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WOMEN AND DEPRESSION
DR.
AMBRISH SINGAL
M.D [PSYCHIATRY] MIPS, MAPA, AIASP, MIAPP, MCSEPI
CONSULTANT PSYCHIATRIST
CONTACT +91-9815333660
Women are more likely to become depressed than men. Because of this
fact, Psychology Information Online provides information about
women and depression, including diagnosis, possible causes and risk
factors that might be responsible for the higher rate of depression
in women, and what to do if you think you are depressed.
Women suffer from unipolar (as opposed to bipolar or manic)
depression in greater numbers than men do; twice as much by
most estimates. At one time it was theorized that women didn't
actually have depression more than men, but that they were more
likely to seek help and therefore have their depression recorded.
However, studies have shown that a larger ratio of women to men do
have this illness. In addition, women seem to suffer from
eating disorders
and
self-injury
in greater numbers than men do.
What Every Woman Should Know About Depression
Life is full of emotional ups and downs. But when the "down" times
are long lasting or interfere with an individual's ability to
function, that person may be suffering from a common, but serious
psychological problem - depression
Clinical depression affects your physical well-being, resulting in
chronic fatigue, sleep problems, and changes in appetite. It affects
your mood, with feelings of sadness, emptiness, hopelessness and
dysphoria. It affects the way you think, interfering with
concentration and decision making. And, it affects your behavior,
with increased irritability and loss of temper, social withdrawal,
and a reduction in your desire to engage in pleasurable activities.
Research indicates that in the United States more than 17 million
people experience depression each year, and nearly two thirds do not
get the help they need. Proper treatment would alleviate the
symptoms in over 80 percent of the cases. Yet, because depression is
often unrecognized, depressed individuals often continue to suffer
needlessly.
Women are almost twice as likely as men to experience depression.
Research continues to explore how this psychological problem affects
women. At the same time, it is important for women to increase their
awareness of what is already known about depression, so that they
seek early and appropriate treatment.
What is Depression?
Depression is a "whole-body" illness, involving your body, mood, and
thoughts. It affects the way you eat and sleep, the way you feel
about yourself, and the way you think about things. A depressive
disorder is not the same as a passing blue mood. It is not a sign of
personal weakness or a condition that can be willed or wished away.
People with depression cannot merely "pull themselves together" and
get better. Without treatment, symptoms can last for weeks, months,
or years. Appropriate treatment, however, can help most people who
have depression.
The symptoms of depression vary from person to person, and the
intensity of the symptoms depends on the severity of the depression.
Depression causes changes in thinking, feeling, behavior, and
physical well-being.
There are three primary types of depression: Major Depression;
Dysthymia; and Bipolar Depression. In addition to these primary
depressions, many people also develop a "reactive depression," which
may be less severe, but still requires psychological treatment. A
reactive depression occurs when you develop many of the symptoms of
depression in response to the stress of a major life problem, but
they are not severe enough to be considered a major depression. If
these milder symptoms of depression occur without a clear life
stress as the cause, and the depression has not lasted long enough
to by considered dysthymia, then it is called an Unspecified
Depression. Other depressions may be caused by the physiological
effects of a medical condition, or by substance abuse. The specific
depression label, beyond the three primary types of depression and
reactive depression, will not be reviewed here.
Major depression - Also known as unipolar or clinical depression,
people have some or all of the depression symptoms listed below for
at least 2 weeks or as long as several months or even longer.
Episodes of the illness can occur once, twice, or several times in a
lifetime.
Dysthymia - The same symptoms are present. However they are usually
milder, but last at least two years. People with dysthymia also can
experience major depressive episodes.
Manic-depression - This is also called bipolar disorder. This type
of depression is not nearly as common as other forms of depression.
It involves disruptive cycles of depressive symptoms that alternate
with euphoria, irritable excitement, or mania.
The Symptoms of Depression and Mania
You should talk to a psychologist for an evaluation, if you
experience several of the following symptom clusters, and the
symptoms persist for more than two weeks, or if they interfere with
your work or your family life. However, not everyone with
depression experiences all of these symptoms, and the severity of
the symptoms also varies from person to person.
Depression
1.
Persistent sad, anxious, or "empty" mood
2.
Loss of interest or pleasure in your usual activities,
including sex
3.
Restlessness, irritability, or excessive crying
4.
Feelings of guilt, worthlessness, helplessness, hopelessness,
pessimism
5.
Sleeping too much or too little, early morning awakening
6.
Appetite and/or weight loss or overeating and weight gain
7.
Decreased energy, fatigue, feeling "slowed down"
8.
Thoughts of death or suicide, or suicide attempts
9.
Difficulty concentrating, remembering, or making decisions
10.
Persistent physical symptoms that do not respond to
treatment, such as headaches, digestive disorders, or chronic pain
Mania
1.
