Depression in Women

Depression in Women

Causes, Symptoms, and Treatment 

Depression is not "one size fits all," particularly when it comes to the genders. Not only are women more prone to depression than men, but the causes of female depression and even the pattern of symptoms are often different.

Many factors contribute to the unique picture of depression in women—from reproductive hormones to social pressures to the female response to stress. Learning about these factors can help you minimize your risk of depression and treat it more effectively.

Understanding depression in women

Depression is a serious condition that can impact every area of your life. It can affect your social life, your family relationships, your career, and your sense of self-worth and purpose. And for women in particular, depression is common.

If you’re feeling sad, guilty, tired, and just generally “down in the dumps,” you may be suffering from major depression. But the good news is that depression is treatable, and the more you understand about depression’s particular implications for and impact on women, the more equipped you will be to tackle the condition head on.

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.

Signs and symptoms of depression in women

The symptoms of depression in women are the same as those for major depression. Common complaints include:

Depressed mood

Loss of interest or pleasure in activities you used to enjoy
Feelings of guilt, hopelessness and worthlessness
Suicidal thoughts or recurrent thoughts of death
Sleep disturbance (sleeping more or sleeping less)
Appetite and weight changes
Difficulty concentrating
Lack of energy and fatigue
For more, see Understanding Depression: Spotting the Signs and Symptoms and Getting Help.

Differences between male and female depression

Although the signs and symptoms of depression are the same for both men and women, women tend to experience certain symptoms more often than men. For example, seasonal affective disorder—depression in the winter months due to lower levels of sunlight—is more common in women. Also, women are more likely to experience the symptoms of atypical depression.

In atypical depression, rather than sleeping less, eating less, and losing weight, the opposite is seen: sleeping excessively, eating more (especially carbohydrates), and gaining weight. Feelings of guilt associated with depression are also more prevalent and pronounced in women. Women also have a higher incidence of thyroid problems. Since hypothyroidism can cause depression, this medical problem should always be ruled out by a physician in women who are depressed.

Causes of depression in women

Women are about twice as likely as men to suffer from depression. This two-to-one difference persists across racial, ethnic, and economic divides. In fact, this gender difference in rates of depression is found in most countries around the world. There are a number of theories which attempt to explain the higher incidence of depression in women. Many factors have been implicated, including biological, psychological, and social factors.

Biological causes of depression in women

Premenstrual problems - Hormonal fluctuations during the menstrual cycle can cause the familiar symptoms of premenstrual syndrome (PMS), such as bloating, irritability, fatigue, and emotional reactivity. For many women, PMS is mild. But for some women, symptoms are severe enough to disrupt their lives and a diagnosis of premenstrual dysphoric disorder (PMDD) is made.

Pregnancy and infertility - The many hormonal changes that occur during pregnancy can contribute to depression, particularly in women already at high risk. Other issues relating to pregnancy such as miscarriage, unwanted pregnancy, and infertility can also play a role in depression.

Postpartum depression - Many new mothers experience the “baby blues.” This is a normal reaction that tends to subside within a few weeks. However, some women experience severe, lasting depression. This condition is known as postpartum depression. Postpartum depression is believed to be influenced, at least in part, by hormonal fluctuations.

To learn more, see Postpartum Depression: Signs, Symptoms, and Help for New Moms.   

Social and cultural causes of depression in womenl.

Role strain - Women often suffer from role strain over conflicting and overwhelming responsibilities in their life. The more roles a woman is expected to play (mother, wife, working woman), the more vulnerable she is to role strain and subsequent stress and depression. Depression is more common in women who receive little help with housework and child care. Single mothers are particularly at risk. Research indicates that single mothers are three times more likely than married mothers to experience an episode of major depression.

Unequal power and status - Women’s relative lack of power and status in our society may lead to feelings of helplessness. This sense of helplessness puts women at greater risk for depression. These feelings may be provoked by discrimination in the workplace leading to underemployment or unemployment. Low socioeconomic status is a risk factor for major depression. Another contributing factor is society’s emphasis on youth, beauty, and thinness in women, traits which to a large extent are out of their control.

Sexual and physical abuse - Sexual and physical abuse may play a role in depression in women. Girls are much more likely to be sexually abused than boys, and researchers have found that sexual abuse in childhood puts one at increased risk for depression in adulthood. Higher rates of depression are also found among victims of rape, a crime almost exclusively committed against women. Other common forms of abuse, including physical abuse and sexual harassment, may also contribute to depression.

Relationship dissatisfaction - While rates of depression are lower for the married than for the single and divorced, the benefits of marriage and its general contribution to well-being are greater for men than for women. Furthermore, the benefits disappear entirely for women whose marital satisfaction is low. Lack of intimacy and marital strife are linked to depression in women.

Poverty - Poverty is more common among women than men. Single mothers have the highest rates of poverty across all demographic groups. Poverty is a severe, chronic stressor than can lead to depression.

