NO.143. Depression in Women

Depression in Women

What is depression?

Clinical depression is a serious and pervasive mood disorder. It causes feelings of sadness, hopelessness, helplessness, and worthlessness. Depression can be mild to moderate with symptoms of apathy, little appetite, difficulty sleeping, low self-esteem, and low-grade fatigue. Or it can be more severe.

What are the symptoms of depression in women?

Symptoms of depression in women include:

Persistent sad, anxious, or "empty" mood
Loss of interest or pleasure in activities, including sex
Restlessness, irritability, or excessive crying
Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
Sleeping too much or too little, early-morning waking
Appetite and/or weight loss or overeating and weight gain
Decreased energy, fatigue, feeling "slowed down"
Thoughts of death or suicide, or suicide attempts
Difficulty concentrating, remembering, or making decisions
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

What are the symptoms of mania in women?

Mania is a highly energized state with elevated mood that can occur in bipolar disorder. Moods in bipolar disorder swing over the course of days or weeks or months from the lows of depression to the highs of mania. Even though mania is an elevated mood, it is serious and needs medical assessment and treatment.

The symptoms of mania include:

Abnormally elevated mood
Irritability
Decreased need for sleep
Grandiose ideas
Greatly increased talking
Racing thoughts
Increased activity, including sexual activity
Markedly increased energy
Poor judgment that can lead to risk-taking behavior
Inappropriate social behavior

Why is depression in women more common than depression in men?

Before adolescence, depression is rare and occurs at about the same rate in girls and boys. However, with the onset of puberty, a girl's risk of developing depression increases dramatically to twice that of boys.

Some experts believe that the increased chance of depression in women may be related to changes in hormone levels that occur throughout a woman's life. These changes are evident during puberty, pregnancy, and menopause, as well as after giving birth or experiencing a miscarriage. In addition, the hormone fluctuations that occur with each month's menstrual cycle probably contribute to premenstrual syndrome, or PMS, and premenstrual dysphoric disorder, or PMDD -- a severe syndrome marked especially by depression, anxiety, and mood swings that occurs the week before menstruation and interferes with normal functioning of daily life.

What increases the chances of depression in women?

According to the National Institutes of Health, factors that increase the risk of depression in women include reproductive, genetic, or other biological factors; interpersonal factors; and certain psychological and personality characteristics. In addition, women juggling work with raising kids and women who are single parents suffer more stress that may trigger symptoms of depression. Other factors that could increase risk include:

Family history of mood disorders
History of mood disorders in early reproductive years
Loss of a parent before age 10
Loss of social support system or the threat of such a loss
Ongoing psychological and social stress, such as loss of a job, relationship stress, separation or divorce
Physical or sexual abuse as a child
Use of certain medications

Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

Is depression hereditary?

Depression can run in families. When it does, it generally starts between ages 15 and 30. A family link to depression is much more common in women. However, there is not always an apparent genetic or hereditary link to explain why someone may develop clinical depression.

How does depression in women differ from depression in men?

Depression in women differs from depression in men in several ways:

Depression in women may occur earlier, last longer, be more likely to recur, be more likely to be associated with stressful life events, and be more sensitive to seasonal changes.
Women are more likely to experience guilty feelings and attempt suicide, although they actually commit suicide less often than men.
Depression in women is more likely to be associated with anxiety disorders, especially panic and phobic symptoms, and eating disorders.

How are PMS and PMDD related to depression in women?

As many as three out of every four menstruating women experience premenstrual syndrome or PMS. PMS is a disorder characterized by emotional and physical symptoms that fluctuate in intensity from one menstrual cycle to the next. Women in their 20s or 30s are usually affected.

How are PMS and PMDD related to depression in women? continued...

About 3% to 5% of menstruating women experience premenstrual dysphoric disorder, or PMDD. PMDD is a severe form of PMS, marked by highly emotional and physical symptoms that usually become more severe seven to 10 days before the onset of menstruation.

In the last decade, these conditions have become recognized as important causes of discomfort and behavioral change in women. While the precise link between PMS, PMDD, and depression is still unclear, abnormalities in the functioning of brain circuits that regulate mood, along with fluctuating hormone levels are both thought to be contributing factors.

How are PMS and PMDD treated?

Many women who suffer with depression along with PMS or PMDD find improvement through exercise or meditation. For individuals with severe symptoms, medicine, individual or group psychotherapy, or stress management may be helpful. Your primary care doctor or Ob-Gyn is a good place to start. Your doctor can screen you for depression and treat your symptoms.

Does depression in women occur during pregnancy?

