"I said I didn't want to be alive anymore," Letourneau, 67, recalled telling his best friend.
He and his friend had gone for a walk when Letourneau confessed and pressed his friend about ways to die painlessly. His friend advised him to admit himself to a hospital.
"When I got back to the house, physically, I was shaking so much -- and emotionally. I couldn't stop," Letourneau said. "I knew I had to get help."
For many men, it takes a lot more than feeling down -- even for long stretches -- to recognize that they are depressed and then step through the doors of a hospital, therapist's office, or a friend's or relative's home to seek help. Men who are depressed may believe they have to defy certain stereotypes about what it means to be a man in order to get appropriate treatment, depression experts and patients say.
"When men get depressed, the depression can be quite severe," said Dr. Ian Cook, professor of psychiatry at the Geffen School of Medicine at UCLA and director of its Depression Program. "The challenge is getting men to acknowledge when they're depressed."
Depression affects about 15 million people in the United States, according to the National Institutes of Mental Health, and men report being depressed about half as often as women.
"It's unclear how much of this represents differences in biology and how much of this is a reporting bias," Cook said. "The stigma issues are somewhat different for men than they are for women."
Steven Lappen of Boston, Mass., has suffered depression since he was a teenager and cites the Frontier Myth, which champions a self-sufficient, hardy lifestyle and mentality for men -- and for women, but to a lesser degree -- as the masculine ideal.
"People lionize that because they want to have that ability," Lappen, 59, said. "Men are bound by that independent, go-it-alone attitude and that asking for help is a sign of weakness. And that is just nonsense because when that sense of self reliance is no longer adequate to the task of bringing them to the Promised Land, they become at risk."
Rather than admit to what they see as a failure to cope with life, men are more likely to abuse drugs and alcohol, isolate themselves, often by working more, and engaging in risky behavior such as gambling or having multiple sexual partners as a way to avoid confronting their illness, depression experts say.
"For the moment, it allows them to feel better and escape from the pain rather than entering the full impact of the depression," said Dr. Jonathan Alpert, psychiatrist and associate director of the Depression Clinical and Research Program at Massachusetts General Hospital. "Men are less likely to talk about lower self esteem or feeling bad about themselves. ... A man's attention is more likely to be gotten by a physical symptom than an emotional one."
The symptoms of depression most commonly seen in men may include loss of sleep or appetite, gaining or losing a significant amount of weight, headaches, irritability and a lack of concentration.