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Depression in women: Understanding the gender gap

About twice as many women as men experience depression. Several factors may increase a woman's risk of depression.

By Mayo Clinic staff

Family. Career. Coping with menstrual cycles, pregnancy and menopause. As a woman, you certainly have plenty of issues to handle. But there's another one you might face that can be especially challenging: depression. About 1 in 8 women develop depression at some point in life. Women are nearly twice as likely as are men to struggle with depression at some point. Depression can occur at any age, but it is most common in women between the ages of 25 and 44.

Some mood changes and depressed feelings occur with normal hormone changes. But hormone changes alone don't cause depression. Other biological factors, inherited traits and life experiences are also involved. Explore more about what contributes to depression in women — and what you can do about it.

Puberty

After girls and boys reach puberty, depression rates are higher in females than in males. And because girls typically reach puberty before boys do, they're more likely to develop depression at an earlier age than are boys. This depression gender gap lasts until after menopause. It's thought that the numerous hormone changes during puberty may increase some women's risk of developing depression. However, temporary mood changes related to changing hormones during puberty are normal — these changes alone don't cause depression.

Puberty is also often associated with other factors that can play a role in depression, such as:

  • Emerging sexuality and identity issues
  • Conflicts with parents
  • Increasing pressure to achieve in school, sports or other areas of life

Premenstrual problems

You may know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability and a blue mood herald the symptoms of premenstrual syndrome (PMS). For most women with PMS, the symptoms are minor and short-lived.

But a small percentage of women have severe and disabling symptoms that disrupt their lives, jobs and relationships. At that point, PMS crosses the line into premenstrual dysphoric disorder (PMDD) — a type of depression that generally requires treatment.

Although the exact interaction between depression and premenstrual syndrome remains unclear, it's possible that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals such as serotonin that control mood. Inherited traits, life experiences and other factors appear to play a role.

Pregnancy

Dramatic hormonal changes occur during pregnancy, and these can affect mood. Other issues may also increase the risk of developing depression during pregnancy or during attempts to become pregnant, including:

  • Lifestyle or work changes
  • Relationship problems
  • Previous episodes of depression, postpartum depression or premenstrual dysphoric disorder
  • Lack of social support
  • Mixed feelings about being pregnant
  • Miscarriage
  • Infertility
  • Unwanted pregnancy
  • Stopping use of antidepressant medications

Postpartum depression

About half of new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings — sometimes called the baby blues — are normal and generally subside within a week or two. But more serious or long-lasting depressed feelings may indicate postpartum depression, particularly if signs and symptoms include:

  • Low self-esteem
  • Anxiety
  • Agitation
  • An inability to care for your baby
  • Thoughts of harming your baby
  • Thoughts of suicide

Postpartum depression is a serious medical condition requiring prompt treatment. It occurs in about 10 to 15 percent of women. It's thought to be associated with major hormonal fluctuations that influence mood, along with a pre-existing predisposition to depression.

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References
  1. Women and depression: Discovering hope. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/depression-what-every-woman-should-know.pdf. Accessed July 2, 2010.
  2. Factsheet: Depression in women. Mental Health America. http://www.nmha.org/index.cfm?objectid=C7DF952E-1372-4D20-C8A3DDCD5459D07B . Accessed July 2, 2010.
  3. Halbreich U, et al. Atypical depression, somatic depression and anxious depression in women: Are they gender-preferred phenotypes? Journal of Affective Disorders 102 (2007) 245.
  4. Zender R. Women's mental health: Depression and anxiety. Nursing Clinics of North America. 2009;44:355.
  5. Marcus SM, et al. Gender differences in depression: Findings from the STAR*D study. Journal of Affective Disorders. 2005;87:141.
  6. Deechera D, et al. From menarche to menopause: Exploring the underlying biology of depression in women experiencing hormonal changes. Psychoneuroendocrinology. 2008;33:3.
  7. Misri S, et al. Depression in pregnant women. Up To Date. http://www.uptodate.com/home/index.html. Accessed July 2, 2010.
  8. Women's Health USA 2007. U.S. Department of Health and Human Services. http://mchb.hrsa.gov/whusa_07/popchar/0204wp.htm. Accessed July 2, 2010.
MH00035 Sept. 1, 2010

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