Abnormally elevated mood
2.
Irritability
3.
Severe insomnia
4.
Grandiose notions
5.
Increased talking
6.
Racing thoughts
7.
Increased activity, including sexual activity
8.
Markedly increased energy
9.
Poor judgment that leads to risk-taking behavior
10.
Inappropriate social behavior
Some people mistakenly try to control their depressive symptoms
through alcohol or other mood-altering drugs. While such drugs may
provide temporary relief, they will eventually complicate the
depressive disorder and its treatment, and can lead to dependence
and the life adjustment problems that come with it. Many people with
drug and alcohol problems have an underlying depression.
Additionally, the chronic substance abuse leads to the development
of additional pessimistic perceptions of life, and additional
stressors that can create depression.
Women at Greater Risk for Depression than Men
Major depression and dysthymia affect twice as many women as men.
This two-to-one ratio exists regardless of racial and ethnic
background or economic status. The same ratio has been reported in
eleven other countries all over the world. Men and women have about
the same rate of bipolar disorder (manic depression), though its
course in women typically has more depressive and fewer manic
episodes. Also, a greater number of women have the rapid cycling
form of bipolar disorder, which may be more resistant to standard
treatments.
Many factors unique to women are suspected to play a role in
developing depression. Research is focused on understanding these
factors, including: reproductive, hormonal, genetic or other
biological factors; abuse and oppression; interpersonal factors; and
certain psychological and personality characteristics. But, the
specific causes of depression in women remain unclear. Many women
exposed to these stress factors do not develop depression. Remember,
depression is a treatable psychological problem, and treatment is
effective for most women
Causes of depression
The reason or reasons why women have unipolar depression more
frequently than men is less definite, due to a great extent to the
fact that we don't fully understand what causes depression, whether
in men or women. Depression is a highly individual disease. Each
case is different. One person's depression may be wholly chemical,
while someone else's is brought on by events and stressful factors
in her life. Yet another person may suffer depression due to a
combination of chemical and environmental factors.
Several theories have been brought forward to explain the greater
frequency of depression in women. At this point it is difficult to
either completely discount any of them or to point to one and say,
"That's it!". There is no question that women have to deal with a
greater number of risks to their physical and emotional well being
than men. We have yet to learn to what extent each of these plays a
role in depression in women. Until then, it is wise to be aware of
these potential risks, in the same way we are aware of risk factors
for heart disease or high blood pressure.
1 Biology
Women experience several major biological changes in their lives;
onset of menstruation, pregnancy, postpartum and menopause. They
also go through a hormonal metamorphosis every month. The
menstruation is also a form of physical stress and thus play a part
in depression in women.
Girls entering puberty are twice as prone to depression as boys, and
it is possible that this is due to the hormonal changes brought on
by the onset of menstruation. This is a time at which they are
vulnerable to internal and external conflicts and pressures which
would be more likely to contribute to depression than changing
hormones.
Despite the image many people have of a pregnant women being
emotional and prone to crying jags, pregnancy depression is rare,
even among women who have suffered bouts of depression before
becoming pregnant.
Postpartum
depression (different from the "baby blues"), however,
affects as many as one in four first-time mothers in one form or
another. Interestingly, menopause, which many people assume is a
time of potential depression for women, does not seem to put them at
a greater risk for depression than men of the same age.
The question of whether premenstrual syndrome leaves women more open
to depression, or is in itself a form of depression, has no easy
answers. Certainly PMS and depression share some characteristics:
irritability, appetite change, listlessness, crying jags. However,
one thing to bear in mind is that when some women think they are
suffering from PMS, they may actually be going through depression.
When the above-mentioned symptoms starts taking over a good part of
each month, she should talk to a psychiatrist about the possibility
that she is actually experiencing depression.
2 Role
in Society
Studies have shown that because of social conditioning, women have a
lower sense of their own self-worth and competence than men do. This
is often reinforced in the workplace in the form of lower pay and
discrimination in hiring and promotion. Add to this the fact that
women still do most of the housework and child-rearing, and you have
not only problems with self-image, but also multiple stresses. They
are the person who had to adjust at every step to make the things go
on working smoothly .It is possible that these are both factors in
greater prevalence of depression in women.
3 Rape
and Abuse
Women (and girls) are much more likely than men to be raped and
physically or sexually harassed/abused.
These experiences factor into many cases of depression. Low
self-esteem, feelings of helplessness and self-blame are by-products
of any form of abuse, and these can either cause or exacerbate
depression. A woman who is the victim of any type of abuse should
consider herself at risk for depression.
4 Special Considerations; Pregnancy and Depression
When it comes to whether or not depression is present during
pregnancy, women's experiences had shown wide variations. Some women
who have had lifelong depression find that it eases off during
pregnancy, and they have no need of their medication. However, some
women who have never experienced depression find that they are
vulnerable to it for the first time when they become pregnant.
