Depression in Women

Women are twice as likely to develop depression than men. In fact, from 10 to 25 percent 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.

• 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

• 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 with depression are more likely to experience symptoms that are less typical of depression, such as sleeping and eating excessively.
• 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 percent 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. The syndrome usually affects women in their 20s or 30s. Some 3 to 5 percent 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 against psychiatric disorders. But depression occurs almost as commonly in pregnant women as it does in non-pregnant women.

• 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

• Depression 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.

• 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).

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 relax. In addition, talking about your concerns 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 down and anxious, consider seeking therapy. Ask your doctor or midwife for a referral to a mental health care 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 fully studied. You should discuss the possible risks and benefits with your doctor.

Depression after the birth of a child
Postpartum depression (a type of depression that follows 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.

• Having a personal or family history of depression or PMDD
• Age at time of pregnancy -- the younger you are, the higher the risk
• Living alone
• Limited social support
• Children -- the more you have, the more likely you are to be depressed in a later pregnancy
• Marital conflict
• Uncertainty about the pregnancy
• A history of depression during pregnancy -- 50% of depressed pregnant women will have postpartum depression

Postpartum blues -- Better known as the "baby blues," this condition affects between 50 and 75 percent of women after delivery. If you are experiencing the baby blues, you will have frequent, prolonged bouts of crying for no apparent reason, sadness, and anxiety. The condition usually begins in the first week (one to four days) after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment. All you'll need is reassurance and help with the baby and household chores.

Postpartum depression -- This is a far more serious condition than postpartum blues, affecting about 1 in 10 new mothers. You may experience alternating "highs" and "lows," frequent crying, irritability, and fatigue, as well as feelings of guilt, anxiety and an inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within days of the delivery or gradually, even up to a year later. Although symptoms can last from several weeks up to a year, treatment with psychotherapy or antidepressants is very effective.

Postpartum psychosis -- This is an extremely severe form of postpartum depression and requires emergency medical attention. This condition is relatively rare, affecting only 1 in 1,000 women after delivery. The symptoms generally occur quickly after delivery and are severe, lasting for a few weeks to several months. Symptoms include severe agitation, confusion, feelings of hopelessness and shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid speech, or mania. Postpartum psychosis requires immediate medical attention since there is an increased risk of suicide and risk of harm to the baby. Treatment will usually include admission to hospital for the mother and medicine.

What causes postpartum depression?
More research is needed to determine the link between the rapid drop in hormones after delivery and depression. The levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy but drop sharply after delivery. By three days following delivery, levels of these hormones drop back to pre-pregnant levels. In addition to these chemical changes, the social and psychological changes associated with having a baby create an increased risk of postpartum depression.

Can postpartum depression be prevented?
Here are some tips that can help prevent or help you cope with postpartum depression:

• Be realistic about your expectations for yourself and your baby.
• Limit visitors when you first go home.
• Ask for help -- let others know how they can help you.
• Sleep or rest when your baby sleeps.
• Exercise; take a walk and get out of the house for a break.
• Screen your phone calls.
• Follow a sensible diet; avoid alcohol and caffeine.
• Keep in touch with your family and friends -- do not isolate yourself.
• Foster your relationship with your partner -- make time for each other.
• Expect some good days and some bad days.

Treating postpartum depression
Postpartum depression is treated differently depending on the type and severity of the woman’s symptoms. Treatment options include anti-anxiety or antidepressant medicines, psychotherapy, and support group participation.

In the case of postpartum psychosis, medicines used to treat psychosis are usually added. Hospital admission is also usually necessary.

If you are breastfeeding, don’t assume that you can't take medicines for depression, anxiety, or even psychosis. There have been no reports of breastfed babies whose mothers are taking antidepressants suffering any ill effects; but as yet, no long-term results are available.

When should a new mom seek professional medical treatment?
A new mom should seek professional help when:

• Symptoms persist beyond two weeks
• She is unable to function normally; she can’t cope with everyday situations
• She has thoughts of harming herself or her baby
• She is feeling extremely anxious, scared and panicked most of the day

Perimenopause, menopause, and depression
Perimenopause is the stage of a woman’s reproductive life that begins 8 to 10 years before menopause, when 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 40s to early 50s. 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; 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; however, there is a growing body of evidence to suggest that estrogen replacement can provide relief of minor physical and emotional symptoms, as well as improve memory problems. This treatment is also useful in preventing osteoporosis. However, hormone replacement therapy alone is not effective in treating more severe depression. Antidepressant drug therapy and/or psychotherapy may be necessary.

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