Depression in women: Understanding the gender gap

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Depression in women: Understanding the gender gap

Family. Career. Coping with menstrual cycles, pregnancy and menopause. As a woman, you certainly have plenty of issues to handle. But there's another one you might face that can be especially challenging: depression. About 1 in 8 women develop depression at some point in life. Women are nearly twice as likely as are men to struggle with depression at some point. Depression can occur at any age, but it is most common in women between the ages of 25 and 44.

Some mood changes and depressed feelings occur with normal hormone changes. But hormone changes alone don't cause depression. Other biological factors, inherited traits and life experiences are also involved. Explore more about what contributes to depression in women — and what you can do about it.

Puberty

After girls and boys reach puberty, depression rates are higher in females than in males. And because girls typically reach puberty before boys do, they're more likely to develop depression at an earlier age than are boys. This depression gender gap lasts until after menopause. It's thought that the numerous hormone changes during puberty may increase some women's risk of developing depression. However, temporary mood changes related to changing hormones during puberty are normal — these changes alone don't cause depression.

Puberty is also often associated with other factors that can play a role in depression, such as:

  • Emerging sexuality and identity issues
  • Conflicts with parents
  • Increasing pressure to achieve in school, sports or other areas of life

Premenstrual problems

You may know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability and a blue mood herald the symptoms of premenstrual syndrome (PMS). For most women with PMS, the symptoms are minor and short-lived.

But a small percentage of women have severe and disabling symptoms that disrupt their lives, jobs and relationships. At that point, PMS crosses the line into premenstrual dysphoric disorder (PMDD) — a type of depression that generally requires treatment.

Although the exact interaction between depression and premenstrual syndrome remains unclear, it's possible that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals such as serotonin that control mood. Inherited traits, life experiences and other factors appear to play a role.

Pregnancy

Dramatic hormonal changes occur during pregnancy, and these can affect mood. Other issues may also increase the risk of developing depression during pregnancy or during attempts to become pregnant, including:

  • Lifestyle or work changes
  • Relationship problems
  • Previous episodes of depression, postpartum depression or premenstrual dysphoric disorder
  • Lack of social support
  • Mixed feelings about being pregnant
  • Miscarriage
  • Infertility
  • Unwanted pregnancy
  • Stopping use of antidepressant medications

Postpartum depression

About half of new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings — sometimes called the baby blues — are normal and generally subside within a week or two. But more serious or long-lasting depressed feelings may indicate postpartum depression, particularly if signs and symptoms include:

  • Low self-esteem
  • Anxiety
  • Agitation
  • An inability to care for your baby
  • Thoughts of harming your baby
  • Thoughts of suicide

Postpartum depression is a serious medical condition requiring prompt treatment. It occurs in about 10 to 15 percent of women. It's thought to be associated with major hormonal fluctuations that influence mood, along with a pre-existing predisposition to depression.

Perimenopause and menopause

The risk of depression may also be heightened during the transition to menopause, a stage called perimenopause, when hormone levels fluctuate erratically. The depression risk also may be heightened in early menopause or after menopause, both times when estrogen levels are significantly reduced.

Most women who experience uncomfortable menopausal symptoms don't develop depression. But for women whose sleep is disrupted for long periods of time or who have a history of depression, this is a vulnerable time. Also, hysterectomy with removal of the ovaries can lead to an abrupt onset of menopause with severe symptoms, including mood changes and sometimes depression.

Life situations and culture affecting depression in women

The higher rate of depression in women isn't due to biology alone. Your life situation and cultural stressors play a role, too. Although these stressors also occur in men, it's usually at a lower rate. Factors that may add to a woman's risk include:

  • Unequal power and status. In general, women earn less money than men do. Women are much more likely to live in poverty than are men, particularly black or Hispanic women. Poverty and limited earning potential bring with them many concerns and stressors, including uncertainty about the future and less access to community and health care resources. Minority women might also face added stress from racial discrimination. These issues can make you feel as if you don't have control over your life and can contribute to feelings of negativity and low self-esteem — which all increase your risk of depression.
  • Work overload. Often women work outside the home and still handle domestic chores. Many women find themselves dealing with the challenges and stress that can accompany single parenthood, such as working multiple jobs to make ends meet. Also, women may find themselves caregivers sandwiched between generations — caring for their young children while also caring for sick or older family members. These kinds of stressors can make you more vulnerable to depression.
  • Sexual or physical abuse. Women who were emotionally, physically or sexually abused as children or adults are more likely to experience depression at some point in their lives than are those who weren't abused. Women are more likely than are men to experience sexual abuse.

Other conditions that occur with depression

Women with depression often have other mental health conditions that need treatment as well. Some conditions that commonly occur along with depression in women include:

  • Anxiety. This is the most common condition that occurs along with depression.
  • Eating disorders. There's a strong link between depression in women and eating disorders such as anorexia and bulimia.
  • Drug or alcohol abuse. Some women with depression also have some form of substance abuse or dependence. Substance abuse can worsen depression and make it more difficult to treat.

Recognizing depression and seeking treatment

Although depression might seem overwhelming, there's effective treatment. Even severe depression often can be successfully treated. Seek help if you have any signs and symptoms of depression, such as:

  • Ongoing feelings of sadness, guilt or hopelessness
  • Loss of interest in things you once enjoyed
  • Significant changes in your sleep pattern, such as falling or staying asleep or sleeping too much
  • Fatigue, or unexplained pain or other physical symptoms without an apparent cause
  • Changes in appetite leading to significant weight loss or weight gain
  • Feeling as though life isn't worth living, or having thoughts of suicide

Not sure how to get treatment? Consider turning to your primary care provider first. This may be your family doctor, an internist, a nurse practitioner, an obstetrician or a gynecologist. Your primary care provider may be able to guide your treatment. Otherwise, he or she can refer you to a mental health provider who specializes in diagnosing and treating mental illness, such as a psychiatrist.

Remember, depression is both common and treatable. If you think you are depressed, don't hesitate to seek help.

Last Updated: 2010-09-01
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