A 48-year-old investment banker came to my office for a psychiatric consultation under duress. His wife had threatened to divorce him if he didn't. For at least a year he had been getting progressively more sullen, noncommunicative, and angry-and had begun to drink himself to sleep each night. It was immediately apparent to me that he was one of the millions of men in the U.S. who suffer from undiagnosed depression.

Most of those receiving treatment for the condition are women, but research and clinical observation indicate that the seeming predominance of depression in women is a result of gender bias and poor diagnosis. Of the estimated 6 million men in the U.S. who have a depressive disorder, many, if not most, may never be treated for their illness.

Like our investment banker, men are often incapable of acknowledging that they're depressed, unable to talk about it, and poorly diagnosed, especially by male doctors. The consequences can be deadly. One large epidemiological study found that 75 percent of people who sought professional help for serious depression were female, whereas 75 percent of those in the same population who committed suicide were male. As the researchers concluded, "Women seek help-men die."

Why do so many men fail to recognize their own depression? In my opinion the main reason is shame. Our culture expects men to be competent, optimistic, energetic, decisive, clear thinking, happy, and, of course, sexually aggressive-all characteristics that depression impairs. Men are expected to keep their doubts to themselves. Acknowledging depression may leave "red-blooded" men in our culture feeling weak and unmanly. Given society's expectations, it isn't surprising that men don't seek treatment.

Instead, men are more likely than women to "self-medicate" their discomfort with alcohol or drugs. Hiding their despair behind a facade of confidence or even arrogance, men may be prone to angry outbursts, conflicts at work, spousal abuse, or road rage. As a psychiatrist who treats many middle- and upper-income men, I see the consequences of untreated depression every day: ruined marriages, faltering careers, drinking problems, sexual dysfunction, loneliness, even physical ailments.

Family and close friends often suspect that a man is depressed long before he is willing to consider that possibility himself. If they say nothing, the problem is likely to get worse. On the other hand, if they try to talk to him about it, he will very likely feel threatened, judged, defensive, and even hostile. What can you do if you suspect that a male friend or family member is depressed?

Show him this article. Tell him he has a problem for which solutions are both available and effective. If he resists seeking help, encourage him to do so for the sake of the family and friends who care about him. This takes great courage on everyone's part, but the payoff can be a dramatic improvement, often in a matter of weeks. Eighty percent of depressed individuals recover with a proper combination of drug therapy and psychotherapy.

The mainstays of drug treatment for depression are the selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Most depressed men will benefit from taking one of those drugs, but only if the medication is used judiciously and in combination with talk therapy. I've found that individual psychotherapy often doesn't work well for depressed men because they have no idea how to perceive or talk about painful emotions. Involving a man's wife, if he has one, in his treatment can make a huge difference because she has probably been the target of the anger or withdrawal brought on by the underlying depression.

I also run all-male group-therapy sessions, which help my patients realize that they're not the only ones suffering from these symptoms and that it's all right to express their innermost feelings.

I initiated all of the above treatments for the investment banker. Through a combination of an SSRI, talk-therapy sessions that included his wife, and participation in a men's support group, not only did he recover from his depression, but his work performance improved and his marriage became more solid than ever. In addition, he found that he was able, for the first time in his adult life, to form close male friendships.