Depression in Women:

Understanding depression in women

Depression is a serious condition that can impact every area of your life. It can affect your social life, your family relationships, your career, and your sense of self-worth and purpose. And for women in particular, depression is common.

If you’re feeling sad, guilty, tired, and just generally “down in the dumps,” you may be suffering from major depression. But the good news is that depression is treatable, and the more you understand about depression’s particular implications for and impact on women, the more equipped you will be to tackle the condition head on.

Signs and symptoms of depression in women

The symptoms of depression in women are the same as those for major depression. Common complaints include: Depressed mood Loss of interest or pleasure in activities you used to enjoy

• Feelings of guilt, hopelessness and worthlessness
• Suicidal thoughts or recurrent thoughts of death
• Sleep disturbance (sleeping more or sleeping less)
• Appetite and weight changes
• Difficulty concentrating
• Lack of energy and fatigue

Differences between male and female depression

Although the signs and symptoms of depression are the same for both men and women, women tend to experience certain symptoms more often than men. For example, seasonal affective disorder—depression in the winter months due to lower levels of sunlight—is more common in women. Also, women are more likely to experience the symptoms of atypical depression.

In atypical depression, rather than sleeping less, eating less, and losing weight, the opposite is seen: sleeping excessively, eating more (especially carbohydrates), and gaining weight. Feelings of guilt associated with depression are also more prevalent and pronounced in women. Women also have a higher incidence of thyroid problems. Since hypothyroidism can cause depression, this medical problem should always be ruled out by a physician in women who are depressed.

Causes of depression in women

Women are about twice as likely as men to suffer from depression. This two-to-one difference persists across racial, ethnic, and economic divides. In fact, this gender difference in rates of depression is found in most countries around the world. There are a number of theories which attempt to explain the higher incidence of depression in women. Many factors have been implicated, including biological, psychological, and social factors.

Biological causes of depression in women

Premenstrual problems - Hormonal fluctuations during the menstrual cycle can cause the familiar symptoms of premenstrual syndrome (PMS), such as bloating, irritability, fatigue, and emotional reactivity. For many women, PMS is mild. But for some women, symptoms are severe enough to disrupt their lives and a diagnosis of premenstrual dysphoric disorder (PMDD) is made.

Pregnancy and infertility - The many hormonal changes that occur during pregnancy can contribute to depression, particularly in women already at high risk. Other issues relating to pregnancy such as miscarriage, unwanted pregnancy, and infertility can also play a role in depression.

Postpartum depression - Many new mothers experience the “baby blues.” This is a normal reaction that tends to subside within a few weeks. However, some women experience severe, lasting depression. This condition is known as postpartum depression. Postpartum depression is believed to be influenced, at least in part, by hormonal fluctuations.

Perimenopause and menopause - Women may be at increased risk for depression during perimenopause, the stage leading to menopause when reproductive hormones rapidly fluctuate. Women with past histories of depression are at an increased risk of depression during menopause as well.

Social and cultural causes of depression in women

• Role strain - Women often suffer from role strain over conflicting and overwhelming responsibilities in their life. The more roles a woman is expected to play (mother, wife, working woman), the more vulnerable she is to role strain and subsequent stress and depression. Depression is more common in women who receive little help with housework and child care. Single mothers are particularly at risk. Research indicates that single mothers are three times more likely than married mothers to experience an episode of major depression.
• Unequal power and status - Women’s relative lack of power and status in our society may lead to feelings of helplessness. This sense of helplessness puts women at greater risk for depression. These feelings may be provoked by discrimination in the workplace leading to underemployment or unemployment. Low socioeconomic status is a risk factor for major depression. Another contributing factor is society’s emphasis on youth, beauty, and thinness in women, traits which to a large extent are out of their control.
• Sexual and physical abuse - Sexual and physical abuse may play a role in depression in women. Girls are much more likely to be sexually abused than boys, and researchers have found that sexual abuse in childhood puts one at increased risk for depression in adulthood. Higher rates of depression are also found among victims of rape, a crime almost exclusively committed against women. Other common forms of abuse, including physical abuse and sexual harassment, may also contribute to depression.
• Relationship dissatisfaction - While rates of depression are lower for the married than for the single and divorced, the benefits of marriage and its general contribution to well-being are greater for men than for women. Furthermore, the benefits disappear entirely for women whose marital satisfaction is low. Lack of intimacy and marital strife are linked to depression in women.
• Poverty - Poverty is more common among women than men. Single mothers have the highest rates of poverty across all demographic groups. Poverty is a severe, chronic stressor than can lead to depression.

Psychological causes of depression in women

• Coping mechanisms - Women are more likely to ruminate when they are depressed. This includes crying to relieve emotional tension, trying to figure out why you’re depressed, and talking to your friends about your depression. However, rumination has been found to maintain depression and even make it worse. Men, on the other hand, tend to distract themselves when they are depressed. Unlike rumination, distraction can reduce depression.
• Stress response - According to Psychology Today, women are more likely than men to develop depression under lower levels of stress. Furthermore, the female physiological response to stress is different. Women produce more stress hormones than men do, and the female sex hormone progesterone prevents the stress hormone system from turning itself off as it does in men.
• Puberty and body image - The gender difference in depression begins in adolescence. The emergence of sex differences during puberty likely plays a role. Some researchers point to body dissatisfaction, which increases in girls during the sexual development of puberty. Body image is closely linked to self-esteem in women, and low self-esteem is a risk factor for depression.

