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Depression in Women

Medically Reviewed by Traci C. Johnson, MD on March 14, 2021

Here are the facts about depression in women: In the U.S., about 15 million people have depression each year. Most of them are women. Unfortunately, nearly two-thirds do not get the help they need.

Depression in women is very common. In fact, women are twice as likely to develop clinical depression as men. Up to 1 in 4 women are likely to have an episode of major depression at some point in life.

 

What Is Depression?

Clinical depression is a serious and pervasive mood disorder. It causes feelings of sadness, hopelessness, helplessness, and worthlessness. Depression can be mild to moderate with symptoms of apathy, little appetite, difficulty sleeping, low self-esteem, and low-grade fatigue. Or it can be more severe.

What Are the Symptoms of Depression in Women?

Symptoms of depression in women include:

  • Persistent sad, anxious, or "empty" mood
  • Loss of interest or pleasure in activities, including sex
  • Restlessness, crankiness, or excessive crying
  • Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
  • Sleeping too much or too little, early-morning waking
  • Appetite and/or weight loss, or overeating and weight gain
  • Less energy, fatigue, feeling "slowed down"
  • Thoughts of death or suicide, or suicide attempts
  • Trouble concentrating, remembering, or making decisions
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

What Are the Symptoms of Mania in Women?

Mania is a highly energized state with elevated mood that can occur in bipolar disorder. Moods in bipolar disorder swing over the course of days or weeks or months from the lows of depression to the highs of mania. Even though mania is an elevated mood, it is serious and needs medical assessment and treatment.

The symptoms of mania include:

  • Abnormally elevated mood
  • Crankiness
  • Less need for sleep
  • Grandiose ideas
  • Greatly increased talking
  • Racing thoughts
  • Increased activity, including sexual activity
  • Markedly increased energy
  • Poor judgment that can lead to risk-taking behavior
  • Inappropriate social behavior

Why Is Depression in Women More Common Than Depression in Men?

Before adolescence, depression is rare and occurs at about the same rate in girls and boys. But with the start of puberty, a girl's risk of having depression increases dramatically to twice that of boys.

Some experts believe that the higher chance of depression in women may be related to changes in hormone levels that occur throughout a woman's life. These changes are evident during puberty, pregnancy, and menopause, as well as after giving birth or having a miscarriage. In addition, the hormone fluctuations that come with each month's menstrual cycle probably contribute to premenstrual syndrome (PMS) and premenstrual dysphoric disorder, (PMDD), a severe syndrome marked especially by depression, anxiety, and mood swings that happens the week before menstruation and interferes with daily life.

What Raises the Chances of Depression in Women?

According to the National Institutes of Health, things that increase the risk of depression in women include reproductive, genetic, or other biological factors; interpersonal factors; and certain psychological and personality characteristics. In addition, women juggling work with raising kids and women who are single parents suffer more stress that may trigger symptoms of depression. Other things that could increase risk include:

  • Family history of mood disorders
  • History of mood disorders in early reproductive years
  • Loss of a parent before age 10
  • Loss of a social support system or the threat of such a loss
  • Ongoing psychological and social stress, such as loss of a job, relationship stress, separation, or divorce
  • Physical or sexual abuse as a child
  • Use of certain medications

Women can also get postpartum depression after giving birth. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

Is Depression Hereditary?

Depression can run in families. When it does, it generally starts between ages 15 and 30. A family link to depression is much more common in women. But there is not always an apparent genetic or hereditary link to explain why someone may have clinical depression.

How Does Depression in Women Differ From Depression in Men?

Depression in women differs from depression in men in several ways:

  • Depression in women may happen earlier, last longer, be more likely to come back, be more likely to be tied to stressful life events, and be more sensitive to seasonal changes.
  • Women are more likely to have guilty feelings and attempt suicide, although they actually take their own lives less often than men.
  • Depression in women is more likely to be linked to anxiety disorders, especially panic and phobic symptoms, and eating disorders.

How Are PMS and PMDD Related to Depression in Women?

As many as 3 out of every 4 menstruating women have premenstrual syndrome or PMS, which is marked by emotional and physical symptoms that change in intensity from one menstrual cycle to the next. Women in their 20s or 30s are usually affected.

About 3% to 5% of menstruating women have PMDD, a severe form of PMS, marked by emotional  symptoms such as sadness, anxiety, mood swings, crankiness, and loss of interest in things.

Women with PMS and PMDD usually get symptoms 7 to 10 days before menstruation and then have dramatic relief once their menstrual flow is underway.

In the past decade, these conditions have become recognized as important causes of discomfort and behavioral change in women. Though the precise link between PMS, PMDD, and depression is still unclear, abnormalities in the functioning of brain circuits that regulate mood, along with fluctuating hormone levels, are thought to contribute.

How Are PMS and PMDD Treated?

Many women who have depression along with PMS or PMDD find improvement through exercise or meditation. For those with severe symptoms, medicine, individual or group psychotherapy, or stress management may help. Your primary care doctor or OB/GYN is a good place to start. Your doctor can screen you for depression and treat your symptoms.

Does Depression in Women Happen During Pregnancy?

