Dec 24, 2002 5 min read

Do the holidays stress you out? Maybe you’re depressed. Major depression affects twice as many women as men, regardless of racial and ethnic background or economic status. The National Institute of Health suspects a variety of factors unique to women plays a role in developing depression.

The National Alliance for the Mentally III (NAMI) describes clinical depression as a serious medical illness – it’s not simply a time of feeling sad or blue. Disturbances in mood, concentration, sleep patterns, daily activities and appetite can manifest themselves in a big way.

It can develop in anyone at any time, but often it’s a life-long condition during which periods of depression alternate with periods of wellness.

Depression occurs in approximately 20 percent of the female population – that’s one in five – but according to the American Psychological Association, depression will be misdiagnosed from 30 to 50 percent of the time.

Approximately 70 percent of all prescriptions for antidepressants go to women.

The average age of onset in is in the early 20s, with depression occurring most often in adult women under the age of 44.

The good news is depression is very treatable when monitored properly.

But why are women targeted twice as often? Researchers believe a combination of biological, genetic and psychosocial factors are to blame.

The most telling biological factor deals with a woman’s reproductive cycle.

Links have been found between depression and periods of intense hormone activity, such as during pregnancy or after the birth of a baby, and during the perimenopausal period.

The use of birth control pills and hormone replacement therapy are also suspected of contributing to depression, but scientists agree more research needs to be done before making any kind of blanket statement.

Other biological factors include how thyroid function differs between men and women and its role in mood disorders, along with gender differences in the circadian rhythm patterns.

Depressed women tend to sleep longer than depressed men, who tend toward insomnia.

Researchers think these differences may point to other differences in the complex system, which regulates sleep and awake activities.

Brain chemicals such as serotonin and hormones like estrogen are thought to play a significant part in developing depression.

Genetically speaking, certain types of depression tend to run along familial lines.

NAMI reports a 25 percent rate of depression in the first-degree relatives (mother, father, siblings) of people with depression and a greater prevalence of the illness in first-degree and second-degree female relatives.

Psychosocial factors that come into play may include the stressors that frequently trigger depression. Women typically have lower-paying jobs, fewer career opportunities and greater family responsibilities than men.

Women are also more likely to be victims of violence, both as adults and during childhood.

Physical and sexual abuses are major contributors to depression. One recent study revealed that 60 percent of the women diagnosed with depressive illnesses had been victims of abuse.

In another study, all the women, 100 percent, who experienced severe childhood abuse developed depression later in life.

Women also exhibit different behavior than men when depressed.

Depressed women more frequently experience guilt, anxiety, increased appetite (including carbohydrate craving), oversleeping, aches and pains with no physiologic cause, weight gain and destructive eating behaviors.

They also internalize distress, whereas men tend to externalize it.

But women are more likely to talk openly about their depression and seek needed help.

Depression can also accompany various chronic illnesses, such as diabetes, cancer, coronary artery disease, neurologic disorders, Alzheimer’s and Parkinson’s, multiple sclerosis, arthritis, chronic pain, and hearing impairment.

How do you know if you’re truly depressed? The symptoms of major depression, according to the National Policy and Resource Center on Women and Aging, are: a depressed mood for most of the day; decreased interest or pleasure in daily activities; significant weight loss or gain; significant increase or decrease in appetite; observable slowness of movements or agitation; almost daily fatigue and loss of energy; almost daily feelings of worthlessness or guilt; indecision or a diminished ability to concentrate; almost daily hypersomnia or insomnia; and frequent thoughts of death or suicide.

Not all of these symptoms will be present in every person, but a number occurring over a period of time can be quite revealing to the professional diagnostician.

Treatment for depression will generally include either medication or psychotherapy, or perhaps both, but not until a complete examination has been performed by a specialist to rule out possible physical causes.

One of several types of antidepressants may be prescribed.

The most commonly used are SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Zoloft and Paxil because they act only on the neurotransmitter serotonin and tend to have fewer side effects.

However, MAOIs (monoamine oxidase inhibitors) and triclyclic antidepressants may also be used, depending on the individual.

But MAOIs and tricyclics affect more than just one neurotransmitter and sometimes interact with other chemicals in the human body as well.

Most medications will take several weeks (up to eight) before the full therapeutic effect will be felt, though many patients report relief of depressive symptoms much sooner.

Relief of symptoms can enhance the effectiveness of psychotherapy, which allows the opportunity to learn more effective ways of coping.

Whatever your individual needs, a good mental health specialist can work with you to get you on the road to health and recovery.

Jan Hawkins is a freelance health care journalist residing in northern Kentucky.