By Kenneth England, MFT, Primary Therapist, Promises Malibu We\u2019ve all heard the expression, \u201cMan up.\u201d Men have grown up with tough guy heroes as role models and have spent their lives hearing messages that they should be strong and unemotional. They learn that they cannot let things \u201cbother them.\u201d And if they are upset and depressed, there are only certain expressions of emotions allowed. Sadness is not one of them. However, research shows almost 10% of men in the United States have anxiety or depression. A recent study of male and females gambling at slot machines illustrated how men feel more comfortable expressing anger and annoyance rather than showing a vulnerable side. It revealed the ways that men and women emoted differently after losing. Women were more likely to show visible signs of sadness, such as crying. Men, on the other hand, demonstrated more anger, frustration and aggression. They kicked the slot machines or guarded over them and intimidated others. Depression in men may still be overlooked or underreported, possibly because it is masked by anger. It\u2019s important for men and their spouses or other relatives to develop an awareness of moods and behaviors to help them recognize the real problem. How to Recognize Depression Be aware of the symptoms. There are telltale signs of depression that include: \tA sense of emptiness or hopelessness \tAnxiousness or irritability \tExhaustion or lack of concentration \tDifficulty sleeping and waking \tChange in eating patterns, either overeating or not having an appetite \tUnexplained physical pain and stomach problems \tApathy or feeling unable to meet the demands of daily life \tFeeling overwhelmed \tThoughts of suicide Let the Healing Begin There is a growing awareness about depression in men but gender stereotyping can still get in the way. It is helpful for men to seek the help of a therapist or a psychiatrist who is experienced with recognizing and treating depression in men. Here are some additional ways to step onto a healing path. \tIdentify complex trauma. Trauma can begin at birth with the way babies attach to their parents. Then there can be various incidents as we age, from accidents and losing loved ones to military combat. But complex trauma is interpersonal damage \u2015 mental, physical, sexual or emotional abuse by a parent or caregiver for a prolonged time, not just a one-time event. That sets men up for long-lasting pain that can easily turn into depression. Clarifying it is a step toward healing it. \tStart talking. Good communication is a skillset that a lot of men don't have and don't think they need. But withholding and not talking about symptoms is one of the reasons depression in men is underdiagnosed. In reality, it\u2019s an important part of the process. If people don\u2019t process or feel things, emotions get bottled up inside and come out in other ways. While it helps to work out, run and engage in physical activity, talking is also an important way to move energy. So talking about it, but especially with someone that is going to understand, will help tremendously. \tGather with other men. Feelings are real and everyone has them. Men can find a lot of freedom in being able to talk about their problems with other guys. Group therapy is powerful because men begin to see that other men also have feelings, which is contrary to some of the gender stereotyping. When they share their feelings with others, they physically feel different. They feel lighter, better. There's a physical manifestation to depression and there is also the reverse \u2015 a physical lifting of depression symptoms or feelings of anxiety that are manifested in the body. \tLearn to recognize changing moods. Because the language of feelings may be foreign to some men, it is important to be able to recognize when they are depressed or anxious. This may mean paying attention to physical symptoms. Do you feel tightness in your stomach? Do you get sweaty palms? Do you get hot in your neck or chest? It may be a physical or mental awareness that the mood has changed. Perhaps things are felt physically but also accompanied by negative self-talk or a craving for a substance or activity. \tRecognize when anger covers depression. Reaching for a certain movie or type of music may be a way to gauge some emotions. Listening to angry music may be a sign a man is either angry or depressed and trying to push back on the depression because anger is one of the ways men cover depression. The unconscious thought process is: Instead of feeling depressed I'll get angry so that I don't feel weak or don't feel like I'm not in charge. Anger can be a defense used to self-protect from being vulnerable. Younger generations are more likely to be raised by individuals who did not grow up with John Wayne movies and who have given more credence and attention to emotions. One recent client who grew up in Southern California was a great emotional communicator, totally in touch with his feelings and able to express them. And celebrities like Jon Hamm, the actor who plays Don Draper in \u201cMad Men,\u201d have opened up about depression. But this kind of fluid expression and admission of sadness is not yet the norm for men. Special care must be given to understanding how men process emotions as well as why they may be reluctant to share their feelings or apt to try to hide them.