Depression in Women

Women experience depression twice as often as men. (see Depression in Women and Men: What's the Difference?) According to the National Mental Health Association:

• Approximately 12 million women in the United States experience clinical depression each year.
• About one in every eight women can expect to develop clinical depression during their lifetime.

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.

Over the course of a lifetime, depression occurs in approximately 20 percent of women compared with 10 percent of men. Although the exact reason for this difference is not known, biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women's higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the "baby blues," but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes.

Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.

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

Diagnosis of Depression in Women

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). 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.

continue: Depression - Differences in Women Compared with Men