Feelings of sadness or anxiety once in a while, or following a major life event, are a normal part of life. Typically these feelings subside after a few days or weeks. However, if you’re suffering from long bouts of depression or if your mood changes are significantly affecting your ability to get out of bed, go to work, care for children, or enjoy hobbies, then you may have some form of a depressive disorder, affecting your mental health.
Depression is one of the most common mental illness diagnoses in the U.S., and in women’s health, American women are roughly 70% more likely to suffer from depression than men. This may be due to the several fluctuations of the hormone levels that women undergo throughout their lifetime. Fluctuations during the menstrual cycle, during pregnancy and postpartum, and transitioning into menopause can all contribute to the stresses and chemical imbalances that are related to depression and mood disorders.
Although the average age of onset is around 32 years, about 3% of teenagers will experience some form of depression. After age 15, girls are twice as likely as boys to have experienced a major depressive episode. Depression in young girls is often linked to substance abuse, anxiety, and eating disorders.
Many women with depression feel as though they cannot or should not seek help, but it’s important to remember that depression is a recognized illness that can be treated effectively with medical intervention. If you or someone you care about may have depression, please call a healthcare provider for an evaluation.
Types of Depression
Depression is a broad category that encompasses several different mental illnesses.
Persistent Depressive Disorder
Patients who have been feeling depressed for at least two years may be diagnosed with persistent depressive disorder. The worst symptoms may come and go, but a depressive mood for a long period of time should raise concerns of a chronic disorder.
Patients with major depression feel overwhelmed by the severity of their symptoms. Their severe form of depressive mood interferes with their ability to live their lives. They may be unable to sleep, work, eat, or even play like normal. Whether the patient has experienced one or multiple episodes of major depression, she should get help from her doctor for her well-being.
Seasonal Affective Disorder (SAD)
This is a disorder in which feelings of depression tend to manifest in the winter months and evaporate in the spring and summer. Experts believe the lack of natural sunlight may contribute to Seasonal Affective Disorder, and several therapeutic techniques involving exposure to light have been developed. Many cases may not respond to light therapy alone and may require psychotherapy or medication as well.
Psychotic depression involves depressive symptoms as well as one or more psychotic symptoms. Psychotic symptoms can include hallucinations – seeing or hearing things that aren’t there – or delusions – holding beliefs that are contrary to reality.
This is a rare mood disorder that features cycles of very intense highs and lows, lasting days, weeks, or months. Along with periods of extremely severe depression, patients with bipolar disorder also experience periods of extreme agitation, activity, and energy known as “mania.” Bipolar disorder goes beyond the normal ups-and-downs of life. The symptoms of bipolar disorder can affect your personal relationships and your ability to work and care for children.
Hormonal fluctuations during the menstrual cycle can cause the familiar symptoms of premenstrual syndrome (PMS), such as bloating, irritability, fatigue, and emotional reactivity. Some women experience symptoms that are severe and disabling and may warrant a diagnosis of premenstrual dysphoric disorder (PMDD). PMDD is characterized by severe depression, irritability, and other mood disturbances beginning about 10 to 14 days before your period and improving within a few days of its start.
Pregnancy and infertility
The many hormonal changes that occur during pregnancy can contribute to depression, particularly in women already at high risk. Other issues relating to pregnancy, such as miscarriage, unwanted pregnancy, and infertility, can also play a role in depression.
This is a type of depression that manifests after a woman delivers a baby. Postpartum depression is not just the “baby blues”; it is actually a chemical imbalance that develops as a result of the hormonal and physical changes a woman’s body endures after pregnancy and childbirth. The stresses of caring for a new infant in this state can overwhelm the mother and endanger both herself and her child. Around 10-15% of mothers may experience postpartum depression. If you or your loved one may be experiencing postpartum depression, medical help and counseling are available.
Menopause and perimenopause
Women may be at increased risk for depression during perimenopause, the stage leading to menopause when reproductive hormones rapidly fluctuate. Women with past histories of depression are at an increased risk of depression during menopause as well.
Causes of Depression
The particular causes of depression are often not easily identified. Most cases of depression probably result from a combination of genetic, physical, psychological, social, and environmental factors. Studies using MRIs have revealed that the brains of patients with depression look distinct from brains without depression, but these images can’t tell us why or how the depression began in the first place.
Depression does tend to run in families. However, it’s not clear how much of this association can be attributed to genes alone or some interaction between genes and the families’ social environment. Stressful events, such as traumas, family losses, abuse, or financial troubles, can trigger depressive episodes in parents and dependents alike.
Signs and Symptoms of Depression
It may be tough to distinguish between moodiness, sadness, and clinical depression. Depression can be a very subjective experience. You may find it helpful to talk with others or do some research online to help put your feelings into words. Some common depression symptoms include:
- Persistent sadness, anxiety, or feelings of emptiness
- Hopelessness, helplessness, or uncontrollable pessimism
- Feeling worthless or guilty
- Fatigue, lethargy, excessive napping
- Weight gain
- Difficulty concentrating or indecisiveness
- Loss of interest in activities you once enjoyed
- Loss of interest in sex
- Suicidal thoughts or self-harm
- Headaches, cramping, or digestive problems
Depression can be successfully treated with medical intervention. Treatment is often most effective when the condition is treated early. Most cases of depression are treated with a combination of psychotherapy and medication.
Some cases of depression, especially mild or moderate depression, may be treated with psychotherapy or “talk therapy.” Often, moderate or major depression will require both psychotherapies as well as medication. Psychotherapy helps patients interpret their feelings, social relationships, and interactions with their environment in healthy and positive ways. A licensed therapist may be able to help you recognize harmful patterns of behavior or emotional triggers that exacerbate your depression.
While antidepressants are the most appropriate treatment for severe major depression in perimenopausal women, estrogen may also be appropriate for mild to moderate symptoms, particularly if the woman has never been depressed before. Studies are underway to compare estrogen and antidepressants and to determine for which patients estrogen may be preferred.
Progesterone, the other major female hormone, does not by itself treat or prevent perimenopausal depression or physical symptoms. However, often combined with estrogen (except in women who have had a hysterectomy), progesterone ensures that excessive buildup of the uterus does not occur, which may lead to a risk of cancer. The major disadvantage of progesterone can be negative side effects such as bloating, headaches, and even mood changes. Should side effects occur, different forms and dose schedules of progesterone may help. Depression is sometimes a side effect of hormone replacement therapy for reasons that are not understood. (It may also occur in some younger women who take birth control pills.) In women who have significant histories of depression and become depressed again when starting hormone replacement therapy, the experts usually advise treating with antidepressant medication and/or stopping hormones altogether.
Popular antidepressants such as Zoloft, Prozac, and Lexapro, are different types of selective serotonin reuptake inhibitors (SSRIs). Another type of antidepressant is selective norepinephrine reuptake inhibitors (SNRIs). Both of these drugs regulate your mood by interacting with the neurotransmitters responsible for positive feelings and happiness. These drugs can have side effects such as nausea, headaches, insomnia, and decreased libido.
Give antidepressants about 6 weeks to have their full desired effect on your mood. Continue taking your prescription even if you start to feel better to keep your symptoms from returning. If you want to stop taking your medication for any reason, talk to your doctor. Cutting your body off of antidepressants too suddenly may result in serious withdrawal symptoms. Your doctor can advise you on how to wean your body off the medication.