Although depression remains one of the most debilitating illnesses for women and men alike, certain factors, such as hormones and response to stress, increase the incidence and intensity of depression for women. According to the National Institute of Mental Health, the NIMH, 20.9 million Americans experience affective or mood disorders in the United States each year, and 6.7 percent of the U.S. adult population experiences major depressive disorder in a given year.
Significance
Major depressive disorder is the leading cause of disability in American adults ages 15 to 44 in a given year, according to the NIMH. More men than women suffer from depression, and many never seek treatment. Eating disorders, anxiety disorders and substance-use disorders commonly coexist with depression in women. Studies cited by the NIMH indicate that women with depression have more severe symptoms of coexisting medical illnesses when they are depressed. In 2006, 33,300 people died by suicide in the U.S., and women are three times as likely to attempt suicide as men.
Types
Many forms of depression exist, according to the NIMH. Multiple depressive symptoms and degree of impairment in functioning distinguish major depression from less severe forms. Symptoms may include: sad or irritable mood; changes in energy, appetite and sleep; loss of interest in once-enjoyed activities; feelings of guilt or worthlessness; and thoughts of death or suicide. Less severe but more chronic depression characterizes dysthymia, where functioning may be intact, but women feel unfulfilled and unhappy. Minor depression sometimes results from a hormonal or environmental change or stressor. With postpartum depression, women become depressed shortly after giving birth. During psychotic depression, women lose touch with reality and may hear voices, see things or become unduly paranoid. In seasonal affective disorder, depressive symptoms occur at particular times of year, often during seasons when there is less sunlight.
Causes
Like most mental illnesses, according to the NIMH, depression in women is likely caused by a combination of genetic, biological, chemical, hormonal and environmental factors. Women with family histories of depression remain at increased risk of developing it. Brain imaging studies found that areas of the brain associated with mood regulation, thinking, sleep, appetite and behaviors function differently in those who are depressed. Hormones directly affect brain chemistry that controls emotions and mood, making women more apt to feel depressed during puberty; before, during or after menstruation and pregnancy; and just prior to and during menopause. The NIMH indicates that women often have prolonged feelings of stress, and a 2000 study in the "Archives of General Psychiatry" revealed that more than 70 percent of depressed girls had experienced a recent stressful event, compared with only 14 percent of boys who were depressed. A 2005 study by Calvette and Cardenosos revealed that young girls and female teens tended to doubt themselves and their problem-solving abilities, and they require higher degrees of approval and success to feel secure, making depression more likely.
Solution
The good news: depression is treatable, and medications and psychotherapy remain the most common treatment methods, according to the NIMH. Many types of anti-depressants -- selective serotonin reuptake inhibitors, or SSRIs; tri-cyclic antidepressants; mono amine oxidase inhibitors, or MAOIs; and serotonin and norepinephrine reuptake inhibitors -- effectively treat depression. Due to a reduced side-effect profile, physicians often choose SSRIs as first-line treatments. NIMH research supports, however, that those who didn't recover after trying one anti-depressant, often improved after being switched to another, or when another medicine was added. Cognitive behavior and interpersonal therapies examine the effects of thoughts and relationships on depression, and top the list of talk therapies used for depression.
Considerations
Anti-depressants may take up to six weeks at therapeutic doses to be fully effective. According to the NIMH, the use of anti-depressants during pregnancy may adversely affect the fetus. MAOIs interact with certain foods and medications, potentiating dangerously high blood pressure. The FDA issued a black box warning indicating that anti-depressants may promote suicidal thinking and behaviors in those taking them. For these reasons, careful monitoring and weighing of the risks and benefits of taking anti-depressants with prescribing physicians remains critical. Because other physical or mental illnesses may mimic depression, full psychiatric and physical evaluations remain crucial for accurate diagnosis and effective treatment.
