Women's Nutrition & Fitness

Depression in Women

With the recent pandemic and people being stuck in their homes, with nowhere to travel, many of them losing their jobs, and among other adversities, the topic of depression was being talked about more than ever.

Many celebrities including Hollywood and Bollywood actors and actresses have opened up about going through depression and their experiences with the mental disorder. According to WHO, in the first year of the COVID-19 pandemic, the global prevalence of anxiety and depression increased by a massive 25%. It is common even now to think of depression as a state of psychological illness, and because it is termed as an illness, the majority of us do not want to talk about it or address the issue. 

We must understand that our brain is an organ, like any other organ in the body, and similar to other organs the brain may also suffer from some of the other issues. This is completely normal. If we suffer from a heart attack we may consult a cardiologist, in the same way, if we have any issues related to the brain consulting a psychologist is the correct way to go about it. And this does not make a person mad or “mental” as the old thinking goes. The stigma attached to the word mental makes seeking treatment for depression difficult and aggravates the problem. 

Coming to the gender differences observed in depression it is seen that women suffer from depression twice that of men. What may be the cause and what makes the female gender more susceptible to depression? Read the following article to understand more about women and depression.

What Is Depression?

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in a person’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide (1). 

While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males. Depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (1). This higher prevalence of depression in women may be related to biological, hormonal, and psychosocial factors.

The biological theories consider differences in brain structure and function among men and women, which may relate to different reproductive hormones. The psychosocial factors such as differences in socialization, stress, coping mechanisms, and styles also contribute to the higher prevalence. The four depressive conditions specific to women are premenstrual dysphoric disorder (PMDD), depression in pregnancy, postpartum depression, and depression related to perimenopause or menopause (2).

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Signs and Symptoms of Depression in Women

Sex differences are also reported for signs and symptoms of depression. Women appear to be more seriously affected by depression than men, with earlier age of onset, greater family history of affective disorders, greater severity of illness, poorer social adjustment, and poorer quality of life (3). Women may also have a more chronic and recurrent course of illness, with more frequent and longer episodes, than men (2). 

If the following signs and symptoms are seen in women and they persist for more than 2 weeks, depression may be the possible diagnosis (4).

  • Persistent sad, anxious, or “empty” mood.
  • Feelings of hopelessness or pessimism.
  • Irritability.
  • Feelings of guilt, worthlessness, or helplessness.
  • Decreased energy or fatigue.
  • Difficulty sleeping, early-morning awakening, or oversleeping.
  • Loss of interest or pleasure in hobbies and activities.
  • Moving or talking more slowly.
  • Feeling restless or having trouble sitting still.
  • Difficulty concentrating, remembering, or making decisions.
  • Changes in appetite or weight.
  • Thoughts of death or suicide, or suicide attempts.
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment.

Causes of Depression in Women (4)

Many potential causes for and contributing factors to women’s increased risk for depression are being examined. Likely, genetic, biological, chemical, hormonal, environmental, psychological, and social factors all intersect to contribute to depression in women.

Genetics

If a woman has a family history of depression, she may be more at risk of developing depression. This however is not a hard and fast rule. Research indicates that the risk for developing depression in women likely involves the combination of multiple genes along with environmental or other factors.

Chemicals and Hormones

The functioning of the brain appears to be a significant factor in depressive disorders. Magnetic resonance imaging (MRI), has shown that the brains of people suffering from depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior do not appear to be functioning normally. In addition to this, important neurotransmitters, which are the chemicals that brain cells use to communicate with other parts of the body appear to be out of balance. But these images do not reveal WHY the depression has occurred.

Studies are also being conducted on the influence of female hormones, which change throughout life. Researchers have shown that hormones directly affect those parts of the brain that control emotions and mood. Specific times during a woman’s life are of particular interest, including puberty; the times before menstrual periods; before, during, and just after pregnancy (postpartum); and just before and during menopause (perimenopause).

Menstruation

A severe form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD) exists wherein women typically experience depression, anxiety, irritability, and mood swings a week before menstruation. This is at such a degree that it interferes with their normal functioning. Studies are being conducted for exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain that is associated with depressive illness in women.

Postpartum phase

Women are particularly vulnerable to depression after giving birth. It may happen because the hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the “baby blues,” but some may suffer from postpartum depression. This is a much more serious condition that requires active treatment and emotional support for new mothers. One study found that postpartum women are at an increased risk for several mental disorders, including depression, for several months after childbirth.

Studies also suggest that women who experience postpartum depression often have had prior depressive episodes. Some experience it during their pregnancies, but it often goes undetected. Research suggests that visits to the doctor may be good opportunities for screening for depression both during pregnancy and in the postpartum period.

