Depression in Women: Understanding the Gender Gap

About twice as many women as men experience depression. Hormones, work overload and sexual abuse are among the factors that may increase a woman's risk of depression.

Family. Career. Coping with menstruation, pregnancy and menopause. As a woman, you certainly have plenty of issues to handle. But there's one more you might face someday: depression.

Nearly twice as many women as men develop depression and related disorders at some point in their lives. A woman's unique biological, psychosocial and cultural factors may increase her risk of depression. Explore more about what lies behind this gender gap in depression.

Biological factors affecting depression in women

The female body itself may influence the development of depression. That's because hormones and related factors may alter mood through various stages of life.

Puberty
Before girls and boys reach puberty, they share similar rates of depression. It's only after puberty that the gender disparity in depression and related disorders truly becomes pronounced. And because girls typically reach puberty before boys do, they may develop depression earlier. By age 15, for example, girls are almost twice as likely as boys to have developed depression.

Because this depression gender gap coincides with puberty and disappears after menopause, some researchers believe that hormonal factors increase a woman's risk of developing depression. On the other hand, puberty is also often associated with other changes that could play a role in depression, such as emerging sexuality and identity issues, parental conflicts and evolving social expectations. These psychosocial factors could interact with hormonal changes during puberty and result in an increased risk of depression.

Premenstrual problems
Many women know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability or a blue mood herald the notorious symptoms of premenstrual syndrome (PMS). For most women with PMS, the associated symptoms are minor and short-lived. But a small percentage of women have such severe and disabling mood-related symptoms that their lives, jobs and relationships are disrupted. At that point, PMS crosses the line into premenstrual dysphoric disorder (PMDD), which tends to respond best to treatment with hormones or psychiatric medications such as antidepressants.

Although the exact interaction between depression and premenstrual syndrome remains unclear, some researchers believe that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals that control mood, such as serotonin. Other research indicates that androgens — so-called male hormones that women also naturally produce at a lower level — may play a role. Still, because such hormonal changes occur in all women, but not all women develop depression, hormonal changes alone can't be responsible for the increased risk of depression in women. Genetic predisposition or other factors also may influence depression.

Pregnancy
Dramatic hormonal changes that occur during pregnancy, along with life, work and relationship changes, affect mood and in some cases may trigger depression during pregnancy. Other factors that can increase the risk of depression during pregnancy include previous episodes of depression or PMDD, marital strife, insufficient social support and ambivalence about being pregnant. Other issues surrounding pregnancy can also lead to depression, such as infertility, miscarriage or an unwanted pregnancy.

Postpartum depression
About half of new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings — sometimes called the baby blues — are normal and generally subside within a week or two. But if they don't subside quickly, if symptoms are severe, if they're accompanied by an inability to care for your baby or thoughts of harming your baby, or if you have feelings of anxiety, low self-esteem, agitation or thoughts of suicide, you might have postpartum depression. This is a serious medical condition requiring prompt treatment. Postpartum depression isn't merely a matter of being unable to cope with having a new baby. Rather, it's probably associated with major hormonal fluctuations that influence mood as well as an underlying predisposition to depression.

Perimenopause and menopause
The risk of depression may also be heightened during the transition to menopause, a stage called perimenopause, when hormone levels fluctuate erratically. And it may also be heightened in early menopause or after menopause, both times when estrogen levels are significantly reduced. Most women who experience uncomfortable menopausal symptoms don't develop depression. But for women whose sleep is disrupted for long periods of time or who have a history of depression, this is a vulnerable time. Hysterectomy with removal of the ovaries can lead to an abrupt onset of menopause with more severe symptoms, including mood changes and sometimes depression.

Social and cultural factors affecting depression in women

It's not just biology that may account for the higher rate of depression in women. Social and cultural stressors may play a role, too. Although these stressors also occur in men, it's usually at a lower rate. Women are more likely than men to shoulder the burden of both work and family responsibilities, for instance. They're also more likely to have lower incomes, be single parents and have a history of sexual or physical abuse, all of which can contribute to depression, especially in women who've had depression in the past.

Unequal power and status
In general, American women earn less money than men do. Single women with children have one of the highest poverty rates in the United States. Low socioeconomic status brings with it many concerns and stressors, including uncertainty about the future and less access to community and health care resources. Minority women might also face added stress from racial discrimination. These issues can make you feel as if you don't have control over your life. That, in turn, can contribute to feelings of passivity, negativism and lack of self-esteem, which all increase your risk of depression.

Work overload
Often women work outside the home and still handle domestic chores. Many women find themselves dealing with the challenges and stress that can accompany single parenthood, such as working multiple jobs to make ends meet. In addition, women may find themselves continuous caregivers sandwiched between generations — caring for their young children while also caring for sick and older family members. These kinds of stressors might make you vulnerable to depression.

Sexual and physical abuse
Women who were emotionally, physically or sexually abused as children are more likely to experience depression at some point in their lives than are those who weren't abused. Women who were raped as teenagers or who experience abuse as adults also have a higher incidence of depression.

Treatment for depression in women

Although it might seem as if these biological, social, cultural and psychological issues all weigh against you, there is effective treatment for depression. Even severe depression often can be successfully treated.

Not sure how to get treatment? For many women, their primary health care provider is often their first source of help. That may be a primary care doctor, a nurse practitioner, an obstetrician or a gynecologist. You may initially feel more comfortable talking about your mood and concerns with your primary provider. In less severe cases of depression, he or she may be able to guide your treatment with medications or help you find mental health professionals who can provide psychotherapy or manage your psychiatric medications.

Believing that your condition is hopeless or incurable is a classic symptom of depression. You might be more likely than a man to develop depression, but don't assume you must simply learn to live with it. Effective treatment can help you enjoy life again.

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