Psychological causes of depression in women

Coping mechanisms - Women are more likely to ruminate when they are depressed. This includes crying to relieve emotional tension, trying to figure out why you’re depressed, and talking to your friends about your depression. However, rumination has been found to maintain depression and even make it worse. Men, on the other hand, tend to distract themselves when they are depressed. Unlike rumination, distraction can reduce depression.

Stress response - Some studies show that women are more likely than men to develop depression under lower levels of stress. Furthermore, the female physiological response to stress is different. Women produce more stress hormones than men do, and the female sex hormone progesterone prevents the stress hormone system from turning itself off as it does in men.

Puberty and body image - The gender difference in depression begins in adolescence. The emergence of sex differences during puberty likely plays a role. Some researchers point to body dissatisfaction, which increases in girls during the sexual development of puberty. Body image is closely linked to self-esteem in women, and low self-esteem is a risk factor for depression.

Risk factors for depression in women

There are a number of different, yet interrelated, risk factors for depression in women. Women of lower socioeconomic status are more likely to develop depression. This makes sense considering that the more sources of stress in a woman’s life, the more likely she is to develop depression. Women of low socioeconomic status are likely to struggle with financial problems, issues of unemployment or underemployment, discrimination, lack of education, and single parenthood. Additional risk factors include marital conflict and dissatisfaction, past sexual or physical abuse, and role strain.

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

Treating depression in women

For the most part, women suffering from depression receive the same types of treatment as everyone else. The main treatment approaches are psychotherapy and antidepressant therapy. However, there are some special treatment considerations for depression in women.

Depression and the reproductive cycle

Hormone fluctuations related to the reproductive cycle can have a profound influence on a woman’s mood. In light of this possibility, you and your doctor should always look for connections between your depressive symptoms and the female reproductive cycle. Is your depression connected to your menstrual period and a possible effect of PMS? Are you pregnant and struggling with complications and concerns related to the vast changes you and your body are undergoing? Are you struggling with the baby blues after recently giving birth? Or are you approaching menopause and dealing with hormonal and emotional fluctuations? All of these milestones in the reproductive cycle can influence or trigger depression. It’s also important to consider mood-related side effects from birth control medication or hormone replacement therapy.

Relationship issues and role strain

Because of the special role that interpersonal issues and role strain plays in female depression, psychotherapy should address them directly. Interpersonal therapy and cognitive-behavior therapy are both effective in teaching new problem solving skills, improving interpersonal relationships, and reducing negative thinking and ineffective coping techniques.

Treatment modifications

Specific aspects of treatment must often be modified for women. Because of female biological differences, women should generally be started on lower doses of antidepressants than men. Women are also more likely to experience side effects, so any medication use should be closely monitored. Finally, women are more likely than men to require simultaneous treatment for other conditions such as anxiety disorders and eating disorders.

Premenstrual dysphoric disorder

Most women are all too familiar with premenstrual syndrome (PMS). Unwelcome symptoms of PMS such as bloating, moodiness, and fatigue appear and reappear each month at the same time in the menstrual cycle. For most women, these premenstrual symptoms are uncomfortable but not disabling. But for up to one out of ten women, symptoms are so distressing and disabling that they warrant a diagnosis of premenstrual dysphoric disorder (PMDD). PMDD is characterized by severe depression, irritability, and other mood disturbances. Symptoms begin about 10 to 14 days before your period and improve within a few days of its start.

Symptoms of Premenstrual Dysphoric Disorder

Feelings of sadness or hopelessness
Feelings of tension or anxiety
Panic attacks
Mood swings and tearfulness
Persistent irritability or anger
Disinterest in daily activities and relationships
 Trouble concentrating
Fatigue or low energy
Food cravings or binge eating
Sleep disturbances
Feeling out of control
Physical symptoms (bloating, breast tenderness, headaches, muscle pain)

 Self-help for PMDD

There are many steps you can take to improve PMDD symptoms. Many involve simple lifestyle adjustments.

Exercise - Regular aerobic exercise can reduce the symptoms of PMDD.

Dietary modifications - Changes to your diet may help reduce symptoms. Cutting back on salt, fatty foods, caffeine, and alcohol is recommended. Eating plenty of complex carbohydrates is also recommended.

Nutritional supplements - Vitamin B-6, calcium, magnesium, Vitamin E, and tryptophan have all been shown to benefit women suffering from PMDD.

Herbal remedies - Evening primrose oil and chaste tree berry are herbal supplements that have both been studied and found to be effective in the treatment of PMDD.

Stress reduction - Relaxation techniques and other strategies to reduce stress may help with PMDD symptoms. Yoga and meditation are particularly effective.

For more severe cases of PMDD, antidepressant therapy may be helpful. Serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil can alleviate the emotional symptoms of PMDD. The medication may be taken consistently, or in some cases, it is only taken during the two weeks leading up to the onset of menstruation.