How to Beat the Blues: A Doctor's Tips Recommendations for Recognizing and Dealing with Depression

If you were clinically depressed, would you know it? Depression is easy to confuse with PMS – and thus ignore. We talked to depression expert and psychologist Carol Landau, Ph.D., to find out the symptoms of true depression and how to beat the blues… Feeling down? You’re not alone. Women are twice as likely as men to suffer from depression. In fact, 20%-25% of American women will fall into a depression in their lifetimes, says Carol Landau, Ph.D., a clinical psychologist and professor of psychiatry and medicine at Alpert Medical School, Brown University. Landau ought to know. She’s one of the leading experts in the country on women and depression. Co-founder of Women’s Health Associates medical practice at Brown University, she has written about the disorder and menopause in medical journals and books. She’s now working on a new book, Midlife Mood Matters: An Exploration of Depression in Women. We sat down for a one-on-one with Landau to find out how depression can affect you. Plus, get her expert tips on dealing with depression. How do you know if you’re just sad or seriously depressed? Sadness is normal and happens to everybody. Depression is a specific clinical condition [that affects your body, mood and thoughts]. To be diagnosed with depression, you have to feel extremely sad or have lost interest in life, and you must experience 4 out of the 7 following symptoms nearly every day and for at least two weeks. Increase or decrease in weight or appetite without conscious dieting Insomnia or excessive sleepiness Agitation or lethargy and difficulty getting out of bed Loss of energy and fatigue nearly every day Feelings of worthlessness or inappropriate guilt Difficulties concentrating, thinking or making decisions Recurrent thoughts of suicide Why is depression more common in women? A lot of women are sensitive to shifts in hormones, so they might suffer from a mood disorder postpartum [after giving birth] and perimenopause [the time just before menopause]. But women are also more sensitive to stress, which is a big factor in depression, especially if they’re living in difficult situations. Why does stress affect women more? Women and men deal with stress differently. Men will engage in an activity. They distract themselves. Of course, they’re not really doing something about the stressor – they just do something else. Women, on the other hand, start brooding: What did I do wrong? How should I have handled it differently? We want to talk about things and will replay interactions in our minds. We’re the ones up worrying at night and that makes them vulnerable to depression. Are other female traits linked to depression? Many women I see in therapy have “selfless syndrome,” a cluster of traits and a sense of self based on meeting others’ needs. Women who fall into unhealthy care-giving situations often suffer from selfless syndrome. They believe their problems result from a failure to relate with enough sensitivity to other people. They often need a lot of supportive and marital therapy to overcome excessive selflessness. As sex roles have evolved, I’ve also seen men who are overly selfless. They, too, tend to be prone to depression. We need to realize that all of us have needs and require reciprocal relationships. What role do hormones play in depression? Many women suffer from premenstrual dysphoric disorder (PMDD), which is similar to premenstrual syndrome (PMS) but more severe. In the 10 days or so before their periods, women are moody, angry and sad. They have low energy and disturbed sleep. Unlike PMS, PMDD symptoms are so bad that they interfere with daily functioning. Women with PMDD are at risk for postpartum and major depression. Do hormones affect our moods during menopause? Actually, women are more likely to have depression during perimenopause, the 2-3 years before their periods end. They’re even more vulnerable if they suffer from hot flashes and night sweats for an extended time. Many believe the resulting sleep disturbance and hormonal disruption trigger depression. So basically, untreated prolonged hot flashes can be as much a risk for depression as severe stress. The American Congress of Obstetrics and Gynecology (ACOG) is very concerned about postpartum depression (PPD). Why? Every year, up to 15% of new moms develop PPD, which is similar to major depression except it usually happens in the months after delivery. PPD is so hazardous because it can affect the bonding relationship [and, ultimately, the baby’s health]. But many PPD cases are confused with the exhaustion that comes from having a new baby. It’s also tough to diagnose PPD because more than half of new moms suffer from “baby blues,” which occurs only in the two weeks after you have a baby. PPD, on the other hand, can occur within the year after giving birth – though it’s usually in the first six weeks after delivery – and can affect your ability to function. Can medications cause depression? Absolutely. Many medications, such as hormones and those used to control or treat high blood pressure, Parkinson’s disease, mononucleosis and stroke – to name a few – can cause depression. That’s a big reason why you should see your primary-care doctor if you’re depressed. Your doctor can clarify if your depressed mood is medically related. How is depression treated in women? Moderately or severely depressed women are usually prescribed a combination of antidepressant medications called selective serotonin reuptake inhibitor, or SSRI, and psychotherapy. But we’re also using SNRIs - serotonin-norepinephrine reuptake inhibitors, such as duloxetine (Cymbalta) and venlafaxine (Effexor) - which are less likely to reduce libido than SSRIs. Are they effective? Recent media reports have suggested antidepressants don’t work and it’s simply a placebo response. But I’ve seen too many people benefit from them to believe that. Women who don’t respond to one antidepressant therapy may receive another medication to enhance the effect of the antidepressant, including buspirone (Buspar), lamotrigine (Lamictal), lithium or anti-seizure medications. What are the latest treatments? We’re also seeing a return of electroconvulsive therapy [also known as electric-shock therapy]. It isn’t as traumatic as what we saw in the movie “One Flew Over the Cuckoo’s Nest” and it seems to be effective for treatment-resistant depression. But I’m concerned about its impact on memory. More promising for resistant mood disorders is vagus nerve stimulation, which delivers an electrical impulse to the left vagus nerve in your neck and, in turn, affects mood centers in your brain. How does therapy fit in? Therapy is critical. Most people with depression might try psychotherapy for eight weeks before taking an antidepressant – as long as they’re not suicidal or very severely depressed. One of the best is cognitive behavioral therapy (CBT) because it lasts longer than the effects of medication – you’re actually changing the way someone thinks. Another effective treatment is interpersonal therapy, in which the therapist challenges the patient’s irrational ideas and gives homework assignments on ways to correct thoughts. It involves bringing in family members and improving social relationships with new conflict resolution strategies and changing social roles. It hasn’t been evaluated as thoroughly as CBT. If you’re battling depression, consider joining a support group too. And don’t just do it online. A lot of support groups provide good information and you need that face-to-face interaction, which can help improve mood. Why don’t more women get treatment? Many lack access to medical care. Even women with insurance have poor access. Many are underinsured with a $5,000 deductible. So if you break your ankle, you’re more likely to get care. If you’re depressed, you’re more likely to feel you should just pull yourself together. How can women avoid depression? Start by getting a handle on stress, which is often easier said than done. Exercise regularly. Physical activity won’t treat major depression, but it can [reduce stress] and definitely help you feel better. Avoid drinking alcohol in excess and taking prescription tranquilizers such as clonazepam (Klonopin) or lorazepam (Ativan), which can make sadness and anxiety worse. Make time for friends. A study of inner-city women in the 1970s found that women who had just one confidante were less likely to have depression. And talk to your primary-care physician if you don’t feel right – he or she can rule out medical causes. Learn more about Landau’s work on depression and women’s health on her website, www.carollandau.com.