Women and Depression

Medical Author: Roxanne Dryden-Edwards, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Depression is a complex matter. In recent years, with burgeoning research progress, we are finding out that depression is much more common than many of us thought. At least 15% (and likely more) of women take an antidepressant during their lifetime. Depression is much more common in women than in men, but the reason for this female predominance is unclear.

Besides the fact that woman suffer from depression more often than men, women tend to develop depression at an earlier age and have depressive episodes that last longer and tend to recur more often. Women may more often have a seasonal pattern to depression, as well as symptoms of atypical depression (such as eating or sleeping too much, carbohydrate craving, weight gain, mood worsening in the evenings, and trouble getting to sleep). Regardless of gender, many depression sufferers may think they can "work through" depression on their own and that a mental-health professional cannot be of help. They may also misunderstand the low risk associated with medication treatment of depression. These mistaken beliefs are, unfortunately, common. Medications for depression may sometimes have annoying side effects, such as agitation, insomnia, drowsiness, or decreased sexual drive or performance, but serious reactions are extremely unusual. Women with clinical depression are suffering. Such bothersome, non-life-threatening side effects, which may lessen with time anyway, are likely to be much more tolerable than untreated depression for many women. Time and again, studies have shown that either counseling or medication therapy, or optimally both together, are extremely effective in safely relieving depression in both women and men.

Many women would probably seek treatment if they realized what the symptoms of depression are. Irritability, loss of interest in usual activities, social isolation, insomnia, loss of energy or problems concentrating, and either weight loss or weight gain can be symptoms of depression. Many women do not recognize these symptoms as warning signs of an oncoming depression. A woman needs to report such symptoms to her physician. Depression may not show itself solely by tearfulness or sadness.

Women with depression have a right to accurate information. They deserve to be warned of the real potential side effects (not word of mouth, gossip, or incomplete media reports) of the medications. They need to be told that many side effects wear off or lessen with continued treatment and that a change in the dose or time the medication is given can alleviate side effects as well. They need to know that there are many classes of antidepressant medication, and many brands within each class of medications, so that if one or more medications fail, others can be prescribed. They need to be persistent in following up with the doctor prescribing the medication, whether it is a primary-care physician or a psychiatrist, to report side effects and progress in relieving the depression symptoms. Too many times women go away without planning follow-up visits or don't realize what side effects to expect.

Even with all of the barriers to the effective relief of depression in women already mentioned, the biggest one is yet to be mentioned. This is the period of time it takes for the medication to take effect. Medication can take about one month to relieve depression. During that time period, a woman may experience bothersome side effects from the medication while not receiving relief from the depression. This is often the most difficult challenge for the treating physician and the woman being treated -- the fact that full benefit of a given dose or medication brand can take four to six weeks. The woman and her physician will need to discuss the expected duration of treatment, which may be longer in women who have had prior episodes of depression. A first episode of depression may require six to 12 months of medication to prevent recurrence of symptoms, but permanent medication for a first episode is required only in rare circumstances.

Women can have many complex issues to tackle once they begin to experience depression. Because women are still the dominant child-care providers more commonly than men, depressed women may have child-care concerns, issues of out-of-control moodiness, crying, or anger at work. They are often juggling work and child care more often than men. In addition, women have to think of risks and benefits of treating depression while they are pregnant or nursing. These issues that affect women as compared to men need to be addressed by primary-care physicians, psychiatrists, psychologists, and other health professionals, and sometimes all health-care providers acting as a team.

The good news is that medication and psychotherapy, particularly when used in combination, are effective in relieving depression. Hopefully, educating the public will result in more women recognizing symptoms of depression, electing to undergo treatment with counseling, medication, or both, and keeping follow-up appointments to monitor their progress. Treatment of depression leads to happier and healthier lives. Women with depression, just like all other women, can enrich the quality of their daily lives with their families. Treatment of depression can help accomplish this goal.

Previous contributing author:

Medical Author: Carolyn Janet Crandall, MD, FACP

REFERENCE:

Bhatia, S.C., and S.K. Bhatia . "Depression in Women: Diagnostic and Treatment Considerations." American Family Physician. July 1999.


Last Editorial Review: 12/15/2010