According to the Anxiety and Depression Association of American (ADAA), more than 15 million Americans—that’s about 7% of the population—are diagnosed with depression in a given year. Most people can tell you that common symptoms of clinical depression may include feelings of sadness, a lack of motivation and/or joy in activities you usually find fun, increased irritability, and problems with sleep.

But what they may not know is that depression manifests itself differently in men and women.

This is no Mars/Venus thing—differences in neurobiology and physiology mean that the disease, and often the best form of treatment, may differ between the sexes. Here are four important ways that depression differs in women and men.

1. Prevalence of Depression and Age of Onset

Epidemiological research suggests women experience depression at nearly twice the rate of men. They are also more likely to
experience their first problems with depression during adolescence. According to Mental Health America, this difference may be due to two kinds of influencing factors.

First, the hormonal differences between the sexes. Many reproductive hormones, like the waxing and waning levels of estrogen and progesterone you see during the course of a normal menstrual cycle, have been linked to changes in mood. But social factors may also be at play. Increased likelihood of financial difficulties, sexual and emotional abuse, and the stresses of balancing work and family may also contribute.

2. Externalizing vs. Internalizing Feelings of Depression

Studies suggest that symptoms of depression are different across genders. In a variety of studies, women tend to report more environmental stressors prior to a depressive episode. They internalized those stressors, leading to symptoms.

Men, on the other hand, tend to externalize their feelings more. Depressed men are more likely to engage in excess anger—which can sometimes lead to lashing out at others and interpersonal violence. This difference may help explain why more women seek help for depression than men.

3. Depression and Suicidal Behavior 

While women are more likely to engage in suicidal ideation, studies suggest that men are more likely to successfully commit suicide. The differences in symptoms may mean that depression is not recognized in its early stages. And social factors may have men downplaying their symptoms—and even keep men from seeking the treatment they need, leading to suicide.

4. Response to Antidepressant Medication

Because of the neurobiological differences between men and women, it’s likely that they will respond differently to antidepressant medications. Studies suggest that women may have a better response to selective serotonin re-uptake inhibitors (SSRIs)—so men may need to consider other options. Pharmacogenomic testing can help patients identify how their genes affect their response to medicines.

Despite these important differences, depression remains a significant problem in the United States for both genders. If you or a loved one are experiencing symptoms—especially if those symptoms are interfering with work, relationships, and activities of daily living—it’s important to seek help from a certified mental health professional no matter what gender you happen to be.