Women experience depression twice as often as men. 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 in women is the same as for men, 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% of women compared with 12% of men. Although the exact reason for this difference is not known, biological, life cycle and psychosocial factors may relate to the higher rate of depression in women.
Women and Depression – Effect of Hormones
Hormones and depression in women may also be linked. Researchers have shown hormones directly effects the brain chemistry controlling emotions and mood. For example, depression in women is particularly common after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. About 10%-15% of women will develop postpartum depression, a serious condition that requires active treatment.
Some women may also be susceptible to a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD affects mood and is thought to occur due to the hormonal changes that happen around ovulation and before menstruation begins. The transition into menopause also seems to affect hormones and depression in women.
Risk Factors for Depression in Women
- Family or personal history of mood disorders
- Loss of a parent before the age of ten
- History of childhood 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 latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), are the same for women and men (Table below). The diagnosis of depression requires the presence of depressed mood or diminished pleasure (anhedonia), plus four other symptoms for at least two weeks.1
Diagnostic Criteria for Major Depression
- Depressed mood
- Diminished interest or loss of pleasure in almost all activities (anhedonia)
- Significant weight change or appetite disturbance
- Sleep disturbance (insomnia or hypersomnia)
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness
- Diminished ability to think or concentrate; indecisiveness
- Recurrent thoughts of death, suicidal
- A pattern of long-standing interpersonal rejection ideation, suicide attempt, or specific plan for suicide
Additional depression diagnosis criteria are as follows:
- The symptoms must cause significant distress or impairment of functioning in social, occupational, or other important areas.
- Depression should not have been precipitated by the direct action of a substance or a general medical condition.
- Symptoms should not meet criteria for a mixed episode (ie, for both manic and depressive episode).
- Symptoms are not better accounted for by bereavement (ie, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).
- A major depressive episode should not be superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified (NOS).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Text Revision. 4th Edition. Washington, DC: American Psychiatric Association; 2000.
The presentation and course of depression in women is sometimes different to that of men (Table below). Seasonal depression is more common in women as are the 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). In addition, women more frequently have symptoms of anxiety, panic, phobia and eating disorders. Women also have a higher incidence of hypothyroidism, a condition that is one of the causes of depression in women. Finally, exogenous and endogenous gonadal steroids may have a greater impact on depression in women than depression in men.
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