Depression: Women Face Twice
From Depressed, or think you might be? You're not alone. Some 7 million women in the United States have clinical depression, according to the National Mental Health Association, and some researchers estimate that only one out of every three women with depression is properly diagnosed.
No matter where in the world they live, it appears that women are more affected by depression than men are. "In country after country, study after study, there's at least a twofold higher rate of depression in women compared to men," says Kimberly Yonkers, MD, an associate professor in the department of psychiatry and director of the Premenstrual Syndrome and Peripartum Treatment Research Program at Yale. "What's more, studies on bipolar individuals indicate that men are more likely to be affected by mania and women by depression."
What's going on here? Why are so many women so depressed? Researchers theorize that women are at higher risk due to a combination of biological and genetic factors -- including the hormonal changes of menstruation, postpartum, and menopause -- as well as from the stresses from work, family responsibilities, and social roles.
The marked difference between men and women in diagnosed depression gets its start around puberty. Before adolescence, depression rates differ only slightly between boys and girls. But between the ages of 11 and 13, female rates of depression climb sharply, and by the age of 15, girls are twice as likely to have experienced a major depressive episode as boys. Female high school students have significantly higher rates of depression, eating disorders, and anxiety disorders.
But Yonkers thinks the roots of female depression can be found even earlier, traced in large part to anxiety. "The rate of anxiety in children is much higher in girls than in boys, and studies suggest that anxiety predisposes people to depression," she says. "If it's something psychosocial in how we rear our little girls, it's happening very early."
The Symptom Gender Gap
Although men and women may have many of the same symptoms when they're depressed, they're likely to perceive them differently. "Women are more likely to notice that they're more tired all the time. There may also be feelings of very low self-esteem, helplessness, and hopelessness. They may have trouble making decisions," says Melodie Morgan-Minott, MD, past president of the Ohio Psychiatric Association and an instructor in psychiatry at Northeastern Ohio University's College of Medicine.
"If a man identifies himself through his work, he'll notice it if he can't do his job properly. If he identifies himself through his sexuality, that'll come to his attention and bring him to the doctor. Women, on the other hand, may notice that it takes them longer to get organized. Stay-at-home moms may find that the kids are getting to them more than they used to and that they don't have the patience they used to have."
Sometimes, women with depression may report a worsening of previous PMS symptoms. "In fact, it's a manifestation of depression which gets worse around the menstrual period," Morgan-Minott says. "It's also difficult when women are going through menopause, a lot of menopause symptoms and depression are confused, and depression is often intensified during menopause." Indeed, half of all women think depression is a normal part of aging and menopause -- one of a number of reasons they may not seek the treatment they need.
Other depression symptoms can include:
A persistent sad, anxious, or "empty" mood
Sleeping too little, early morning awakening, or sleeping too much
Reduced appetite and/or weight loss, or increased appetite and weight gain
Restlessness, irritability
Persistent physical symptoms that don't respond to treatment
Thoughts of suicide or death
Although men are more reluctant to admit to depression than women, women may also feel stigmatized. Half of all women surveyed by the National Mental Health Association cite embarrassment or shame as barriers to treatment. "People still see it as some kind of weakness in moral character to be depressed, and I think that holds true for both men and women," Yonkers says.
This attitude isn't helped by the lingering perception of female depression as "just hormones." "Women previously have been dismissed as histrionic or hormonal, and now we know they're dealing with very real symptoms of depression," says Morgan-Minott.
Attributing depression to hormones has developed a negative, "anti-feminist" connotation, but it's also simple science. Depression is, at least in part, a function of brain chemistry, and fluctuations in hormone levels affect brain chemistry, although scientists are still studying exactly how that happens.
Who Gets Treated?
The good news for women is that, although they're more likely to be affected by depression than men, they're also more likely to get treated. "The detection rate is higher for women, and it's more likely that a woman with depression will leave a doctor's office with a prescription for treatment than men will," says Yonkers.
The best way to get that treatment, of course, is to seek it out. Women experiencing depressive symptoms for more than a few days should see their doctor for a referral to a mental health specialist.
"You may have an external stressor leading to depression, or you may have a genetic tendency to become depressed. You may be experiencing a change in biochemical levels such as serotonin and possibly norepinephrine," says Morgan-Minott.
