In The Know Zone

depression and gender

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. [11]

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. [12]

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. [13]

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. [14] 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. [15]

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. [16]

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 [17]

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. [18]

Depression in Men

While men are diagnosed with depression only half as often as women, they may contribute disproportionately to depression’s death toll. At least two-thirds of those who commit suicide are depressed, and men commit suicide more than five times as often as women. (Women attempt suicide more than four times as often as men, but typically employ less lethal means.) [19]

Men in this country are conditioned from childhood to believe that emotions are essentially feminine, and men are supposed to stoically endure pain, especially psychic pain. This leads many men to deny their depression, attempt to blunt the suffering by self-medicating with alcohol or drugs, or to give vent to their pain and frustration through angry, aggressive or even abusive behavior.

They may become “workaholics” putting in very long hours at their jobs (often to compensate for their diminished energy and ability to concentrate).

The reluctance of men to seek help is only one of the barriers to effective treatment. The way the disease manifests itself—or, at any rate, the way its symptoms are reported by male patients—often differ significantly from those reported by women.

Men are more likely to acknowledge irritability, fatigue, sleep disturbances, difficulty focusing on work and loss of enthusiasm for work or hobbies than they are feelings of sadness, low self-worth and guilt. The feelings of worthlessness and despair may also lead to a pattern of high-risk behavior. It has been suggested by some researchers that the standard definition of depression and the diagnostic measures derived from that definition may need to be changed for male patients. [20]

Reluctance to seek treatment is a self-defeating attitude, since men are no more capable than women of “getting over” depression without proper treatment, either in the form of antidepressant medication, psychotherapy or both.

[19] National Center for Health Statistics, U.S.A Suicide: 2001 Official Final Data, 2003 in Vital Statistics of the United States, Mortality, 2001,. Department of Health and Human Services, Washington, D.C.

[20] Kytle R, Strock M, Spearing M, et. al.,, Men and Depression, pp 7-8, 2003 National Institute of Mental Health, Washington, DC

[11] Grayson CE, ed., Cleveland Clinic/WebMD, Depression in Women, 2004, available at; accessed 28 June 2004

[12] Zajecka JM, ed. Depression in Women: Issues in Recognition and Management, 2003, available from; Accessed 30 June 2004

[13] Ibid.

[14] Cited in Goldman HH, Rye P, Sirovatka P, eds., Mental Health: A report of the Surgeon General, 2001, Chap. 4, p. 8, available at; accessed 28 June 2004

[15] Weismann MM, Bland RC, Canino GJ, et. al, Cross-national epidemiology of major depression and bipolar disorder; Journal of the American Medical Association, 1996;276:293-299

[16] Mental Health: A report of the Surgeon General, Chap. 4., p. 9

[17] Depression in Women: Issues in Recognition and Management

[18] Ibid.

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