"Depression in Women and Men: What's the Difference?" was the subject of a one-day program co-sponsored by the National Institute of Mental Health (NIMH) and the Society for Women's Health Research (SWHR) on Saturday, March 24, 2001, as part of the Smithsonian Resident Associates series.

To open the meeting, Phyllis Greenberger, SWHR Executive Director, offered a brief overview of the Society's work. Established more than ten years ago, the Society is a Washington DC-based national advocacy organization dedicated to improving the health of women through research. It was founded by researchers, scientists, and activists who were seeking to end inequities in medical research. It now works to increase public and private funding for research on women's health, promote the inclusion of women in medical research studies, and encourage the scientific examination of basic biological and physiological differences between men and women.

A major focus for the Society has been clinical trials, Ms. Greenberger explained. For many years, women were not appropriately and proportionally represented in clinical trials. Therefore, much of medical knowledge came from what was known about the male body; findings from studies done on men were generalized to apply to women.

The Society has worked to change the way clinical trials-and scientific research in general-is performed. The number of ways in which the organization has succeeded is evident in increased funding for women's health research, passage of a federal law requiring women to be included in federally funded medical research, and strengthened Food and Drug Administration guidelines that include women in all phases of a drug's testing; in addition, the Society played a role in the establishment of the Office of Research on Women's Health at the National Institutes of Health.

As more and more researchers are investigating sex differences, Ms. Greenberger stated, they are noting that males and females often have different reactions to drugs, experience different patterns of diseases, and show different symptoms for the same disease.

The knowledge gained from appropriately studying gender differences has broadened the definition of "women's health." The scientific community has gone from focusing narrowly on reproductive organs to looking broadly at diseases and conditions that affect women exclusively, predominately, or differently. "We've gone from thinking of women as 'little men' to studying biological differences between genders," said Ms. Greenberger. "Now we know women's distinct biology sometimes makes it necessary to treat women and men differently."

"I believe we've made great strides in accomplishing what we set out to do," she said. "But there is still much to be done." Though the knowledge base built from clinical research on women is growing, it remains far less than that developed from studies on men. Medicine must progress from simply noting biological distinctions to actively researching why they occur, Ms. Greenberger said.

The Smithsonian program will demonstrate, she explained, that depression is an area with an abundance of gender differences not only at the biological and physiological level but at the sociological level as well. Depression in both women and men is a debilitating disorder that disrupts relationships and daily lives and affects nearly ten percent of the population. Though depression is a treatable disease, about eighty percent of episodes of depression are not diagnosed and treated.

Ms. Greenberger highlighted these issues relating to women and depression:

• We are just beginning to learn about the ways in which medications are processed differently in women and men and how this affects treatment choices-such as dosages-and outcomes.
• Serotonin is a neurotransmitter used by the brain for mood balance. Males and females process this neurochemical and others, such as estrogen, in different ways.
• Suicide attempts are more common in women. Men are more successful in taking their own lives, but more women attempt it.
• Men are more likely to be diagnosed with alcohol problems, but women are at higher risk for developing alcohol problems following an episode of depression. Women experiencing depression are more likely to develop alcohol problems within a few years of their first depressive episode.
• Depression treatment issues during pregnancy and postpartum are particularly challenging.
• Under the age of 13, approximately equal numbers of girls and boys experience depression. Once children reach the age of 13, more girls than boys become depressed.

Understanding why these sex differences occur undoubtedly will help in understanding the biological basis of depression, and how better to treat it in both women and men, concluded Ms. Greenberger.