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An ultimatum may be the best option to motivate a depressed young adult to regain some self respect.

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London - When Michael Foley found himself waking up at four o’clock every morning and feeling down throughout the day, he told himself he was just stressed.

The 42-year-old bank manager from Hastings, East Sussex, was under huge pressure at work as well as going through a custody battle with his former wife. Given time, he thought, the feelings would just pass, so instead of confiding in his new wife Joanna, 40, a nurse, he simply tried to carry on with things as normal.

“I didn’t tell anybody how down I was and that I had terrible insomnia,’ he says. ‘I didn’t want to burden Joanna, especially because it involved my ex-wife.

“It didn’t occur to me to seek treatment - I was in denial and I wouldn’t have thought a doctor could have helped anyway. I just tried to hold it together at work and at home until, eventually, I snapped.”

In fact, Michael was suffering from depression so severe that one evening when Joanna was out, he took an overdose of painkillers.

Luckily, she found him in time and after being taken to casualty, he made a full recovery. It was only then that he conceded he needed help.

Figures released by the Office of National Statistics last month show that since the start of the downturn in 2007, the suicide rate among men aged between 45 and 59 has increased by 8.5 percent.

Overall suicides hit 6,045 in 2011, with deaths among men accounting for 4,550 of them - the highest level for a generation.

Depression is the biggest psychological disorder in the Western world, affecting one in four in Britain. Although the illness affects twice as many women as men, females are much more likely to seek treatment.

Men, in contrast, carry on in silence which means their condition often remains undiagnosed - tragically, in many cases, until it’s too late. As a result, mental health experts are calling male depression a hidden epidemic and asking women to look out for signs in their husbands and partners.

The number of young men with mental health problems has always been high - 20 percent of those aged between 16 and 24 suffer - but now the condition is affecting a rising number of middle-aged men.

‘It’s worrying that the group most at risk now is middle-aged men because they’re not usually perceived to be a problem,’ says Marjorie Wallace, founder of the mental health charity Sane.

For wives and partners, living with a man in this condition can be profoundly distressing, particularly when pleas to discuss the issue are stonewalled. Caroline Carr, a clinical hypnotherapist, went through the experience during her husband’s depression a decade ago. She has since written a book and founded a website - mypartnerisdepressed.com - to help others in the same position.

“It’s extremely difficult to be the partner of a depressed man. My husband Jim worked in television, and his depression was triggered by a period in which he wasn’t getting as much work,” she says.

“It was such a shock for me, and I felt desperately worried. I didn’t know what to expect, or what to do for the best. I’ve been told by many other women they feel the same.

“It’s common for men to pour their energy into functioning normally elsewhere in their lives, particularly at work. At home, they become withdrawn and distant.

“They often want to take themselves away for a time because they feel they can deal with their problems better alone. They can also lash out, revealing the tremendous anger they feel towards themselves and the world by saying terrible things.

“My husband would often snap at me for no reason and I sometimes felt he blamed me for the way he felt. Of course, he couldn’t help his behaviour, but it’s difficult for women not to take it personally and wonder if they’re doing something wrong.”

She adds: “Jim did seek treatment, which helped over time, but I needed support too and I didn’t know where to find it. Confiding in friends made me feel I was being disloyal.

“I went to my GP and asked for counselling, but the practice counsellor was already seeing Jim and suggested there might be a conflict of interests. I felt utterly drained.”

The first step in coping with a partner’s depression is understanding the possible reasons. It is often assumed that because middle-aged men are in their prime and settled in their family lives and careers, they should be content.

But experts say the recession has had a massive impact on men’s sense of stability and, as a result, their mental health.

Joe Ferns, the Samaritans’ director of policy, research and development, says: “Men often feel pressure to live up to an ideal of masculinity measured by career success, and if anything jeopardises that - for example, being made redundant - it can be devastating, particularly as there are fewer opportunities to start again. Just the fear of losing a job can be enough to trigger depression.”

But stress caused by the economic climate is not the only reason for soaring levels of depression in this age group. Men in their 40s and 50s are facing unique social pressures, too.

