Depression: Depression in Women

Women are twice as likely to develop depression than men. In fact, from 10% to 25% of women will experience an episode of major depression at some time in their lives.

Why is Depression More Common in Women?

Rates of depression are similar in girls and boys before adolescence. However, with the onset of puberty, a female's risk of developing depression increases dramatically, to twice that of males. Experts believe that women may be more prone to depression because of changes in hormone levels that occur throughout a woman's life such as during puberty, pregnancy and menopause, as well as after giving birth, having a hysterectomy, or experiencing a miscarriage. In addition, the hormone fluctuations that occur with each month's menstrual cycle increase the risk for premenstrual syndrome, or PMS, and premenstrual dysphoric disorder, or PMDD.

According to the National Institutes of Health, several other factors that are unique to women may contribute to their higher rates of depression. These include reproductive, genetic or other biological factors, interpersonal factors, and certain psychological and personality characteristics.

In addition, for women trying to balance a home and a career, stresses continue to pile up.

What Factors Place a Woman at Higher Risk For Depression?

• Loss of a parent before age 10
• Physical or sexual abuse as a child.
• History of mood disorders in early reproductive years.
• Family history of mood disorders.
• Use of certain oral contraceptives.
• Use of certain infertility treatments.
• Ongoing psychological and social stress (e.g., loss of job, relationship stress, separation or divorce).
• Loss of social support system or the threat of such a loss

How Does Depression Differ in Women and Men?

There are 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 are successful less often than men.
• Depression in women is more likely to be associated with anxiety disorders, especially panic and phobic symptoms, and eating disorders.
• Depressed women are less likely to abuse alcohol and other drugs.

Premenstrual Syndrome, Premenstrual Dysphoric Disorder and Depression

Up to 75% of menstruating women experience premenstrual syndrome (PMS), a disorder characterized by emotional and physical symptoms that fluctuate in intensity from one menstrual cycle to the next. Women in their 20's or 30's are usually who are affected.

About 3-5% of menstruating women experience premenstrual dysphoric disorder, or PMDD, a severe form of PMS, marked by highly emotional and physical symptoms that usually become more severe 7 to 10 days before the onset of menstruation.

In the last decade, these fluctuations in hormone levels have become recognized as important causes of discomfort and behavioral change in women. While the precise link between PMS, PMDD and depression is still unknown, chemical changes in the brain and fluctuating hormone levels are both thought to be contributing factors.

Treating PMS and PMDD

Many women find improvement by exercising, taking vitamins and avoiding caffeine. For individuals with severe symptoms, medicine, individual and group psychotherapy, stress management, or marital therapy can be helpful.

Depression in Pregnancy

Pregnancy has long been viewed as a period of well-being that protected women against psychiatric disorders. But depression occurs almost as commonly in pregnant women as it does in those who are not pregnant.

What Factors Increase My Risk of Being Depressed in Pregnancy?

The factors which increase the risk of depression during pregnancy are:

• Having 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 include:

• It can interfere with a woman's ability to care for herself during pregnancy. She may be less able to follow medical recommendations, and 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.

How Does Pregnancy Impact Depression?

Pregnancy may impact depression by:

• The stresses of pregnancy can cause depression or a recurrence or worsening of depression symptoms.
• Depression during pregnancy can increase the risk for having depression after delivery (postpartum depression, see below).

So What are My Options if I'm Depressed During My 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 to 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 all else fails and you're still feeling down and anxious, consider seeking therapy. Ask your doctor or midwife for a referral to a mental healthcare professional.

Treating Depression During Pregnancy

Growing evidence suggests that many of the currently available antidepressant medicines are safe for treating depression during pregnancy, at least in terms of short-term effects on the baby. Long-term effects have not been properly studied. You should discuss the possible risks and benefits with your doctor.

Depression After the Birth of a Child

Postpartum depression, depression following childbirth, is a complex mix of physical, emotional, and behavioral changes that are attributed to the chemical, social, and psychological changes associated with having a baby. For more on this condition, including causes and treatments, see the article on postpartum depression.

Perimenopause and Menopause and Depression

Perimenopause is the stage of a woman's reproductive life that begins 8 to 10 years before menopause. During this time the ovaries gradually begin to produce less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the decrease in estrogen accelerates. At this stage, many women experience menopausal symptoms.

What is Menopause?

Menopause is 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. It is a normal part of aging and marks the end of a woman's reproductive years. Menopause typically occurs in a woman's late 40's to early 50's. However, women who have their ovaries surgically removed undergo "sudden" menopause.

The drop in estrogen levels during perimenopause and menopause triggers physical, as well as emotional changes -- such as depression or anxiety and changes in memory. Like 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.

Coping With the 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:

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

What are my Options For Treating Depression During This Phase of My Life?

Depression during perimenopause and menopause is treated in much the same way as depression that strikes at any other time.

If you are experiencing symptoms of depression, talk to your doctor about finding a treatment that will work for you.

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