The Dimensions of Depression in Women
Adolescence
Studies show that the higher incidence of depression in females
begins in adolescence, when roles and expectations change
dramatically. The stresses of adolescence include forming an
identity, confronting sexuality, separating from parents, and making
decisions for the first time, along with other physical,
intellectual, and hormonal changes. These stresses are generally
different for boys and girls, and may be associated more often with
depression in females. Some researchers have suggested that men and
women differ in their expression of emotional problems. In
adolescence, boys are more likely to develop behavioral and
substance abuse problems, while girls are more likely to become
depressed.
Adulthood:
relationships and work roles Stress can contribute to depression in
many people. The higher incidence of depression in women may not be
due to greater vulnerability, but to the particular stresses that
many women face. These stresses include major responsibilities at
home and work, single parenthood, and caring for children and aging
parents. Social expectations play a role here as well. In two career
families, women are more likely to have responsibility for a greater
share of child care and household responsibilities. Role conflict
is also an issue, as debate continues regarding whether women need
to choose between family and work responsibilities, and about which
choice is the "proper" one.
Reproductive events
Women's reproductive events include the menstrual cycle, pregnancy,
the post pregnancy period, infertility, menopause, and sometimes,
the decision not to have children. These events bring fluctuations
in mood that for some women include depression. Researchers have
confirmed that hormones have an effect on brain chemistry. Changes
in emotions and mood often result. The specific biological mechanism
explaining hormonal involvement in depression is not known.
Many women experience certain behavioral and physical changes
associated with phases of their menstrual cycles. In some women,
these changes are severe, occur regularly, and include depressed
feelings, irritability, and other emotional and physical changes.
Called premenstrual syndrome, its relation to depressive disorders
is not yet understood. Some have questioned whether it is, in fact,
a disorder. Further research will eventually add to our
understanding of this condition.
Postpartum depressions can range from transient "blues" following
childbirth to severe, incapacitating, psychotic depressions. Studies
suggest that women who experience depression after childbirth very
often have had prior depressive episodes. However, for most women,
postpartum depressions are transient, with no adverse consequences.
Pregnancy (if it is desired) seldom contributes to depression, and
having an abortion does not appear to lead to a higher incidence of
depression. Women with infertility problems may be subject to
extreme anxiety or sadness, though it is unclear if this contributes
to a higher rate of depressive illness. In addition, young
motherhood may be a time of heightened risk for depression, due to
the increased stress.
Personality and psychology
Studies show that individuals with certain characteristics--
pessimistic thinking, low self-esteem, a sense of having little
control over life events, and proneness to excessive worrying-- are
more likely to develop depression. These attributes may heighten the
effect of stressful events or interfere with taking action to cope
with them. Some experts have suggested that the traditional
upbringing of girls might foster these traits and that may be a
factor in the higher rate of depression in women.
Other researchers have suggested that women are not more vulnerable
to depression than men, but simply express or label their symptoms
differently. Women may be more likely to admit feelings of
depression, brood about their feelings, or seek professional
assistance. Men, on the other hand, may be socially conditioned to
deny such feelings or to bury them. Men also have a greater tendency
to "act out" when they are under stress. This results in higher
rates of alcoholism in men, and higher rates of physical violence.
Victimization
Studies show that women molested as children are more likely to have
clinical depression at some time in their lives than those with no
such history. In addition, several studies show a higher incidence
of depression among women who were raped as adults. Since far more
women than men were sexually abused as children, these findings are
relevant. Women who experience other commonly occurring forms of
abuse, such as physical abuse and sexual harassment on the job, also
may experience higher rates of depression. Abuse may lead to
depression by fostering low self-esteem, a sense of helplessness,
self-blame, and social isolation. At present, more research is
needed to understand whether victimization is connected specifically
to depression.
Poverty Women
and children represent seventy-five percent of the US. population
considered poor. Some researchers are exploring the possibility that
poverty is one of the "pathways to depression." Low economic status
brings with it many stresses, including isolation, uncertainty,
frequent negative events, and poor access to helpful resources.
Sadness and low morale are more common among persons with low
incomes and those lacking social supports. But research has not yet
established whether depression is more prevalent among those facing
environmental stressors such as these. One very large study has
shown that depression tends to equally effect the poor and the rich.
Depression in later adulthood
Once, depression at menopause was considered a unique illness known
as "involutional melancholia." Research has shown, however, that
depressive illnesses are no different, and no more likely to occur,
at menopause than at other ages. In fact, the women most vulnerable
to change-of-life depression are those with a history of past
depressive episodes. An old theory, the "empty nest syndrome",
stated that when children leave home, women may experience a
profound loss of purpose and identity that leads to depression.