Menopause

Increased hormonal changes during the transition between pre-menopause to menopause may cause depression in women. While some women may transition into menopause without any problems with mood, others experience an increased risk for depression and this may even occur among women without a history of depression. However, depression becomes less common for women during the post-menopause period.

Stress

Stressful life events such as trauma, loss of a loved one, a difficult relationship, or any stressful situation usually are seen to happen before a depressive episode. Additional work and home responsibilities, caring for children and aging parents, abuse, and poverty also may trigger a depressive episode. Evidence suggests that women respond to these events in such a way that prolongs their feelings of stress as compared to men, making them more prone to depression. 

Treatment and Management

Depression, even in the most severe cases, is highly treatable. The earlier the treatment can begin, the more effective it is recurrence can be prevented. It is advisable to consult a medical health professional who will conduct a complete diagnostic evaluation for depression.

A complete history of symptoms, including when they started, how long they have lasted, their severity, whether they have occurred before, and if so, how they were treated will be asked. Family history, use of alcohol or drugs, death, or suicidal thoughts are also enquired. Once diagnosed, there are several treatment modalities, the most common being medication and psychotherapy.

Medication

Usually, antidepressant drugs are prescribed that work on the chemical messengers in the brain. The doses of antidepressants prescribed by the doctors should be followed strictly to experience a full effect. The medicines should be taken for the amount of time specified to prevent a relapse. The decision to stop taking medication should be made by the person and her doctor together and should be done only under the doctor’s supervision. Antidepressants may cause mild and often temporary side effects which should be reported to the doctor immediately if persistent or troublesome.

Psychotherapy

Also called “talk therapy”— can help considerably. Some regimens are short-term (10 to 20 weeks) and other regimens are longer-term, depending on the needs of the individual. Two main types of psychotherapies— cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)—are effective. It may be the best treatment option for mild to moderate depression. However, for major depression or certain women depending on the causative factor, psychotherapy may not be enough.

Electroconvulsive Therapy (ECT)

Formerly known as “shock therapy,” ECT used to have a negative reputation. But in recent years, it has improved substantially and can provide relief for severe depression. 

New ways and treatment options are being researched to better understand, diagnose and treat depression (4)

How can you help a friend or relative who is depressed?

The first and most important is to help her get an appropriate diagnosis and treatment. Encourage her to stay in treatment, or to seek different treatment if no improvement occurs after 6 to 8 weeks.

In addition, you can also:

  • Offer emotional support, understanding, patience, and encouragement.
  • Engage her in conversation, and listen carefully.
  • Never disregard the feelings she expresses, but point out realities and offer hope.
  • Never ignore comments about suicide, and report them to your friend’s or relative’s therapist or doctor.
  • Invite her out for walks, outings, and other activities. Keep trying but don’t push her to take on too much too soon. 
  • Remind her that with time and treatment, the depression will lift.

Conclusion

Depression in women is more prevalent than in men due to various factors. In addition to increased frequency, and perhaps intensity, of depression, there are several aspects of mood disorders that are relevant only to women. It becomes critical for physicians, women, as well as their families, to understand the risks and benefits of treating depression during the different phases in a woman’s life so that well-informed decisions regarding the treatment and intervention can be made and the best outcome assured.

Women go through a roller coaster of emotions and feelings during different life aspects. From being a child to bearing children and grandchildren women face many hardships which may result in them facing depression and other mental issues. Ignoring these issues will do more harm. Women should understand that it is important to talk about how they feel and not be afraid to express themselves. They should ask for help whenever required and not be ashamed of their feelings. Afterall “ strongest people are those who win battles others know nothing about”

How did you find this article? Do write about your views in the comments below.

Author: Dr Pooja Nilgar (Content writer and editor)

References

  1. Marcus, M., Yasamy, M.T., van Ommeren, M.V., Chisholm, D. and Saxena, S., 2012. Depression: A global public health concern.
  2. MacQueen, G. and Chokka, P., 2004. Special issues in the management of depression in women. Canadian Journal of Psychiatry49(1), pp.27-40.
  3. Kornstein, S.G., Schatzberg, A.F., Thase, M.E., Yonkers, K.A., McCullough, J.P., Keitner, G.I., Gelenberg, A.J., Ryan, C.E., Hess, A.L., Harrison, W. and Davis, S.M., 2000. Gender differences in chronic major and double depression. Journal of Affective disorders, 60(1), pp.1-11.
  4. Sympson, S. C. (2000) ‘Rediscovering Hope’, Handbook of Hope, pp. 285–300. doi: 10.1016/b978-012654050-5/50017-8.

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