Depression in Women

Apocalypse Suicide Page
Good Mood
Living with Depression
Mental Health Recovery
NIMH
SHOCKED! ECT

HealthyPlace.com Radio
Depression Support Groups

Books on Depression
Conference Transcripts
Depression Videos
Diaries - Journals
Disorders Definitions
Mental Health News
Online Depression Tests
Psychiatric Medications
Resources
Site Map

Email
ICQ
Instant Messenger

Visit and Post

Abuse
ADD/ADHD
Addictions
Anxiety-Panic
Bipolar
Eating Disorders
Personality Disorders
Self-Injury

send this page to a friend

Women experience depression twice as often as men. The diagnostic criteria for depression are the same for both sexes, but women with depression more frequently experience guilt, anxiety, increased appetite and sleep, weight gain and comorbid eating disorders. Women may achieve higher plasma concentrations of antidepressants and thus may require lower dosages of these medications. Depending on the patient's age, the potential effects of antidepressants on a fetus or neonate may need to be considered. Research indicates no increased risk or developmental malformations from in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. SSRIs are effective in treating premenstrual dysphoric disorder and many comorbid conditions associated with depression in women. Psychotherapy may be used alone in women with mild to moderate depression, or it may be used adjunctively with antidepressant drug therapy. Women who have severe depression accompanied by active suicidal thoughts or plans should usually be managed in conjunction with a psychiatrist. (Am Fam Physician 1999;60:225-40.)

More Info

A Woman's Guide to Diagnosing Depression and Treatment

You May Be Depressed. What Do You Do Now?

Over the course of a lifetime, depression occurs in approximately 20 percent of women compared with 10 percent of men.¹ Although the exact reason for this difference is not known, the higher prevalence of depression in women is most likely due to a combination of gender-related differences in cognitive styles, certain biologic factors and a higher incidence of psychosocial and economic stresses in women.² Possible biologic mechanisms may include differences in brain structure and function, genetic factors and the cognitive-behavioral or mood-related effects of female gonadal steroids on neurotransmitters and enzyme functions in vulnerable persons.^3,4 Some risk factors for depression in women are listed in Table below.^5-7

Risk Factors for Depression in Women

Family history of mood disorders
Personal past history of mood disorders in early reproductive years
Loss of a parent before the age of 10 years
Childhood history of physical or sexual abuse
Use of an oral contraceptive, especially one with a high progesterone content
Use of gonadotropin stimulants as part of infertility treatment
Persistent psychosocial stressors (e.g., loss of job)
Loss of social support system or the threat of such a loss

Information from references 5 through 7.

Diagnosis

The diagnostic criteria for major depression, as established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), are the same for women and men (Table below).⁸ The nine symptoms of depression are divided into two subgroups: psychologic (four symptoms) and physical (five symptoms). The diagnosis of depression requires the presence of depressed mood or the inability to experience pleasure, plus four other symptoms. Thus, five of nine symptoms must be present. Inclusion, exclusion and duration criteria must also be met.

Diagnostic Criteria for Major Depression

Psychologic symptoms

Depressed mood
and/or
Reduction of interest and/or pleasure in activities, including sex
Feelings of guilt, hopelessness and worthlessness
Suicidal thoughts (recurrent)

Physical symptoms

Sleep disturbance (insomnia or hypersomnia)
Appetite/weight changes
Attention/concentration difficulties
Decreased energy or unexplained fatigue
Psychomotor disturbances

For the diagnosis of major depression, at least one of the first two psychologic symptoms and four of the remaining eight psychologic and physical symptoms must be present for at least two weeks. The symptoms are not accounted for by bereavement, general medical conditions, medications, or drug or alcohol abuse. The symptoms must result in significant impairment of social, occupational or school functioning. A modifier such as "postpartum onset" may be added if symptoms start within four weeks postpartum.

advertisement

Although the same diagnostic criteria are used for both genders, the presentation and course of depression are sometimes different in women (Table below).^2,4,7,9 Compared with men, women may more often experience seasonal depression⁹ and symptoms of atypical depression (i.e., hypersomnia, hyperphagia, carbohydrate craving, weight gain, a heavy feeling in the arms and legs, evening mood exacerbations and initial insomnia).⁸ In addition, women more frequently have symptoms of anxiety, panic, phobia, eating disorders and dependent personality. Women also have a higher incidence of hypothyroidism, a condition that can cause depression.⁷ Thus, it is important to screen depressed female patients for hypothyroidism. Finally, exogenous and endogenous gonadal steroids may have a greater impact on mood in women than in men.

