There is no difference between the number of men and women who experience depression, according to a recent survey. But you wouldn't know it from looking inside a therapist's office.

Women are still twice as likely to be diagnosed and treated with depression as men.

Dr. Harold, or "Woody", Neighbors is well aware of the pitfalls that men face when it comes to coping with depression. That's why he walks with his friends as often as can. He uses the opportunity to talk openly about what's happening in his life, what's on his mind. He hasn't always been good about opening up to his friends about emotional issues.

"I was worried that they would somehow think less of me as a competent strong individual," says Neighbors.

He should know better. Neighbors is a professor of Public Health at the University of Michigan and has been conducting focus groups with African American men coping with depression as part of an ongoing study. Ironically, he'd been telling these men to ask for help. But it wasn't until something terrible happened in his own life that he understood how difficult it really is to reach out.

Neighbors' daughter, Kamilah, died from a heart attack years ago. She was only 33 years old and getting a PhD at the School of Public Health, the same school where Neighbors teaches.

"She was in the building," says Neighbors. "And we'd see each other. After she passed away, it was probably a good six or seven months before I could set foot in this building."

Still, Neighbors was determined to get back to work. He made plans with students to get together everywhere on campus except the Public Health Building. But his grief was overpowering.

"Some days, it really felt like I had been walking around in somewhat of a daze," he says. "Things were just a little fuzzy. I'd be in conversations with some of my students and I would have this sensation that I'd drifted off while they were talking."

Neighbors would wake up in the morning and not want to get out of bed. "I just started feeling you know symptoms of fatigue, rumination, difficulties in concentration," he says.

How do we understand depression in men?

Neighbors talks about feeling tired, and not being able to concentrate. Maybe you've noticed, he hasn't used the word depression. That's pretty common, says Dr. John Sonnega, he's the director of the University of Michigan's stress management program.

"Men will say I'm tired and I'm not really engaged in work," states Sonnega. "And we may not interpret that as depression."

Sonnega says depressed men are also more likely to report aggression, substance use and violent behavior to mental health professionals. That has researchers wondering - is this really depression, or is it something else? Sonnega asks, "Are the men actually depressed and we're just not calling them depressed?"

Recognizing men as depressed is still only half the battle. Men are less likely to get diagnosed with depression than women. But they are also much less likely to seek help. Sonnega says there are three stigmas standing in the way: "The stigma of mental health. The stigma of masculinity. And the stigma of work. In all three of those, you're not supposed to talk about your emotions. Not at work, not if you're a man. Not about mental health in particular."

Sonnega feels that men have to learn to talk about their emotional health. So that when they do experience difficulties, they know how to reach out and talk about what's going on with them, rather than bottle up their feelings.

Finding a way for men to open up

For Woody Neighbors - it took him a long time before he felt comfortable asking for help. He recalls it being about five or six months after his daughter's death. At this point, the pain became too much for him. "This is something that I don't think I could carry all by myself."

So Neighbors reached out. He started individual counseling. He told people at work about his depression and took a medical leave. Most importantly he says, he called up his best friends and asked them for a favor: "Would you two agree to form a walking group with me? We need to walk minimally once a week. Maybe twice a week."

His friends happily agreed to walk with him. And while he walked he talked. That combined with the counseling and the medical leave helped Neighbors get through his grief. This was years ago. But to this day he still walks with his friends - and they talk about everything. His walking buddy, Wayne Mcullough says, "I broadcast to everybody. My wife almost cringes at how much people know about us."

This report is part of a multi-media mental health journalism series made possible by the Scattergood Foundation. Renee Gross is a radio journalist and independent producer based in Ann Arbor, Michigan.