However, studies show no increase in depressive illness among women
at this stage of life.
As with younger age groups, more elderly women than men suffer from
depressive illness. Similarly, for all age groups, being unmarried
(which includes widowhood) is also a risk factor for depression.
Despite this, depression should not be dismissed as a normal
consequence of the physical, social and economic problems of later
life. In fact, studies show that most older people feel satisfied
with their lives.
About 800,000 persons are widowed each year, most of them are older,
female, and experience varying degrees of depressive symptomatology.
Most do not need formal treatment, but those who are moderately or
severely sad appear to benefit from self-help groups or
psychotherapy. Remarkably, a third of widows/widowers meet criteria
for major depressive episode in the first month after the death, and
half of these remain clinically depressed 1 year later. These
depressions respond to psychotherapy and standard antidepressant
medications.
Treatment for Depression
Even severe depression can be highly responsive to treatment.
Indeed, believing one's condition is "incurable" is often part of
the hopelessness that accompanies serious depression. Information
about the effectiveness of modern treatments for depression is
clear. As with other psychological problems, the earlier treatment
begins, the more effective it is. Of course, treatment will not
eliminate life's inevitable stresses and ups and downs. But it can
greatly enhance your ability to manage such challenges and lead to
greater enjoyment of life. There are also some alcohol and drug addiction treatment programs that focus on helping women deal with various issues.
Types of treatment for depression
The most commonly used treatments for depression are psychotherapy
and antidepressant medication, or a combination of the two. Which
of these is the right treatment for an individual depends on the
nature and severity of the depression and, to some extent, on
individual preference. In mild or moderate depression, psychotherapy
is most likely the most appropriate treatment But, in severe or
incapacitating depression, medication is generally recommended, in
addition to psychotherapy. In combined treatment, medication can
relieve physical symptoms quickly, while psychotherapy allows you to
learn more effective ways of handling your problems.
Psychotherapy
Psychotherapy is used to treat depression in several ways. First,
supportive counseling can help to ease the pain of depression, and
can address the hopelessness of depression. Second, cognitive
therapy works to change the pessimistic ideas, unrealistic
expectations, and overly critical self-evaluations that create the
depression and sustain it. Cognitive therapy can help the depressed
person recognize which life problems are critical, and which are
minor. It also helps them to develop positive life goals, and a more
positive self-assessment. Third, problem solving therapy is usually
needed to change the areas of the person's life that are creating
significant stress, and contributing to the depression. This may
require behavioral therapy to develop better coping skills, or
Interpersonal therapy, to assist in resolving relationship problems.
Research has shown that these psychotherapies are particularly
helpful for treating depression.
Medications
Except in the more severe depressions, and bipolar depression,
medication is usually an option, rather than a necessity.
Antidepressant medication does not cure depression, it only helps
you to feel better by controlling certain symptoms. If you are
depressed because of life problems, such as relationship conflicts,
divorce, loss of a loved one, job pressures, financial crises,
serious medical problems in yourself or a family member, legal
problems, or problems with your children, taking a pill will not
make those problems go away.
The medications used to treat depression include tricyclic
antidepressants, monoamine oxidase inhibitors (MAOIs), serotonin
reuptake inhibitors (SRIs), and bupropion. Each acts on different
chemical pathways of the human brain related to moods.
Antidepressant medications are not habit-forming. To be effective,
medications must be taken for about 4-6 months (in a first episode),
carefully following the doctor's instructions. Medications must be
monitored to ensure the most effective dosage and to minimize side
effects.
Your prescribing doctor will provide information about possible
side-effects and/or dietary restrictions. Always remember that all
prescription drugs have potential side effects. In addition, other
medically prescribed medications being used should be reviewed
because some can interact negatively with antidepressant medication.
Pregnant, Nursing, or Childbearing-Age Women
In general, during pregnancy, all medications (including
psychotherapeutic medications) should be avoided where possible, and
other methods of treatment should be
tried.
A woman who is taking a psychotherapeutic medication and plans to
become pregnant should discuss her plans with her doctor; if she
discovers that she is pregnant, she should contact her doctor
immediately. During early pregnancy, there is a possible risk of
birth defects with some of these medications, and for this reason:
1) Lithium is not recommended during the first 3 months of
pregnancy.
2) Benzodiazepines are not recommended during the first 3 months of
pregnancy.
The decision to use a psychotherapeutic medication should be made
only after a careful discussion with the doctor concerning the risks
and benefits to the woman and her baby. Small amounts of medication
pass into the breast milk; this is a consideration for mothers who
are planning to breast-feed.
A woman who is taking birth-control pills should be sure that her
doctor is aware of this. The estrogen in these pills may alter the
breakdown of medications by the body, for example increasing side
effects of some antianxiety medications and/or reducing their
efficacy to relieve symptoms of anxiety. |