“This group are a ‘buffer generation’ who fall between their older fathers with their stiff-upper-lip attitudes, and their younger, more emotionally articulate sons,” says Mr Ferns. “They’re expected to provide for their families in the traditional way, but also be sensitive and self-aware, and they often feel that they’re not particularly good at either.

“Beyond the age of 30, men tend to have fewer supportive peer relationships than women, so they rely on their partners for emotional support. But they often assume women need strong masculine partners. They think if they’re struggling, that constitutes weakness, so they try to cope alone.”

During Michael Foley’s severe depression, his unwillingness to talk about his feelings pushed his relationship with his wife Joanna to the brink. She says: “He masked his feelings by laughing and joking, and when I caught him crying he just said he missed his two children by his ex-wife, because he wasn’t seeing them that often. I tried to get him to open up, but he wouldn’t.

“I felt utterly helpless and we split up for a short time. It was only after his overdose that he began to talk to me about what he’d been going through. He sought medical help and began taking anti-depressants, and is coping much better.”

So what are the signs to look out for?

“Depressed men will often sleep or eat more or less than normal,” says Caroline Carr, “and you may notice them taking less care with their appearance. Where women will talk about feeling depressed, men tend to show it by drinking more, making self-deprecating comments and appearing angry - or they can struggle to show any emotion at all.”

Ainsley Johnstone noticed exactly that in her husband Matthew, 48, when the award-winning advertising executive began suffering crippling depression in his late 20s.

She says: “For Matthew, depression was about having no feeling at all - he says it was like he’d been visited by the Dementors from Harry Potter. He had no love for himself, so it was very hard for him to show his love for me.”

The couple wrote the best-selling book Living With A Black Dog about their experience. Her advice to women in a similar situation is to get as much information as possible.

“It’s crucial to try to understand what you’re dealing with so you know their behaviour isn’t about you,” she says. “It’s also vital to keep trying to raise the subject and say you’re ready to listen and not judge.”

Find a good time and place and ask open, gentle questions. Simply listening is often enough.

“At the Samaritans, we advise choosing a place where the other person feels comfortable,” says Joe Ferns. “Going for a walk can sometimes be less confrontational than sitting face-to-face with somebody.

“Don’t forget to ask how they feel, because men will sometimes stick to the facts of what’s going on rather than expressing emotions.”

He adds: “If you say the wrong thing, don’t panic. Show you understand, which you can do by asking follow-up questions and repeating key things they’ve said.”

It is important to try not to let your own feelings get in the way at this stage. “I tried hard to ask a lot of questions so I understood what Matthew was going through,” says Ainsley. “Once I understood more, I realised his depression was nothing to do with me and our relationship.”

Sometimes, men find it easier to talk to someone who is not emotionally involved, so encourage them to visit a doctor or call a mental health charity, if they are still unwilling to talk to you.

Asking one of their friends to have a chat can be an option. Even sharing their experiences with strangers on internet forums for men in a similar position can make a difference.

If they refuse to seek help, do not pressure them. Caroline says: “They may be worried about the consequences for their careers and the way people perceive them if they speak out. Just try to ensure they know all the options.”

Matthew, who now speaks in public about his experience, is immensely grateful for the support given to him by his wife.

“By continually asking questions and encouraging me to open up, she made sure we continued communicating with one another, which was the key to getting through it together,” he says.

WHAT ARE THE WARNING SIGNS?

According to the Samaritans, these are some of the key signs of male depression:

* A change in routine, such as sleeping or eating more or less

* Drinking and/or smoking more than usual

* Becoming withdrawn and taking less pleasure in family life

* Instead of seeming down, they often appear angry, aggressive or irritable

* Avoiding loved ones, perhaps by staying later at work, and seeing their friends less often than usual

* Talking a lot about ?stress’ ? more socially acceptable for men to admit to than depression

* Losing interest in their appearance

* Being unusually clumsy

* Making negative statements about themselves, even as a joke

* Making statements such as ‘It’s like the whole world is against me’

* Sexual dysfunction or lack of interest in sex. - Daily Mail

* The South African Depression And Anxiety Group: www.sadag.org

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