Women & depression

Nearly twice as many women as men develop depression-related disorders at some point in their lives. What's behind that gender gap?

Learn about the unique biological, psychosocial and cultural factors that may increase a woman's risk of depression, and how the interaction of all these factors may make you more susceptible to developing depression — and more likely to actually be diagnosed with depression than a man is.

Biological factors in depression
The female body itself may influence the development of depression. That's because hormones may alter mood through various stages of life. In fact, before girls and boys reach puberty, they share similar rates of depression. It's only after puberty that the gender disparity in depression-related disorders truly becomes pronounced. By age 15, for example, girls are almost twice as likely as boys to have developed depression.

Because this gender gap coincides with puberty and disappears after menopause, some researchers believe that hormonal factors can increase a woman's risk of developing depression. On the other hand, puberty is also often associated with other changes that could play a role in depression, such as emerging sexuality and identity issues, parental conflicts and evolving social expectations. These psychosocial factors could interact with hormonal changes in women and result in an increased risk of depression.

Drastic fluctuations in hormones can have a profound effect on a woman's life. Coupled with personality factors, relationship issues, socioeconomic factors and other issues, women are more vulnerable to depression than men. Here's a look at how these factors influence depression in women.

Premenstrual problems
Most women know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability or a blue mood herald premenstrual syndrome (PMS). For most women, though, the symptoms associated with PMS are minor and short-lived. But a small percentage have such severe and disabling premenstrual symptoms — depression and hopelessness, for instance — that their lives, jobs and relationships are disrupted. This condition is known as premenstrual dysphoric disorder (PMDD), and it may require treatment with hormones or antidepressants.

Although the exact interaction between depression and premenstrual syndrome remains unclear, some researchers believe that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals, such as serotonin, that control mood. Other research indicates that androgens — so-called male hormones that women also naturally produce, such as testosterone — may play a role. Still, because such hormonal changes occur in all women, but not all women develop depression, hormonal changes alone cannot be responsible for the greater risk of depression. Genetic predisposition or other factors may also influence depression.

Pregnancy
Pregnancy itself doesn't directly cause depression. But the dramatic hormonal changes that occur during pregnancy, along with life, work and relationship changes, affect mood and in some cases may trigger depression. Other factors that can increase the risk of depression during pregnancy include previous depressions or PMDD, marital strife, insufficient social support and ambivalence about being pregnant. Other issues surrounding pregnancy can also lead to depression, such as infertility, miscarriage or an unwanted pregnancy.

It can sometimes be hard to recognize depression during pregnancy because the symptoms can mimic natural changes that may occur, such as appetite changes, fatigue, disrupted sleep and changes in sex drive.

Postpartum depression
Although having a new baby is generally exciting, about half of women 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 if they don't or if symptoms are severe, with inability to care for the baby and feelings of anxiety, low self-esteem, agitation or thoughts of suicide, you might have postpartum depression. This is a serious medical condition requiring treatment. Postpartum depression isn't merely a matter of being unable to cope with having a new baby, but rather is probably associated with major hormonal fluctuations that influence mood.

Perimenopause and menopause
The risk of depression may increase again during the transition to menopause (perimenopause), when hormone levels fluctuate erratically, as well as after menopause, 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 prior history of depression, this is a vulnerable time. Hysterectomy with removal of the ovaries can lead to an abrupt onset of menopause with more severe symptoms, including mood changes and sometimes depression.

Social and cultural factors in depression
It's not just biology that may account for the higher rate of depression in women. Social and cultural stresses may play a role, too. Although these stresses also occur in men, it's usually at a lower rate. Women are more likely than men to shoulder the burden of both work and family responsibilities, for instance. They're also more likely to have lower incomes, be single parents and have a history of sexual or physical abuse, all of which can contribute to depression, especially in women who've had depression in the past.

Unequal power and status
In general, U.S. women earn less money than men do. Single women with children have one of the highest poverty rates in the United States. Low socioeconomic status brings with it many concerns and stresses, including uncertainty about the future and less access to community and medical 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. That, in turn, can contribute to feelings of passivity, negativism and lack of self-esteem, which all increase your risk of depression.

Work overload
Many women work outside the home but still handle the bulk of domestic chores. That means they often log more hours each week than men attending to the needs of others. Many women also find themselves dealing with the challenges and stresses that can accompany single parenthood, such as working multiple jobs to make ends meet. In addition, many find themselves as caregivers sandwiched between generations — caring for their young children while also caring for sick and older family members. These kinds of stresses might make you vulnerable to depression.

Sexual and physical abuse
Women who were sexually molested or otherwise abused as children are more likely to experience depression at some point in their lives than those who weren't. Women who were raped as teenagers or young adults also have a higher incidence of depression. Although sexual abuse also occurs in boys and young men, it's more common among girls and young women. Adult women who experience abuse — physical, emotional, sexual — are also at greater risk of depression.

Getting treatment for depression
No matter the precise cause of depression, women often have different symptoms than men do. Women, for instance, are more likely to experience higher degrees of guilt, anxiety, feelings of worthlessness, fatigue, sleep disturbances, weight gain and carbohydrate craving. They're also more likely to have a type of depression called seasonal affective disorder, to be chronically depressed and to have recurring episodes of depression. In addition, family members are more likely to label women depressed. That can lead to a higher rate of diagnosis of depression in women than in men.

Although it might seem as if these biological, social, cultural and psychological issues all weigh against you, treatment for depression can be effective. Even severe depression often can be successfully treated.

Not sure how to get treatment? For many women, their obstetrician or gynecologist plays an important role in primary or preventive health care. You may initially feel more comfortable talking about your mood with them. They may be able to start treatment and can also help you find mental health professionals who can provide an evaluation for psychotherapy or treatment with antidepressants.

Believing that your condition is hopeless or incurable is a classic symptom of depression. You might be more likely than a man to develop depression, but don't assume you must simply learn to live with it. The right treatment can help you enjoy life again.

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