional distress they feel, said study leader Lisa Martin, a health policy studies professor at the University of Michigan. 
 
 "Word choice matters," she said. 
 
 melissa.healy@latimes.com
– Depression might be known more as a women's disease, but new research shows men suffer just as much—only differently. When rage, risk-taking, and substance abuse are taken into account, men are just as likely to be diagnosed with depression as women, the study says. In fact, if nontraditional symptoms are properly identified, men may actually be more likely to suffer from major depression, the Los Angeles Times reports, adding it's news that may help explain why men are four times more likely to commit suicide. Researchers created two checklists—one gender-neutral, and one for how males react to the disease—to see if men could be diagnosed more accurately. After analyzing 5,700 adults for behaviors like anger attacks and irritability, about 30% of men and women were found to have experienced depression at some point, while 26% of men and 22% of women battled major depression. "We have not been asking about and taking into account a range of symptoms that may be gender-specific," said one expert, while the study lead told USA Today, "If we can get men who have depression to recognize it in themselves and get treatment, that is really significant."