Pregnancy was once assumed to be a period of well-being that protected women against psychiatric disorders. But depression in women occurs almost as commonly in pregnant women as it does in those who are not pregnant. The factors which increase the risk of depression in women during pregnancy are:

A history of depression or PMDD
Age at time of pregnancy -- the younger you are, the higher the risk
Living alone
Limited social support
Marital conflict
Uncertainty about the pregnancy

What is the impact of depression on pregnancy?

The potential impact of depression on a pregnancy includes the following:

Depression can interfere with a woman's ability to care for herself during pregnancy. She may be less able to follow medical recommendations and to sleep and eat properly.
Depression can cause a woman to use substances such as tobacco, alcohol, and/or illegal drugs, which could harm the baby.
Depression can make bonding with the baby difficult.

Pregnancy may have the following impact on depression in women:

The stresses of pregnancy can contribute to the development of depression or a recurrence or worsening of depression symptoms.
Depression during pregnancy can increase the risk for having depression after delivery (called postpartum depression).

What are my options if I'm depressed during pregnancy?

Preparing for a new baby is lots of hard work. But your health should come first. Resist the urge to get everything done, cut down on your chores, and do things that will help you relax. In addition, talking about things that concern you is very important. Talk to your friends, your partner, and your family. If you ask for support, you will find you often get it.

If you're feeling down and anxious, consider seeking therapy. Ask your doctor or midwife for a referral to a mental health care professional.

How is depression in women treated during pregnancy?

Growing evidence suggests that many of the currently available antidepressant medicines, including most SSRIs (except for Paxil), appear to have minimal (if any) risks when treating depression during pregnancy, at least in terms of the potential short-term effects on the baby. Long-term effects continue to be studied. Risks can differ depending on medication as well as many other factors during a pregnancy that can endanger a developing fetus. Untreated depression can put both mother and infant at risk. Often, electroconvulsive therapy (ECT) is considered to be the safest and most effective treatment for severe depression during pregnancy.

You should discuss the possible risks and benefits of treatment with your doctor.

How is postpartum depression in women treated?

Postpartum depression, or depression following childbirth, can be treated like other forms of depression. That means using medicines and/or psychotherapy. If a woman is breastfeeding, the decision to take an antidepressant should be made with the baby's pediatrician along with her own psychiatrist after a discussion of risks and benefits. Most antidepressants are expressed in very small amounts in breast milk and their possible effects on a nursing infant, if any, are not well understood.

Does the prevalence of depression in women increase at midlife?

Perimenopause is the stage of a woman's reproductive life that typically begins in her 40s (or earlier for some) and lasts until menstruation has ceased for a year (and a woman is considered to be in menopause). In the last one to two years of perimenopause, the decrease in estrogen accelerates. At this stage, many women experience menopausal symptoms.

Does the prevalence of depression in women increase at midlife? continued...

Menopause is the period of time when a woman stops having her monthly period and experiences symptoms related to the lack of estrogen production. By definition, a woman is in menopause after her periods have stopped for one year. Menopause typically occurs in a woman's late 40s to early 50s. However, women who have their ovaries surgically removed undergo "sudden" menopause.

The drop in estrogen levels during perimenopause and menopause triggers physical and emotional changes -- such as depression or anxiety. Like at any other point in a woman's life, there is a relationship between hormone levels and physical and emotional symptoms. Some physical changes include irregular or skipped periods, heavier or lighter periods, and hot flashes.

How can I cope with symptoms of menopause?

There are many ways you can ease menopause symptoms and maintain your health. These tips include ways to cope with mood swings, fears, and depression:

Eat healthfully and exercise regularly.
Engage in a creative outlet or hobby that fosters a sense of achievement.
Find a self-calming skill to practice -- such as yoga, meditation, or slow, deep breathing.
Keep your bedroom cool to prevent night sweats and disturbed sleep.
Seek emotional support from friends, family members, or a professional counselor when needed.
Stay connected with your family and community and nurture your friendships.
Take medicines, vitamins, and minerals as prescribed by your doctor.
Take steps such as wearing loose clothing to stay cool during hot flashes.

How is depression in women treated?

There are a variety of methods used to treat depression, including medications such as antidepressants, brain stimulation techniques like ECT, and individual psychotherapy.

Family therapy may be helpful if family stress adds to your depression. Your mental health care provider or primary care doctor will determine the best course of treatment for you. If you are uncertain whom to call for help with depression, consider checking out the following resources:

Community mental health centers
Employee assistance programs
Family doctors
Family service/social agencies
Health maintenance organizations
Hospital psychiatry departments and outpatient clinics
Local medical and/or psychiatric societies
Mental health specialists such as psychiatrists, psychologists, social workers, or mental health counselors
Private clinics and facilities
State hospital outpatient clinics
University or medical school-affiliated programs