Depression: Differences in Women Compared with Men
Physical properties	Differences in women compared with men
Lifetime prevalence rate	20 percent (10 percent in men)
Age of onset	May be earlier
Duration of episodes	May be longer
Course of illness	May more often be recurrent
Seasonal effect on mood	Greater
Association with stressful life events	More frequent
Atypical symptoms of depression (e.g., hypersomnia, hyperphagia)	Experienced more often
Severity of depression	May be greater if self-rated by the patient
Guilt feelings	May be experienced more often
Suicidal behavior	Suicide attempted more often but much less often successfully
Association of anxiety disorders, especially panic and phobic symptoms	Greater
Association of eating disorders	Greater
Association of alcoholism and substance use disorder	Usually less
Association of thyroid disease	Greater
Association of migraine headaches	Greater
Association of antisocial, narcissistic and obsessive-compulsive personalities	Less
Effect of exogenous and endogenous gonadal steroids on mood	Greater
For the diagnosis of major depression, at least one of the first two psychologic symptoms and four of the remaining eight psychologic and physical symptoms must be present for at least two weeks. The symptoms are not accounted for by bereavement, general medical conditions, medications, or drug or alcohol abuse. The symptoms must result in significant impairment of social, occupational or school functioning. A modifier such as "postpartum onset" may be added if symptoms start within four weeks postpartum. Information from American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994: Copyright 1994.

Depression and Suicide

Depression is a significant risk factor for suicidal behavior in both sexes. Women, especially those younger than 30 years of age, more often attempt suicide, whereas men more often complete the act of self-destruction.¹⁰ In fact, the male-to-female ratio for completed suicides is greater than 4:1,¹⁰ possibly because women frequently choose less lethal methods. In addition, women often attempt suicide to change the dynamics of interpersonal relationships. Significant risk factors for suicide by women are listed in Table below.^10-12

High-Risk Factors for Suicidal Behavior in Women

Risk for suicide attempts

Age less than 30 years

Threatened loss of intimate relationship

Living alone

Current psychosocial stressors (e.g., recent loss of job)

Substance abuse

Personality disorder (e.g., borderline personality disorder)

Clinical depression

Risk for completed suicide

Severe clinical depression, especially with psychosis

Substance abuse

Past history of suicide attempts

Current active suicidal ideation or plan

Divorced or widowed status

One or more active or chronic medical illnesses

Feelings of hopelessness

Panic disorder

Severe anxiety, especially if mixed with depression

During the initial visit, every patient with depression should be screened for suicidal thoughts, intent and plan, as well as the availability and lethality of a method for committing suicide. This screening may provide an opportunity for lifesaving intervention.¹⁰

Self-poisoning is the method employed in 70 percent of all suicide attempts by women.¹¹ Thus, at the initial visit with a depressed female patient, it is prudent to prescribe only one week of an antidepressant (especially one that is potentially lethal in overdose, such as a tricyclic agent). It is also important to enlist the aid of at least one of the patient's family members or friends to monitor intake of the prescribed antidepressant so that the patient does not hoard the medication for use in a suicide attempt.

Hospitalization is necessary for patients with severe depression, psychosis, substance abuse, severe hopelessness or limited social support. Patients should also be hospitalized if they articulate or display a strong urge to act on suicidal thoughts or if they have a specific suicide plan that is likely to be successful. Typically, such patients require management by a psychiatrist.

Outpatient management is appropriate for patients with less severe depression who have infrequent suicidal thoughts, who are willing to contract for safety and let go of their instrument of suicide, who have good social support and who are willing to return for regular follow-up.¹²