Pregnancy was once assumed to be a period of well-being that protected women against psychiatric disorders. But depression is almost as common in pregnant women as it is in those who are not pregnant. Things that can raise the risk of depression in women during pregnancy are:

  • A history of depression or PMDD
  • Age at time of pregnancy (the younger you are, the higher the risk)
  • Living alone
  • Limited social support
  • Marital conflict
  • Uncertainty about the pregnancy

What Is the Impact of Depression on Pregnancy?

The potential impact of depression on a pregnancy includes:

  • Affecting a woman's ability to care for themselves during pregnancy. They may be less able to follow medical recommendations and to sleep and eat properly.
  • Causing a woman to use substances such as tobacco, alcohol, and/or illegal drugs, which could harm the baby.
  • Making it hard to bond with the baby.

Pregnancy may have an impact on depression in women:

  • The stresses of pregnancy can contribute to the start of depression, a recurrence of depression symptoms, or worsening symptoms.
  • Depression during pregnancy can raise the risk of depression after delivery (called postpartum depression).

What Are My Options if I'm Depressed During Pregnancy?

Preparing for a new baby is lots of hard work. But your health should come first. Resist the urge to get everything done, cut down on your chores, and do things that will help you relax. In addition, talking about things that concern you is very important. Talk to your friends, your partner, and your family. If you ask for support, you will find you often get it.

If you're feeling down and anxious, consider seeking therapy. Ask your doctor or midwife for a referral to a mental health care professional.

How Is Depression in Women Treated During Pregnancy?

Growing evidence suggests that many antidepressant medicines, including most SSRIs (except for Paxil), appear to have minimal (if any) risks when treating depression during pregnancy, at least in terms of the potential short-term effects on the baby. Long-term effects continue to be studied.

Risks can differ, depending on medication as well as many other things during a pregnancy that can endanger a developing fetus. Untreated depression can put both mother and infant at risk. Sometimes, electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) are used to treat severe depression during pregnancy when other treatments have not worked

Discuss the possible risks and benefits of treatment with your doctor.

How Is Postpartum Depression in Women Treated?

Sometimes postpartum depression, or depression after childbirth, can be treated like other forms of depression. That means using medicines and psychotherapy. If a woman is breastfeeding, the decision to take an antidepressant should be made with the pediatrician along with their own psychiatrist after a discussion of risks and benefits. Most antidepressants are expressed in very small amounts in breast milk and their possible effects on a nursing infant, if any, are not well-understood.

A drug called brexanolone (Zulresso) was approved specifically to treat postpartum depression. Given through an IV over a course of 3 days, it has been found to bring relief to most women.

Does Depression in Women Increase at Midlife?

Perimenopause is the stage of a woman's reproductive life that typically begins in their 40s (or earlier) and lasts until menstruation has stopped for a year. In the last 1 to 2 years of perimenopause, the decrease in estrogen speeds up. At this stage, many women have menopausal symptoms.

Menopause is the period of time when a woman stops having their monthly period and has symptoms related to the lack of estrogen production. By definition, a woman is in menopause after their periods have stopped for a year. Menopause typically happens in a woman's late 40s to early 50s. But women whose ovaries are surgically removed have "sudden" menopause.

The drop in estrogen levels during perimenopause and menopause triggers physical and emotional changes such as depression or anxiety. Like at any other point in a woman's life, there is a relationship between hormone levels and physical and emotional symptoms. Some physical changes include uneven or skipped periods, heavier or lighter periods, and hot flashes.

How Can I Cope With Symptoms of Menopause?

There are many ways you can ease menopause symptoms and maintain your health. These tips include ways to cope with mood swings, fears, and depression:

  • Eat healthfully, and exercise regularly.
  • Engage in a creative outlet or hobby that fosters a sense of achievement.
  • Find a self-calming skill to practice such as yoga, meditation, or slow, deep breathing.
  • Keep your bedroom cool to prevent night sweats and disturbed sleep.
  • Seek emotional support from friends, family members, or a professional counselor when needed.
  • Stay connected with your family and community, and nurture your friendships.
  • Take medicines, vitamins, and minerals as prescribed by your doctor.
  • Take steps, such as wearing loose clothing, to stay cool during hot flashes.

How Is Depression in Women Treated?

There are a variety of ways to treat depression, including medications such as antidepressants, brain stimulation techniques like ECT or TMS, and individual psychotherapy.

Family therapy may help if family stress adds to your depression. Your mental health care provider or primary care doctor will determine the best course of treatment for you. If you are unsure who to call for help with depression, consider checking out these resources:

  • Community mental health centers
  • Employee assistance programs
  • Family doctors
  • Family service/social agencies
  • Health maintenance organizations
  • Hospital psychiatry departments and outpatient clinics
  • Local medical and/or psychiatric societies
  • Mental health specialists such as psychiatrists, psychologists, social workers, or mental health counselors
  • Private clinics and facilities
  • State hospital outpatient clinics
  • University or medical school-affiliated programs
WebMD Medical Reference

Sources

SOURCES:

National Institute of Mental Health: "Depression: What Every Woman Should Know," "Depression."

FDA: "The Lowdown on Depression," "Understanding Antidepressant Medications." 

American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000; Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric, 2000.

Fieve, R., MD. Bipolar II, Rodale Books, 2006.

The Journal of the American Medical Association: “Recommendations for Screening Depression in Adults.” 

BMC Public Health: “The interrelation between premenstrual syndrome and major depression: Results from a population-based sample.”

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