She advises women to use all the therapeutic tools available to them -- medication and counseling. Most current research indicates that while both antidepressant medications and therapy are effective in combating depression, the most potent treatment combines the two.
No matter where in the world they live, it appears that women are more affected by depression than men are. "In country after country, study after study, there's at least a twofold higher rate of depression in women compared to men," says Kimberly Yonkers, MD, an associate professor in the department of psychiatry and director of the Premenstrual Syndrome and Peripartum Treatment Research Program at Yale. "What's more, studies on bipolar individuals indicate that men are more likely to be affected by mania and women by depression."
What's going on here? Why are so many women so depressed? Researchers theorize that women are at higher risk due to a combination of biological and genetic factors -- including the hormonal changes of menstruation, postpartum, and menopause -- as well as from the stresses from work, family responsibilities, and social roles.
The marked difference between men and women in diagnosed depression gets its start around puberty. Before adolescence, depression rates differ only slightly between boys and girls. But between the ages of 11 and 13, female rates of depression climb sharply, and by the age of 15, girls are twice as likely to have experienced a major depressive episode as boys. Female high school students have significantly higher rates of depression, eating disorders, and anxiety disorders.
But Yonkers thinks the roots of female depression can be found even earlier, traced in large part to anxiety. "The rate of anxiety in children is much higher in girls than in boys, and studies suggest that anxiety predisposes people to depression," she says. "If it's something psychosocial in how we rear our little girls, it's happening very early."
The Symptom Gender Gap
Although men and women may have many of the same symptoms when they're depressed, they're likely to perceive them differently. "Women are more likely to notice that they're more tired all the time. There may also be feelings of very low self-esteem, helplessness, and hopelessness. They may have trouble making decisions," says Melodie Morgan-Minott, MD, past president of the Ohio Psychiatric Association and an instructor in psychiatry at Northeastern Ohio University's College of Medicine.
"If a man identifies himself through his work, he'll notice it if he can't do his job properly. If he identifies himself through his sexuality, that'll come to his attention and bring him to the doctor. Women, on the other hand, may notice that it takes them longer to get organized. Stay-at-home moms may find that the kids are getting to them more than they used to and that they don't have the patience they used to have."
Sometimes, women with depression may report a worsening of previous PMS symptoms. "In fact, it's a manifestation of depression which gets worse around the menstrual period," Morgan-Minott says. "It's also difficult when women are going through menopause, a lot of menopause symptoms and depression are confused, and depression is often intensified during menopause." Indeed, half of all women think depression is a normal part of aging and menopause -- one of a number of reasons they may not seek the treatment they need.
Other depression symptoms can include:
A persistent sad, anxious, or "empty" mood
Sleeping too little, early morning awakening, or sleeping too much
Reduced appetite and/or weight loss, or increased appetite and weight gain
Restlessness, irritability
Persistent physical symptoms that don't respond to treatment
Thoughts of suicide or death
Although men are more reluctant to admit to depression than women, women may also feel stigmatized. Half of all women surveyed by the National Mental Health Association cite embarrassment or shame as barriers to treatment. "People still see it as some kind of weakness in moral character to be depressed, and I think that holds true for both men and women," Yonkers says.
This attitude isn't helped by the lingering perception of female depression as "just hormones." "Women previously have been dismissed as histrionic or hormonal, and now we know they're dealing with very real symptoms of depression," says Morgan-Minott.
Attributing depression to hormones has developed a negative, "anti-feminist" connotation, but it's also simple science. Depression is, at least in part, a function of brain chemistry, and fluctuations in hormone levels affect brain chemistry, although scientists are still studying exactly how that happens.
Who Gets Treated?
The good news for women is that, although they're more likely to be affected by depression than men, they're also more likely to get treated. "The detection rate is higher for women, and it's more likely that a woman with depression will leave a doctor's office with a prescription for treatment than men will," says Yonkers.
The best way to get that treatment, of course, is to seek it out. Women experiencing depressive symptoms for more than a few days should see their doctor for a referral to a mental health specialist.
"You may have an external stressor leading to depression, or you may have a genetic tendency to become depressed. You may be experiencing a change in biochemical levels such as serotonin and possibly norepinephrine," says Morgan-Minott.
She advises women to use all the therapeutic tools available to them -- medication and counseling. Most current research indicates that while both antidepressant medications and therapy are effective in combating depression, the most potent treatment combines the two.
