A Woman’s Guide to Depression

Women are 2-3 times more likely than men to develop depression or an anxiety disorder. Blame hormones, genetics and stress, experts say. Find out how being female affects mental health, what kinds of questions are asked to diagnose illness and which treatments are available. Plus, could you be depressed? Like their bodies, men’s and women’s brains and minds are mostly alike, but they do differ in some significant ways. These brain differences arise from both our genes and from environmental factors that include family, culture and experience. There is no neat line between biology and psychology. When our brains undergo change, because of an experience or medication, our thoughts and feelings change as well. When our thoughts and feelings change, as a result of life experience or psychotherapy, our brains undergo change. Culture also interacts with our biology and psychology. For example, different cultures have different traditions about how they understand menopause, and those traditions influence the way symptoms are expressed. Why Your Sex Matters Sex differences in the brain and the evidence of mental illness on brain scans help to steer research in the most promising directions, but brain scans cannot yet make a diagnosis. Mental disorders are diagnosed on the basis of feelings, thoughts and behaviors. Therefore, our ideas about normal feelings, thoughts and behaviors play an important role in our concept of some mental disorders. What we view as normal is often closely related to our gender. For example, we generally expect women to be more passive and dependent than men, and we are more tolerant of men’s anger and aggression than we are of women’s. When men or women deviate from expected behaviors, even when they are fully able to function and are not troubled by symptoms, there is a tendency to consider them abnormal. Women’s mental and physical symptoms are often taken less seriously than men’s. Women who have alcohol problems tend to drink quietly at home rather than getting drunk and violent in a tavern. A belligerent alcoholic man attracts more attention than a depressed and withdrawn woman. Women are more likely to receive prescriptions for psychiatric medications, perhaps because they make more visits to health care providers and suffer more chronic illnesses during their longer life spans. It is important to remember that medication can be used both too often and not often enough. Some prescriptions are written before a thorough diagnosis is made. Alternatively, many people who could benefit from medication are not being treated with it. Mental Health and Women Women suffer from depression and anxiety disorders two or three times more often than men. The differences are due to a combination of genetics, hormones and stressful experiences. Stress is a universal human experience that can be positive and negative. Many life changes, like getting married or having a baby, are both stressful and positive. Stress causes changes in our behavior, thoughts and feelings, as well as in our body functions: heart rate, digestion and breathing. Stress that is not overwhelming can be beneficial to our growth and creativity, but stress that is overwhelming can make us vulnerable to mental and other illnesses. Some forms of stress are more common in women than in men: poverty, sexual abuse and assault, and domestic violence. Jobs traditionally filled by women, such as secretarial work, nursing and teaching, that have a high level of responsibility and a low level of power, raise a person’s risk of depression. Women are also more likely to experience sexual harassment, which can increase their risk of anxiety and depression. Stressful experiences like illness, abandonment and disasters cause bodily changes, sadness, irritability, relationship problems and, sometimes, mental disorders. Mental disorders can also occur for no apparent reason. Domestic violence is a factor in many kinds of mental illnesses. Women have often been blamed for their own victimization. One would hear questions like, “Why didn’t she leave?” or “What did she do to deserve it?” As a society, we have begun to recognize the criminal nature of domestic violence and to develop legal and other support systems that recognize its impact. Doctors need to be aware of domestic violence and ask appropriate questions at every visit. Women are often ashamed of being victims, and it may take several visits before a woman feels comfortable enough to reveal her situation to her health care provider. These questions have to be asked in private because abusers often stick close to their victims during medical visits and punish them if they reveal the truth. We have also learned a great deal about coping with stress, particularly through social support networks. Women who suffer from infertility, depression or cancer are less likely to become depressed when they have strong support systems and/or they can join a group of others with similar experiences. A natural disaster is often easier to bear than a rape or assault because others are present and there is mutual support. Being active and helping others is the best way to overcome feelings of helplessness and powerlessness. People with mental illnesses suffer more discrimination and have more difficulty obtaining health care than people with other kinds of illnesses. This is particularly true of schizophrenia, alcohol and substance abuse, and depression. There is a tendency to believe that these conditions can be overcome by determination and prayer. While both determination and prayer can be very useful in overcoming diseases, they are not treatments. A person with a disease should not be blamed for his or her own suffering. For example, some states in the United States have put pregnant women with alcohol and substance abuse problems in jail, ignoring the fact that many of them desire treatment. As a result, women with these treatable medical conditions are afraid to seek prenatal care for fear of punishment. Diagnosing Mental Illness An accurate diagnosis is the basis for successful treatment of any disorder. A health provider should ask, and a patient should be prepared to report: 1. What are your symptoms now? 2. What is the history of your symptoms? Under what circumstances did they start? How long have you had them? How have they changed? What has made them worse or better? What treatments have you had, and how did they work? 3. What is your personal history? Who is in your family? How was it for you growing up? Any problems? What and how did you do in school? What kinds of relationships have you had? 4. What is your sexual history? What were you taught? What do you know? What are your past and current sexual practices and concerns? 5. What is your family history, especially of similar symptoms? If others in your family had them, what, if anything, helped them? 6. What is your social history? Jobs? Personal habits like smoking, drinking, drugs? Marital/relationship status? Religion and spirituality? 7. What is your medical history? Reproductive history: When you started menstruating, any problems? Birth control? Conceptions? Abortions? Miscarriages? Pregnancies and deliveries? Sexually transmitted diseases? Illnesses? Surgeries? Hospitalizations? Past and current medications? A complete mental health examination also includes a brief test of your mental functions: alertness, memory, concentration, abstraction, and level of general knowledge. Treatment Overall, mental health care is as effective as other kinds of medical care. All health care providers should spend time talking with patients, but in mental health, talking therapy – or psychotherapy – has developed into a specialized skill. For most mental illnesses, a combination of psychotherapy and medication works best. Several different types of clinicians – psychiatrists, social workers, psychologists, counselors – provide several kinds of psychotherapy: supportive, psychodynamic, interpersonal and cognitive-behavioral. Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research. To learn more about the Society for Women’s Health Research, visit their website. For more information, visit our Depression Health Center. Could You Be Depressed? Depression affects 20 million people in any given year and is a serious enough disorder to compromise one's ability to function normally day to day.