Understanding depression in women
Depression is a serious condition that can impact every area of your life. It can affect your social life, relationships, career, and sense of self-worth and purpose. And for women in particular, depression is common. In fact, according to the National Mental Health Association, about one in every eight women will develop depression at some point during her lifetime.
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.
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
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- Sleep disturbance (sleeping more or sleeping less)
- Appetite and weight changes
- Difficulty concentrating
- Lack of energy and fatigue
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Differences between male and female depression
Although some of 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.
| Differences between male and female depression |
| Women tend to: |
Men tend to: |
| Blame themselves |
Blame others |
| Feel sad, apathetic, and worthless |
Feel angry, irritable, and ego inflated |
| Feel anxious and scared |
Feel suspicious and guarded |
| Avoid conflicts at all costs |
Create conflicts |
| Feel slowed down and nervous |
Feel restless and agitated |
| Have trouble setting boundaries |
Need to feel in control at all costs |
| Find it easy to talk about self-doubt and despair |
Find it “weak” to admit self-doubt or despair |
| Use food, friends, and “love” to self-medicate |
Use alcohol, TV, sports, and sex to self-medicate |
| Adapted from: Male Menopause by Jed Diamond |
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 that attempt to explain the higher incidence of depression in women. Many factors have been implicated, including biological, psychological, and social factors.
Biological and hormonal 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.
- Perimenopause and menopause – Women may be at increased risk for depression during perimenopause, the stage leading to menopause when reproductive hormones rapidly fluctuate. Women with past histories of depression are at an increased risk of depression during menopause as well.
- Health problems – Chronic illness, injury, or disability can lead to depression in women, as can crash dieting or quitting smoking.
Psychological causes of depression in women
- Focusing on and rehashing negative feelings – 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.
- Overwhelming stress at work, school, or home – Some studies show that women are more likely than men to develop depression from 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.
- Body image issues – 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.
Social causes of depression in women
As with men, social factors can also play a part in causing depression in women, along with lifestyle choices, relationships, and coping skills. These may include:
- Marital or relationship problems; balancing the pressures of career and home life
- Family responsibilities such as caring for children, spouse, or aging parents
- Experiencing discrimination at work or not reaching important goals, losing or changing a job, retirement, or embarking on military service
- Persistent money problems
- Death of a loved one or other stressful life event that leaves you feeling useless, helpless, alone, or profoundly sad
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, hormones, 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.
How depression treatment is different for women
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.
Self-help for depression in women
You can make a huge dent in your depression with simple lifestyle changes: exercising every day, avoiding the urge to isolate, eating healthy food instead of the junk you crave, and carving out time for rest and relaxation.
Feeling better takes time, but you can get there if you make positive choices for yourself each day and draw on the support of others.
Expose yourself to a little sunlight every day. Sunlight can help boost your mood. Take a short walk outdoors, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or sit out in the garden. Aim for at least 15 minutes of sunlight a day. If you live somewhere with little winter sunshine, try using a light therapy box.
- Talk about your feelings to someone you trust, face-to-face. Share what you’re going through with the people you love and trust. Ask for the help and support you need. You may have retreated from your most treasured relationships, but they can get you through this tough time. If you don’t feel that you have anyone to confide in, look to build new friendships. Start by joining a support group for depression.
- Try to keep up with social activities even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.
- Get up and moving. Studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue. You don’t have to hit the gym. A 30-minute walk each day will give you a much-needed boost.
- Aim for 8 hours of sleep. Depression typically involves sleep problems. Whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.
- Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
4 Fast mood boosters that can lift you out of a funk
Getting the blues can happen to anyone, but it doesn’t mean you have a chronic medical condition like depression. A little diversion might help you feel like yourself again. “If you’re down about something, step away from it for a period and do something else,” suggests Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School. Consider these boosters, and take the steps to fit them into your life.
Mood booster 1: Exercise
Exercise is healthful right down to the cellular level. It improves circulation and nerve function, it helps to regulate mood, and it makes you feel better about yourself
Action steps: For a quick pick-me-up, try a medium- to high-intensity workout such as a brisk 30-minute walk, an aerobics class, or a game of tennis. For a remedy that will stay with you, go for a daily activity you can sustain, such as a daily lower-intensity walk.
Mood booster 2: Meditate
Meditating produces brain changes that promote positive emotions and reduce negative emotions such as fear and anger. It can lower your heart rate, blood pressure, breathing rate, oxygen consumption, adrenaline levels, and levels of cortisol, a hormone released in response to stress.
Action steps: Many health centers offer meditation classes. Sign up for one, or consider taking yoga, which combines physical and mental practices. If it’s hard for you to get to a class, buy a guided meditation book or CD, which can introduce you to meditation practice.
Mood booster 3: Socialize
Being isolated can lead to loneliness, which can make you sad. Spending time with others helps improve mood. We’re wired to be social. Focusing on others can move you off a preoccupation with self-defeating thoughts.
Action steps: Avoid isolation. Get together with a friend, family member, or group at least once a month. Visit with friends at home. Get out of your house, go to a movie, or check out an art exhibit. If you don’t have someone to spend time with, go to church or take a class.
Mood booster 4: Find purpose
Dedicating time to a meaningful activity improves mood, reduces stress, and keeps you mentally sharp. The activity can be as simple as taking up a new hobby or volunteering your time. You worry less about every little ache and pain in your own life when you move the focus to a new interest.
Action steps: Volunteer for a library, hospital, school, day care center, or charitable group. Tutor neighborhood kids. Babysit. Contact the chamber of commerce to mentor young business people. Take up gardening, painting, dancing, or gourmet cooking.
Adapted with permission from Harvard Health Letter, a newsletter published by Harvard Health Publications.
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
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- 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)
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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.
