Women - Depression Sex And Age: Depression

Content provided by the Faculty of the Harvard Medical School

Women

All over the world, depression is much more common in women than in men. In the United States, the ratio is two to one, and depression is the main cause of disability in women. One out of eight women will have an episode of major depression at some time in her life. Women also have higher rates of seasonal affective disorder, depressive symptoms in bipolar disorder, and dysthymia.

Why are women so disproportionately affected? Many theories have been advanced to explain this difference. Some experts believe that depression is underreported in men (see "Men"). But there may also be other, more complex reasons for women's greater vulnerability to depression.

In the United States, approximately 12 million women are affected by depression each year, and one out of eight women will have an episode of major depression at some time in her life.

Stress

A survey of 30,000 people in 30 countries has found that in similar circumstances, women are more likely than men to say they are under stress. Other studies suggest that women are three times more likely than men to become depressed in response to a stressful event. And women are disproportionately subject to certain kinds of severe stress — especially child sexual abuse, adult sexual assaults, and domestic violence.

Everyday experiences as well as traumatic ones may provoke stress, leading to depression in women. Women, who are often raised to care for others, tend to subordinate their own needs more than men. For example, women who work outside the home also tend to work a "second shift" — taking care of housework, children, and older relatives. Many have too much to do in too little time, with too little control over how it is done. Marriage and children, while a haven for some women, ratchet up the stress level for others. Studies have found that, compared with their single counterparts or married men, married women are less likely to feel satisfied. In an unhappy marriage, the wife is three times more likely to be depressed than the husband. Being a mother of young children increases your risk for depression, too.

Another kind of stress is poverty. Women are on average poorer than men — especially single mothers with young children, who have a particularly high rate of depression.

The effect of hormones

Premenstrual syndrome (PMS) can involve emotional fluctuations on top of physical symptoms such as bloating and tiredness. Women with PMS may feel sad, anxious, irritable, and angry. They may also suffer from crying spells, mood changes, trouble concentrating, loss of interest in daily activities, and a feeling of being overwhelmed or out of control. Sometimes depression is mistaken for PMS, or vice versa. To help distinguish the two, chart your symptoms through two menstrual cycles to see if they appear only in the week before menstruation and go away a day or two after bleeding begins. If a clear and persistent pattern emerges, it's likely that changing hormone levels are to blame. If a clear pattern doesn't emerge, depression may be the culprit.

Premenstrual dysphoric disorder is a severe form of PMS that occurs in 2%–10% of menstruating women. It can cause symptoms similar to a major depressive episode in women who are unusually sensitive to the changing hormone levels of the menstrual cycle. Some of that sensitivity may be due to interactions between female hormones and neurotransmitters that regulate mood and arousal.

Whether PMS, premenstrual dysphoric disorder, or depression is at the root of your symptoms, it's important to talk to your doctor about the fluctuations in your mood and how best to treat them.

Researchers are also investigating whether hormones play a role in depression around the time of menopause. Some women report feeling depressed during perimenopause, a time of transition that occurs in the months or years before menstruation stops. It's commonly believed that declining levels of estrogen are to blame, although this has not been proved scientifically. When estrogen is given to treat depression, the results have been mixed. For now, estrogen's role in depression during perimenopause remains controversial.

Genes

There is evidence to suggest that genes play a role, too. Researchers have identified certain genetic mutations that are linked to severe depression — some of which are found only in women. In one of these cases, the mutation is in a gene that controls female hormone regulation. These biological differences could account for some of the difference in the rates of depression between men and women.

Last updated:	January 23, 2007