Depression preys on women, lying in wait at the major milestones of life, ready to envelop them in sadness and emotional pain.

Women suffer from depression twice as often as men, a disparity researchers believe may be in part linked to the role of female hormones. Depression is the most common emotional disorder seen in women, affecting one in four women at some time in life.

Depression engulfs the entire being, affecting mental outlook, physical health, sleep patterns and social function. It can make life dull and gray, taking the fun out of pleasurable activities and sapping the energy to create or to interact with friends and family.

Although it may make a woman feel helpless, depression is treatable. If you suffer from depression or have a loved one who does, seek professional help. Medication, psychological therapy and even lifestyle changes can all improve symptoms.

It’s important to be able to recognize depression. True depression is more than an occasional sense of feeling down or blue. It’s normal to feel temporary depression when a relationship ends or when faced with the loss of a job or money problems, but most people are able to deal with these losses, to seek comfort and support from others and to continue to function. Depression that becomes overwhelming and persistent is a serious illness requiring medical attention.

Types of Depression
Depression is not a single illness There are several types of depression, and all can occur at varying levels in different individuals.

Major (or unipolar) depression is at least twice as common in women as in men and is diagnosed in persons with at least five of the following symptoms that persist for at least two weeks:

• feeling depressed most of the time,
• problems with sleep,
• loss of interest in activities that are normally pleasurable,
• constant feelings of fatigue and lack of energy,
• a change in eating habits that produces a significant weight loss or gain,
• feeling worthless, guilty and hopeless,
• problems concentrating and thinking clearly,
• difficulty making decisions and
• recurrent thoughts of suicide.

Women with fewer symptoms may suffer from mild depression.

Bipolar depression is an illness that involves swings between the symptoms of major depression and mania. During periods of mania, a person is prone to excitability, rapid speech, heightened energy levels, an inflated sense of self and impulsive behaviors that might include extravagant shopping sprees or inappropriate sexual encounters.
Bipolar depression is equally common in men and women, although women are likely to have more episodes of depression and to cycle more rapidly between the two extremes. This form of depression tends to be a lifelong condition, although when well managed a person can lead a normal life.

Dysthymia is a chronic low-level depression that lasts for at least two years and is more common in women. Persons with this form of depression seem unhappy and lack enthusiasm for life. Their depressed mood is often seen by others as a function of their personalities. Without treatment they face an above average risk of suffering an episode of major depression in the future.

The higher rates of major depression and dysthymia in women occur at all social and income levels and across many cultures.

In children, depression is equally common among males and females, but after puberty girls face a greater risk. By age 15 a teenage girl is twice as likely to have experienced an episode of major depression as a male. Hormone changes in puberty may be responsible, but in the early teen years role and gender expectations change dramatically, making it difficult to determine the exact cause.

Both pregnancy and the postpartum period are associated with a higher risk of depression, at least in part due to significant hormonal changes. Pregnancy and the early months of caring for a child are also periods of physical, emotional and for some women financial stress.

A British study of 9,000 women during and after pregnancy found that rates of depression were highest in the eighth month of pregnancy and lowest eight months after the birth. Fourteen percent of women had depressive scores that put them on the threshold of clinical depression in the eighth month. Two months after birth the rate was nine percent.

The baby blues, which can affect up to half of new mothers, is common in the days after childbirth when hormone levels fall rapidly. Most women recover in about two weeks.

The 10 to 15 percent of women who continue to feel overwhelmed and sad for a longer period may be suffering from postpartum depression and should get professional help.

Divorce, single parenting, financial problems and abusive relationships or a history of abuse as a child can all contribute to depression in women. Failure to get help can lead to persistent sadness, a negative self image and damage to important family and social relationships.

Treatment Options
Depression is a debilitating but highly treatable condition. Treatment options vary by the type and severity of a patient’s depression. Patience is important since it’s often necessary to try more than one approach to find the right fit for an individual.

Basic approaches to treatment involve either medication or psychological therapy. Some studies have shown success with lifestyle changes and counseling in women with mild to moderate depression.

The class of drugs known as selective serotonin reuptake inhibitors (SSRIs) are very effective, especially in the treatment of women. They work by making more of the neurotransmitter serotonin available for use by the brain.

Serotonin is a neurochemical that affects mood, appetite and overall sense of well-being. Fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil) are commonly prescribed SSRIs. One advantage of this class of drugs is that they tend to have fewer side effects than some other antidepressants.

Another major class of antidepressant, the tricyclic drugs, work by increasing the availability of the brain chemical norepinephrine.

A third class, MAO inhibitors, work for some patients but have dangerous interactions with a number of foods and must be taken with care.

Patients treated for bipolar depression often need to be treated with a combination of drugs and must work closely with a physician to find the most effective combination.
Therapy is frequently used in combination with medication. Cognitive therapy focuses on helping patients avoid negative thought and behavior patterns that may contribute to the depression.

Life is a series of peaks and valleys that we have to negotiate. But when the normal downs get so deep that they become overwhelming and threaten to engulf us, it’s important to recognize depression and seek help. Effective treatments are available.

