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Women and Depression

Women are twice as likely as men to suffer from a Depressive Disorder.   Based on American statistics, one fifth of all women will suffer from a Major Depressive Episode in their lifetime, and one quarter will suffer from any kind of Depressive Disorder [ref].  Depression in women is more likely to be chronic, recurrent and difficult to treat than in men [ref, ref]. 

The reasons for these higher rates in women are unclear, though one hypothesis is that it may be related to the functioning of reproductive hormones, such as estrogen and progesterone.  The times in a woman's life when she experiences significant changes in her hormone levels, such as in the premenstrual period, at menopause [ref], during pregnancy and after delivery, are all times when she is at an increased risk for developing a Depressive Episode

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is also quite common among women. About 5% of women experience this condition, and another 20% will have significant premenstrual symptoms that do not meet the full criteria for the condition but that are still bothersome [ref].

PMDD tends to impair women's ability to function in their work or social roles to the same extent as a full-blown Major Depressive Episode, and causes significant absenteeism and lost productivity at work [ref]. Women with PMDD also seem to be at an increased risk for having Major Depressive Disorder or Postpartum Depression [ref].

Depression in Pregnancy and Postpartum Depression

Depression during pregnancy and following delivery (Postpartum Depression) are important health concerns for mothers and their infants, for not only do these conditions affect the health and wellbeing of the mother, but they also have significant effects on the health of the developing fetus and infant.   About 15% of all women will experience a depression during pregnancy or in the year after delivery [ref].

Studies have shown that Depression during pregnancy can lead to pregnancy complications, such as preterm delivery [ref, ref], pre-eclampsia [ref], and low birth weight [ref].  Low-birth weight itself has been shown to lead to various health problems in individuals later in life [ref, ref, ref], including Depressive Disorders [ref, ref].  Mothers who experience Dysthymic Disorder during pregnancy have an even greater risk of giving birth to low-birth weight infants than mothers with a Major Depressive Episode [ref].

After delivery, maternal Depression can also affect the child in significant ways, such creating a disturbance in the attachment bond with the child, slowing the child's emotional and intellectual development, and increasing the risk of behavioral problems and school difficulties for the child [ref].  For all these reasons, Depression during or following pregnancy should be taken seriously and treatment should be offered.

Women are more likely to suffer from a Depression during pregnancy in the following situations [ref]:

  • They already have a Major Depressive Disorder
  • They stopped their antidepressant medication around the beginning of the pregnancy  
  • They are giving birth at a young age, especially adolescence
  • They are a single parent or living alone
  • They already have a large number of children
  • They have endured sexual abuse in the past
  • They have few social supports
  • They are poor
  • They have mixed feelings about their pregnancy
  • They have experienced major stresses or negative life events around the time of the pregnancy

These situations also increase the chances of a mother developing a Postpartum Depression.  In addition, having depressive symptoms or a full-blown Major Depression during pregnancy is also an important risk factor for having a Postpartum Depression.

Mother's who experience a Postpartum Depression should also be screened for Bipolar Disorder, as this will turn out to be the true underlying condition in about half of the cases of Postpartum Depression [ref].

Menopause and Depression

Perimenopause is the time in a woman's life when her reproductive hormone cycles begin to change, eventually leading to her mentrual cycles stopping completely. Menopause is defined as the date of the woman's final menstrual period, though this date is usually determined in retrospect, 12 months after the final menstrual period.

Perimenopause usually lasts anywhere from 4 to 8 years. During this period, women often experience various "menopausal" symptoms, such as hot flushes, night sweats, irregular menstrual cycles, headaches, and mood changes, among others.

During perimenopause, women are at an increased risk of developing a Depressive Episode [ref, ref]. For some women this may be their first Depressive Episode in their lifetime, though in women who already have Major Depressive Disorder, menopause will often trigger a relapse.

After the final menstrual period and the end of perimenopause, there is an end to this heightened risk of having Depressive Episodes [ref].

 

Depression in the Elderly

Overview of Treatments