Depression Experts Explain Why Women Suffer and How to Cope
Women are roughly twice as likely as men to suffer from depression. That may be a startling statistic for some, but for women whose lives are often turned on their heads it is a somber reality. In this article, Colorado experts in women’s health and mental health discuss the causes and provide suggestions for coping and treating it.
Kari Thurman, 47, a Broomfield resident, first suspected she was depressed in 2000 and has had ups and downs since. Asked what triggers her depression, she cites the expectations of others and those she puts on herself. She also mentions a rough patch with one of her children (she’s a mother of five) and the need to return to work after raising kids for years.
“I’ve felt for a very long time I was expected to be the thin, happy, Kari who said yes to everything when I was younger,” Thurman says.
Similarly, Sarah Montoya, a 31-year-old school teacher and mother of three boys has also lived with depression for much of the last 10 years. But unlike Thurman, Montoya can name the reason: post-partum depression. During each bout, she says, “I felt like I was in a dark hole.” These feelings arrived with each baby and went away as they grew older.
Thurman and Montoya are by no means alone. In 2015, the National Institute of Mental Health released a study that looked at the 12-month prevalence of a major depressive episode among U.S. adults. Women were at 8.5 percent, while men were at 4.7. The overall lifetime risk of depression for women is somewhere between 18 and 21 percent — also roughly twice the rate of men.
The obvious question is why? And despite much research, the answer remains unclear. There is a large body of evidence, however, pointing to the biological differences between women and men.
Each stage in a woman’s life brings with it fluctuations in estrogen and progesterone, which play a role in the brain’s ability to metabolize serotonin and other neurotransmitters, or brain chemicals, that affect mood, concentration, weight and sleep. In other words, the very things that can throw a woman’s life out of balance. This theory seems to play out in hormone-related depressive disorders (see sidebar).
“Women have more hormonally-related incidences of depression starting around adolescence and puberty,” says Dr. Margarita Roykhman, an OB-GYN with Colorado Complete Health for Women. “And it can come up again any time in life, but can be more common around pregnancy, especially post-partum, and menopause.”
Not Just Biology
Biology and hormones, however, don’t tell the whole story. Roykhman says there are also “situational stressors.” For a woman experiencing post-partum depression, for example, socio-economic status, poor support at home, single parenthood or an unwanted pregnancy could be culprits.
Dr. Sanh Nguyen, a psychiatrist with AllHealth Network, echoes this. Women are often expected to juggle work and child-rearing, or they’re expected to return to work after raising children for years. They’re also more likely to be the victim of sexual assault or domestic violence, he says, often at the hands of someone they know.
Don’t Wait, Get Help
“There’s this myth that if you have enough willpower you can will it away,” says Roykhman.
Not true. Treatment should be sought, and that can range from self-care for more mild cases (see sidebar) to medication and therapy for more severe cases. For those who can pinpoint their depression to a more biological process, hormone treatments can help.
“Mental health issues are a part of all of our lives,” Nguyen says. “We want to go after issues of mood right away, because the longer folks are in it, the harder it is to get them out of it.”
Take a closer look at three hormone-related depressive disorders that affect women:
Pre-Menstrual Dysphoric Disorder is a more severe form of PMS, symptoms of PMDD include anxiety, extreme irritability, difficulty focusing and, of course, depression. PMDD tends to be short-lived, showing up the week before the period starts and lasting until shortly after bleeding begins. Antidepressants, hormone therapy in the form of birth control pills, and diet and exercise changes can all help treat it, according to the Mayo Clinic, a leading medical practice and research nonprofit.
Peri-Natal Depression is experienced during or after pregnancy and includes post-partum depression. Symptoms vary from woman to woman, but the Mayo Clinic reports they may include:
- Frequent crying
- Trouble sleeping not associated with frequent urination
- Fatigue or low energy
- Changes in appetite
- Loss of enjoyment in once pleasurable activities
- Decreased desire to self-care (exercise, bathe, etc.)
- Increased anxiety
- Trouble feeling connected to your baby
Many pregnant or nursing women, or their families, can be resistant to medication, but Roykhman says there are pregnancy risks if depression is left untreated, including miscarriage, bleeding, a higher risk for poor growth and other development issues, as well as pre-term delivery. He says selective serotonin reuptake inhibitor anti-depressants, known as SSRIs, are more safe and can be prescribed during.
Perimenopause and Menopause-Related Depression has a prevalence rate around 25 percent, making women most at risk for depression at this stage in life. Women who’ve had prior depressive episodes — be they hormonal or more not — are more likely to experience them again during this period. For these women, antidepressants or hormone replacement therapy could help. HRT can raise alarm bells for some but “it alone can improve symptoms of depression, and some of the HRT options are really safe,” Roykhman says. “It depends on a women’s current medical problems and her history to determine which are safest.”
For those suffering from mild depression, Drs. Roykhman and Nguyen suggest some coping strategies that can help:
Seek out support. It’s important for women to talk with friends and peers who have dealt with depression.
Get enough sleep. Aim for 7 to 8 hours per night. There’s nothing that’s more important to functioning.
Be active. It can be difficult to muster the will, so start small, with a 30-minute walk, and build from there.
Try other therapies. Some women report success with acupuncture and massage therapy. And, since depression can be associated with inflammation, look at your diet and seek out a professional if you need help.
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