REFERENCES:
Jeff Bauer, “Symptoms of Depression More Common During Pregnancy than After,” RN, December 2001.
Marie-Antoinette Brown et al, “The Effects of a Multi-Modal Intervention Trial of Light, Exercise, and Vitamins on Women’s Mood,” Women & Health, November 2001.
“Dealing with Anxiety, Depression and Chronic Fatigue Syndrome,” Chapter 33, PDR Family Guide to Women’s Health and Prescription Drugs, Annual 2001.
“Depression After Surgery Raises Risk of Future Heart Problems,” Women’s Health Weekly, December 13, 2001.
“Depression Associated with Heart Failure in Women,” Mental Health Weekly, February 11, 2002.
“Depression During Pregnancy and After,” Harvard Mental Health Letter, September 2002.
“Depression in Women,” American Family Physician, September 15, 2002.
“Depression: What Every Woman Should Know,” Pamphlet by: National Institute of Mental Health, August 8, 2000.
Marta Elliott, “Gender Differences in Causes of Depression,” Women & Health, July 2001.
Elizabeth Goodman and Robert Whitaker, “A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity,” Pediatrics, September 2002.
Joan Griffin et al, “ The Importance of Low Control at Work and Home on Depression and Anxiety,” Social Science and Medicine, March 2002.
“New Report Issues Latest Findings on Women’s Mental Health,” Women’s Health Weekly, May 16, 2002.
Ann Peden et al, “Preventing Depression in High-Risk College Women,” Journal of American College Health, May 2001.
“Pregnant Minority Women Have High Rates of Depression,” Women’s Health Weekly, May 16, 2002.
Heidi Splete, “Early Violence, Later Depression,” Clinical Psychiatry News, November 2001.

High Risk after Bypass
Symptoms of depression in the days following heart bypass surgery greatly increase the chance that a woman will have further heart problems in the following year.
According to a study conducted at the University of Maryland 44 percent of women with depression after bypass surgery had a serious heart-related problem the following year, compared with only 18 percent of women who were not depressed after surgery. By comparison, the risk for men after bypass surgery was 20 percent for those with symptoms of depression and 6 percent for those with no depression.
As a result, heart surgeons are evaluating patients after surgery and, when appropriate, prescribing antidepressant medication.
[SOURCE: “Depression after Surgery Raises Risk of Future Heart Problems,” Women’s Health Weekly, December 13, 2001]

Obesity and Depression
Girls who suffer from depression in their late teens are at risk of developing obesity as young adults, a New Zealand study concluded.
The study found that girls who scored high on depression scales in their late teens were three times as likely to be obese by age 26 compared with girls who showed signs of depression earlier in the teen years. This link between late adolescent depression and a high risk for obesity in the 20s was not seen in males.
Researchers theorize that by treating depression in older teenage girls they may be able to alleviate the depression and help these young women avoid later obesity, a condition that is more difficult to treat than depression.
[SOURCE: “Depression in Late Adolescence a Risk Factor for Obesity in Young Women,” Clinical Psychiatry News, September 2001]

Fighting Depression with Exercise, Light, Vitamins
Women with mild to moderate depression may be helped by a three-pronged approach involving a daily vitamin and a brisk 20-minute walk outdoors each day that increases their exposure to light.

A group of 112 women aged 19 to 78 with symptoms of mild to moderate depression participated in either a treatment or a control group for eight weeks. The treatment group showed an improvement in overall mood, feelings of self-esteem and general feelings of well-being.

Researchers concluded that this type of therapy is an effective, self-directed option for women with mild to moderate symptoms of depression without the side effects of medication or the cost associated with drugs or psychotherapy.
[SOURCE: Marie-Annette Brown et al, “ The Effects of a Multi-Modal Intervention Trial of Light, Exercise and Vitamins in Women’s Mood,” Women & Health, November 2001]

Depression Linked To Heart Failure
Older women who suffer from depression face a greater risk than their peers of developing heart failure. A study found that 19 percent of women suffering from depression developed heart failure over the next 14 years. The same was not true for men with depression.
Ten percent of women who were not depressed developed heart failure in the same period.

As well as heart failure, depressed women were more likely to develop high blood pressure, diabetes and movement problems.
[SOURCE: “Depression Associated with Heart Failure in Women,” Mental Health Weekly, February 11, 2002]

Therapy Effective for Depressed College Women
Studies show that one third of college women experience symptoms of depression ranging from mild to severe. Negative thinking, low self-esteem and lack of social support all contribute to depression in this group.

An intervention program targeting negative thinking was developed for a volunteer group of 92 college women from the University of Kentucky. Counselors used cognitive-behavioral therapy in group settings over a six-week period. Results were compared with a control group with similar symptoms who received no treatment.

The women in the treatment group had a greater decrease in symptoms of depression and negative thinking and an increase in self-esteem compared with the control group. The benefits of the six-week program were still apparent 18 months later.
[SOURCE: Ann Peden et al, “Preventing Depression in High-Risk College Women,” Journal of American College Health, May 2001]

Depression Common in Pregnant Minority Women
A study of pregnant Hispanic and African-American women found that more than half may be suffering from depression.

The study focused on minority women living in urban areas. Researchers found that these women had fewer sources of social support and more losses of supportive persons in their lives.

Depression affects parenting behavior, and the children of depressed mothers are at greater risk of developing depression themselves.
[SOURCE: “Pregnant Minority Women Have High Rates of Depression,” Women’s Health Weekly, May 10, 2002]