Depression and women

National Women's Health Report, August, 2003

Depression Across the Lifespan

Researchers are fairly sure that one main reason for the nearly 2:1 disparity in depression rates between women and men lies in women's hormones. Here's how depression is associated with the major hormonal milestones in a woman's life.

Adolescence. No one knows why the depression gender gap begins in adolescence, or why it occurs so quickly. One theory is that girls going through puberty experience greater distress and are more vulnerable to stress than pre- or post-pubertal girls, says Meir Steiner, MD, PhD, professor of psychiatry and behavioral neurosciences and obstetrics and gynecology at McMaster University in Hamilton, Ontario.

* Menstruation. About 75 percent of premenopausal women experience some symptoms of premenstrual syndrome (PMS), such as irritability. (12) But three to eight percent of those women experience premenstrual dysphoric disorder, or PMDD, a much more severe form of PMS that greatly interferes with their daily life. The interaction of hormones with neurotransmitters is probably at play, notes Dr. Steiner.

For instance, evidence suggests that women with increased sensitivity of the serotonin system have a higher risk of developing PMDD, since the fluctuations in estrogen and progesterone levels that occur premenstrually have a direct effect on the availability of serotonin precursors. So, it's no surprise that drugs that affect the serotonin system (specifically selective serotonin reuptake inhibitors, or SSRIs) very effectively treat severe PMS and PMDD. The U.S. Food and Drug Administration has already approved two such drugs to treat PMDD: fluoxetine (Sarafem) and sertraline (Zoloft).

* Pregnancy and postpartum. Rates of depression in pregnant women mirror those of nonpregnant women, small wonder since the overall onset of depression peaks between the ages of 25 and 44--prime childbearing years. (10,13)

These days, doctors are likely to recommend antidepressants for pregnant women who are depressed or who want to continue taking their medication, since research indicates no increased risk of birth defects from in utero exposure to SSRIs or tricyclic antidepressants.

Postpartum depression is also a concern. Although many women experience a mild case of the "blues" after giving birth (between 26 and 85 percent, depending on the study) (9) about 10 to 15 percent of women have more significant depressive symptoms in the first weeks following birth. Most of these episodes clear up without treatment within three to six months (although you should still seek help if your symptoms last longer than two weeks). But about one in every 500 to 1,000 women will experience what's called postpartum psychosis, severely affecting her ability to function. In some extreme cases, it may lead to suicide or the murder of the baby. (12)

There is almost a definite link between the enormous psychological, physiological and hormonal changes that occur in a woman's body just after birth and these mood changes, notes Dr. Steiner, with the sharp fall in estrogen that occurs days after delivery possibly triggering a postpartum psychosis in vulnerable women.