Women and depression

Depression is more common in women than in men all over the world, and in the United States, the ratio is two to one. One out of eight women will have an episode of major depression at some time in her life. In fact, depression is the main cause of disability in women.

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

One possible culprit is 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.

Hormones may also contribute to depression in women. 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, it may help to chart 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.

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.

Finally, 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. These biological differences could account for some of the difference in the rates of depression between men and women.

As research progresses, we'll no doubt learn more about why depression disproportionately affects women. In the meantime, a woman who experiences depression may want to take note of other aspects of her life that may be affecting mood, and share the information with her doctor. That will help determine how best to treat symptoms.

Are you, or do you know, a woman living with depression? Would you like to share your own insights into what may have triggered the symptoms, and how best to alleviate them?

Women's Health Watch
Harvard Women's Health Watch puts you in closer touch with everything that's happening right now in the new age of women's health and medicine: new prevention strategies, diagnostic techniques, medications, and treatments. From heart disease to breast cancer, from hormone therapy to exercise, Harvard Women's Health Watch focuses on health from a woman's perspective.