Women and Depresion
Clinical depression is a serious medical illness that is much more than temporarily feeling sad or blue. It involves disturbances in mood, concentration, sleep, activity, appetite, and social behavior. Depression can develop in anyone at any age; and, although it is highly treatable, it is frequently a life-long condition in which periods of wellness alternate with recurrences of illness.
Clinical depression affects twice as many women as men, both in the U.S. and in many societies around the world. It is estimated that one out of every seven women will suffer from depression in their lifetime. Additionally, women experience higher rates of seasonal affective disorder and dysthymia (chronic depression). While the rates of bipolar disorder (manic depression) are similar in men and women, women have higher rates of the depressed phase of manic depression and rapid-cycling bipolar disorder.
What causes the higher rate of depression in women?
The explanation for the gender gap in susceptibility to depression lies in a combination of biological, genetic, psychological, and social factors.
Biological factors
There appear to be important links between mood changes and reproductive health events. Thus, the gender gap in depression is most evident during the female reproductive years. Some women experience behavior and mood changes premenstrually. As many as 10 percent to 15 percent experience a clinical depression during pregnancy or after the birth of a baby. There also appears to be an increase in depression during the perimenopausal period, but after menopause this does not appear to be the case.
Additionally, differences in thyroid function between men and women may contribute to the gender difference in the prevalence of mood disorders.
Another biological factor that may contribute to gender differences in depression can be linked to circadian rhythm patterns, the complex system that regulates sleep and activity over each 24-hour period. Depressed women report more hypersomnia (excessive sleeping) than do men. Gender differences in the activity of neurotransmitters including serotonin and the effects of estrogen on their function may also be linked to the gender disparity in rates of depression.
Genetic factors
Some forms of depression run in families. There is a 25 percent rate of depression in the first-degree relatives (mother, father, siblings) of people with depression and greater prevalence of the illness in first-degree and second-degree female relatives. But depression also occurs in people who have no family history of the disease.
Psychosocial factors
Psychosocial factors that may contribute to women's increased vulnerability to depression include the stress of multiple work and family responsibilities, sexual and physical abuse, sexual discrimination, lack of social supports, traumatic life experiences, and poverty.
Several studies of depression among college students and within the Amish community of eastern Pennsylvania have shown no gender difference in the rates of depression, suggesting that greater social equality may help reduce the higher rates of depression in women.
Women also appear to be more willing than men to admit feelings of depression and report past episodes of depression to physicians, perhaps also contributing to the gender difference in depression rates.
Psychological make-up plays an important role in one's vulnerability to depression as well. Thus, women with low self-esteem, pessimistic views, and tendencies towards stress are prone to clinical depression.
Studies also indicate that sexual and physical abuse are major risk factors for depression. Women are twice as likely as men to have experienced sexual abuse. A recent study found that three out of five of the women diagnosed with depressive illnesses had been victims of abuse. In one major study, 100 percent of women who had experienced severe childhood sexual abuse developed depression later in life.
Are there gender differences in the course of a depression?
Women have a higher one-year prevalence of the illness, may experience longer episodes, and have a lower rate of spontaneous remission than men. Older women are also more likely to have recurrent depressive episodes than older men. Women are two to three times more likely to develop double depression (clinical depression and chronic depression together).
Although men and women exhibit similar symptoms of depression, women report more atypical symptoms including anxiety, somatization (the physical expression of mental processes such as aches and pains with no physiological cause), increases in weight and appetite, oversleeping, and expressed anger and hostility.
How about gender differences in the treatment of depression?
Psychotherapy
Psychotherapy is an effective treatment for depression. Studies have shown that interpersonal therapy and cognitive/behavioral therapy can be very effective for the treatment of mild to moderate depression. Psychotherapy may be particularly useful for women patients during pregnancy and during times when they are trying to conceive to avoid possible effects on the developing fetus that may result from the use of some medications.
Anti-depressant medications
There is no clear evidence of gender differences in the effectiveness of anti-depressant medications; although, women experience more adverse side effects than do men. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, and Luvox have fewer side effects and have been found to be particularly useful and effective in women patients.
Some doctors suggest increasing doses of anti-depressant drugs premenstrually, as the menstrual cycle may alter drug-absorption rates.
This fact sheet is based on an article written by Susan J. Blumenthal, M.D., M.P.A., Assistant Surgeon General, U.S. Department of Health and Human Services published in NAMI's The Decade of the Brain (Fall 1996, Volume VII, Issue 3).
Permission is granted from:
National Alliance for the Mentally Ill
NAMI HelpLine: 1-800-950-NAMI [6264]