Risk factors for depression in women

There are a number of different, yet interrelated, risk factors for depression in women. Women of lower socioeconomic status are more likely to develop depression. This makes sense considering that the more sources of stress in a woman’s life, the more likely she is to develop depression. Women of low socioeconomic status are likely to struggle with financial problems, issues of unemployment or underemployment, discrimination, lack of education, and single parenthood. Additional risk factors include marital conflict and dissatisfaction, past sexual or physical abuse, and role strain.

Treating depression in women

For the most part, women suffering from depression receive the same types of treatment as everyone else. The main treatment approaches are psychotherapy and antidepressant therapy. However, there are some special treatment considerations for depression in women.

Depression and the Reproductive Cycle

Hormone fluctuations related to the reproductive cycle can have a profound influence on a woman’s mood. In light of this possibility, you and your doctor should always look for connections between your depressive symptoms and the female reproductive cycle. Is your depression connected to your menstrual period and a possible effect of PMS? Are you pregnant and struggling with complications and concerns related to the vast changes you and your body are undergoing? Are you struggling with the baby blues after recently giving birth? Or are you approaching menopause and dealing with hormonal and emotional fluctuations? All of these milestones in the reproductive cycle can influence or trigger depression. It’s also important to consider mood-related side effects from birth control medication or hormone replacement therapy.

Relationship Issues and Role Strain

Because of the special role that interpersonal issues and role strain plays in female depression, psychotherapy should address them directly. Interpersonal therapy and cognitive-behavior therapy are both effective in teaching new problem solving skills, improving interpersonal relationships, and reducing negative thinking and ineffective coping techniques.

Treatment Modifications

Specific aspects of treatment must often be modified for women. Because of female biological differences, women should generally be started on lower doses of antidepressants than men. Women are also more likely to experience side effects, so any medication use should be closely monitored. Finally, in addition to antidepressant treatment, women are more likely than men to require simultaneous treatment for other conditions such as anxiety disorders and eating disorders.

Premenstrual dysphoric disorder

Most women are all too familiar with premenstrual syndrome (PMS). Unwelcome symptoms of PMS such as bloating, moodiness, and fatigue appear and reappear each month at the same time in the menstrual cycle. For most women, these premenstrual symptoms are uncomfortable but not disabling. But for up to one out of ten women, symptoms are so distressing and disabling that they warrant a diagnosis of premenstrual dysphoric disorder (PMDD). PMDD is characterized by severe depression, irritability, and other mood disturbances. Symptoms begin about 10 to 14 days before your period and improve within a few days of its start.

Symptoms of Premenstrual Dysphoric Disorder
Feelings of sadness or hopelessness Feelings of tension or anxiety Panic attacks Mood swings and tearfulness Persistent irritability or anger Disinterest in daily activities and relationships	Trouble concentrating Fatigue or low energy Food cravings or binge eating Sleep disturbances Feeling out of control Physical symptoms (bloating, breast tenderness, headaches, muscle pain)

Self-help for PMDD

There are many steps you can take to improve PMDD symptoms. Many involve simple lifestyle adjustments.

• Exercise - Regular aerobic exercise can reduce the symptoms of PMDD.
• Dietary modifications - Changes to your diet may help reduce symptoms. Cutting back on salt, fatty foods, caffeine, and alcohol is recommended. Eating plenty of complex carbohydrates is also recommended.
• Nutritional supplements - Vitamin B-6, calcium, magnesium, Vitamin E, and tryptophan have all been shown to benefit women suffering from PMDD.
• Herbal remedies - Evening primrose oil and chaste tree berry are herbal supplements that have both been studied and found to be effective in the treatment of PMDD.
• Stress reduction - Relaxation techniques and other strategies to reduce stress may help with PMDD symptoms. Yoga and meditation are particularly effective.

For more severe cases of PMDD, antidepressant therapy may be helpful. Serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil can alleviate the emotional symptoms of PMDD. The medication may be taken consistently, or in some cases, it is only taken during the two weeks leading up to the onset of menstruation.

Related links for depression in women

General information about depression in women

Depression in women: Understanding the gender gap – Explore the unique biological, psychosocial, and cultural factors that may increase a woman’s risk for depression. (Mayo Clinic)
Mood Disorders and the Reproductive Cycle – Review how changing levels of female reproductive hormones over the life cycle can impact depression. Includes information about estrogen, thyroid impairment, and the effect of oral contraceptives. (HealthyPlace)
More Women Suffer Depression – Article looks into some of the reasons why women around the world are more susceptible to depression than men. (Psychology Today)

Premenstrual dysphoric disorder

Facts for Health: Premenstrual Dysphoric Disorder – Click through short, informative articles on premenstrual dysphoric disorder. Includes screening information, personal experiences, and details about treatments such as light therapy and dietary modification. (Madison Institute of Medicine)
Diagnosis and Treatment of Premenstrual Dysphoric Disorder – Comprehensive article geared towards medical professionals. Learn about treatment options including therapy, medications, lifestyle changes, herbal treatments, and nutritional supplements. (American Academy of Family Physicians)

Pregnancy and depression

Antidepressants: Are they safe during pregnancy? – Uncover the risks of taking antidepressants during pregnancy. Learn which antidepressants are safer than other and what can happen if you stop taking your medication during pregnancy. (Mayo Clinic)

Depression in adolescent and teenage girls

Depression in Adolescence: Does Gender Matter? – Investigate the reasons behind the dramatic increase in depression rates after the age of 13 among girls. (NYU Child Study Center)

Delving deeper into depression in women

Women's Depression in the Workplace – Learn how depression can hurt your job performance and find a list of signs of depression in the workplace. (HealthAtoZ)

Melinda Smith, M.D., and Jaelline Jaffe, Ph.D. contributed to this article. Reviewed by Jeanne Segal, Ph.D., Last modified on: 11/15/07.