| Depression
in Women
Women
are diagnosed with depression more than twice as frequently as
men. Somewhere between 10 and 25 percent of women will endure
at least one bout of depression in their lives.
A
variety of explanations are proposed for this difference in the
prevalence of depression in men and women. A hormonal component
is likely, since the rates of depression prior to puberty are
the same in males and females, but jump sharply to adult rates
for girls by age 15.
Hormonal
differences are also evident in forms of depression relating to
the reproductive cycle. These include Premenstrual Dysphoric Disorder
(PMDD)—a brief dysthymic state preceding menstruation that afflicts
about eight percent of women—as well as depression during pregnancy
and postpartum depression.
Postpartum
depression affects between 10 and 25 percent of new mothers, and
is characterized by a bout of major depression, usually occurring
within the first month following the birth.
Depression
during pregnancy has only begun to be recognized as a widespread
phenomenon. In fact, it was believed until recently that pregnancy
afforded women some protection against depression. The failure
of depressed women to take care of themselves during pregnancy
is now seen as a risk to the fetus. One study suggests that depression
may triple the risk of preterm delivery and low birth weight infants.
There
is still debate among researchers as to whether the years surrounding
menopause carry a higher risk of depression in women. Some believe
that women with a prior history of depression and those with instability
in the portion of the nervous system controlling blood vessel
constriction and dilation may be at higher risk.
The
way women respond to the stress of the modern world is also suggested
as a cause. Bolstering this hypothesis is a study of the agrarian
Old Order Amish of Lancaster, Pennsylvania, among whom depression
rates are very low—and the same for men and women. That, however, is something of an anomaly:
the rate of depression has otherwise proven to be consistent in
its 2-1 female bias in studies in the U.S. and at least 10 other
countries—Canada, Puerto Rico, France, Germany, Italy, Lebanon,
Taiwan, Korea and New Zealand.
Another
factor often suggested is that the difference is less in prevalence
than in diagnosis—that women are more aware of their emotional
states (or more willing to acknowledge them) than men, and thus
seek help more readily. This is probably true, but insufficient
to explain the overwhelming incidence of depression among women.
Still
another element in the mix may be a difference in genetic influence.
A study of 2,662 sets of twins found that a family history of
depression and other mood disorders was more strongly linked to
depression in women than in men, for whom there appeared to be
only a weak familial link.
Regardless
of the reason, the fact remains that depression is a particular
bane of women.
Women
usually complain of the classic symptoms of depression. Indeed,
given their dominance as patients, these symptoms are in large
measure derived from female patients. Nevertheless, there are
some signs and symptoms more frequently seen in women, including:
- Atypical
depression (mood that brightens with positive events,
overeating, oversleeping, a leaden sensation in the arms and
legs, and extreme sensitivity to perceived rejection)
- Seasonal
depression
- Accompanying
anxiety
- Family
history of psychiatric disorders
- Recent
stressful life events
- Suicide
attempts
They
are also more likely to have physical complaints accompanying
their depression, including migraine headaches, fibromyalgia (chronic,
generalized musculoskeletal pain and fatigue of unknown origin),
chronic fatigue syndrome, gastrointestinal pain, backaches and
limb pain.
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