Women and Depression

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.

Does pregnancy influence depression?

Although it was once thought that pregnancy was associated with low rates of mental illness in women, recent research reveals that 10 percent to 15 percent of women experience depression during pregnancy. As many as 80 percent of women experience the "postpartum blues," a brief period of depressive symptoms. Additionally, 10 percent to 15 percent of women suffer from postpartum clinical depression within three months of delivery. There is a three-fold increase in risk for depression during or following a pregnancy among women with a past history of mood disorders. Once a woman has experienced a postpartum depression, her risk of having another reaches 70 percent.

One woman in a thousand experiences a postpartum psychosis-a medical emergency where the woman may inflict harm upon herself and/or her baby. The first episode of bipolar disorder in women frequently occurs following the birth of a child.

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.

• Antidepressant medications

  There is no clear evidence of gender differences in the effectiveness of antidepressant 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 antidepressant drugs premenstrually, as the menstrual cycle may alter drug-absorption rates.

Is it safe to take antidepressants during pregnancy?

Because of the potential risk to the developing fetus or newborn, the costs and benefits of the use of antidepressants must be weighed carefully for women who are pregnant, breast-feeding, or trying to conceive. Most large-scale studies have not shown any significant increase in birth defects in children of women using tricyclic antidepressants (Anafranil, Elavil, Pamelor) or SSRIs during pregnancy; but be certain to consult with your own physician because not all studies have had similar results. However, MAOIs (Nardil, Parnate) may adversely affect the developing fetus and lead to complications during delivery. Lithium (commonly prescribed for bipolar disorder) has been linked to an increased incidence of birth defects; however, many healthy babies have been born to mothers using this medication.

Doctors should choose the lowest effective dose of medication and select drugs with the least sedative and anticholinergic (rapid heartbeat, high blood pressure, slow digestion, dry mouth, constipation, and urinary retention) potency because of possible adverse effects on the newborn. In patients with severe depression, doctors must weigh the risks and benefits in both the mother and the infant of medication as compared to not administering drug therapy.

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)

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