Women and Depression

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Guest Blog by Dr. Sadhna Sahani

Women are twice as more susceptible to depression as compared to men. According to the statistics by National Institute of Mental Health, approximately 12 million women in the United States suffer from depression each year. About one in every eight females between the age of 25-44 can expect to develop signs of clinical depression during their lifetime. Additionally, statistics released by Eurostat show that approximately 25% of the population in European countries suffer from depression, wherein Western European countries reported the highest shares of people suffering from depression. Ireland has the highest share of 12% followed by Portugal, Germany, and Finland.

Women hold many life roles: mother, wife, employee, friend, healer, caregiver, and more. The complexity within these roles often leads to ups and downs throughout life. Most of these mood changes are caused by life events (e.g., arguments with loved ones) or due to hormonal changes (e.g., menstrual cycle, pregnancy, menopause). The “struggle” and “strive” and the “ups” and “downs” can influence the healthy rhythm in the daily life activities and relationships. In some cases it lasts for days and weeks, and in others it is more persistent and lasts for months and years.

What is Depression?

Depression is one of the conditions of mood disorder which is characterized by intense feelings of sadness, hopelessness, failure, and rejection. These feelings/symptoms need to persist over time in order for them to be diagnosed as a type of depression. It is an illness that influences the body, mood/emotions, and thoughts, and affects the ability to work, perform and enjoy relationships. Not only it affects one’s personal behavior but also the way an individual sees, feels and perceives the outside world. According to the World Health Organization (WHO), as of 2017, 300 million people around the world suffer from depression.

There are various factors which may contribute or cause depression, ranging from developmental (Miller et. al., 2015), psychological (Yang et. al., 2015), hormonal (Studd et al., 2005), reproductive (Studd et al., 2012), and genetic factors. Apart from above listed scenarios there are also socially-driven aspects which are a topic of major concern, contributing to higher risk of clinical depression among women. These comprise work-related or occupational stress (Quick et. al., 2016), family responsibilities, sexual abuse, poverty and other socioeconomic inequities.

All the above-mentioned factors may lead to different forms of depression, such as:

  • Major Depression – It is the most prominent, severe, and persistent form of depression, with onset occurring at any age. Symptoms include mood swings that can sometime appear as irritability, and people do not enjoy activities that are usually enjoyable. Importantly, depression is manifested differently in different genders: women were found to experience more vegetative and atypical symptoms, and reported a higher severity of depression than men (Scheibe et al., 2002).
  • Postpartum Depression – It involves the feeling of loneliness, discomfort, and exhaustion after the childbirth.
  • Persistent Depressive Disorder (PDD) – It is less severe form of mood disorder, which lasts for longer periods of time. People suffering from PDD feel less pleasure, and tend to experience a lack of energy and motivation as well as disengagement from life.
  • Premenstrual Dysphoric Disorder (PMDD) – It is feeling of physical discomfort and emotional misbalance few days before and after the menstrual cycle.

Surprisingly, 20-40% of women may experience premenstrual depression with signs and symptoms varying from woman to woman, including:

  • Sudden mood swings, a feeling of emptiness, being emotional, hopelessness, and despair
  • Irritability, anger, guilt, anxiousness
  • Severe tiredness and a feeling of exhaustion
  • Lack of concentration and inability to remember details
  • Decreased interest in usual activities and relationships
  • Panic attacks
  • Change in appetite, or food cravings
  • Trouble sleeping or sleeping too much
  • Feeling overwhelmed or out of control
  • Physical symptoms, such as breast tenderness, joint or muscle pain, weight gain, and bloating

Occupational stress is a growing problem in many workplaces, and it is becoming a problem of greater magnitude specifically for working women. It is partially because of sex-specific job stressors, and to some extent finding difficulties maintaining balance between work and family. Research findings have suggested that women are more likely to work long hours if they work in a male-dominated work environment. Also, it has been shown that people who work on weekends (Weston et. al., 2019) tended to work in service sector jobs with lower pay. Such jobs, when combined with frequent or complex interactions with the public or clients, have been linked to higher levels of depression.

Organizational psychologists said that actions are required to be taken that could help with the overwhelming responsibilities at workplaces. Mindfulness techniques (Call et. al., 2015, Bishop et. al., 2002) have been shown to reduce the symptoms of anxiety and stress. Additionally, it is also important that employers recognize work-related stress as significant health and safety issue by ensuring safe working environment, organizing a meeting with HR Managers, incorporating regular sessions of employees with health professionals.

Treatments

Unfortunately, less than half of women experiencing depression ever seek any treatment, and on top of that there are approximately 30-50% of mis-diagnosis rates (B.J. Floyd, 1997). When it comes to treatment, not only pharmacological stress relievers (citalopram, sertraline, escitalopram etc.) but also psychological therapies have shown to be effective possibilities to alleviate depression. However, the treatment type and duration could vary depending upon the cause of depression: Clinical (organic) or Situational.

Clinical depression could also be accompanied by chronic medical conditions like organic brain disorders (Alzheimer’s disease, Parkinson’s disease etc.) (Koho Miyushi, 2001). In these cases, the treatments vary bsased on the organic cause of the depression. Mostly, clinical depression requires a long-term treatment plan including medication supplemented with rehabilitation therapies under supervision.

On the contrary, situational depression is short-term, and can develop after a single or multiple traumatic events. The condition usually resolves as time passes and the situation improves. Supportive psychotherapy is primarily the preferred treatment for situational depression as it can help enhance coping mechanisms and resilience. Cognitive behavioral therapy (CBT) is one of the most common forms of talk therapy (one to one or group therapy), or psychotherapy, that aims to improve mental health. It mainly focuses on challenging and changing cognitive distortions (thoughts, beliefs, and attitudes), behaviors, improving emotional regulation, and developing coping mechanisms on an individual level when feelings of depression hit.

Self-help techniques like regular exercise, yoga, meditation, and breathing techniques are other possibilities that can immensely help improve and boost the mood as well as reaching a calm state of mind. Fortunately, depression has shown great treatment success rates. Very recently the drug Zulresso has been approved by the FDA to effectively treat postpartum (situational) depression. More than 80% of women with depression are successfully cured through pharmacotherapy, psychotherapy, or a combination of both. With a healthful lifestyle and the right treatment plan, different forms of depression are manageable.

Future perspective

The new agenda of the WHO focusses on gathering the prevalence and causes of mental health problems in women, and poses for the Sustainable Development Goals. It focusses on promoting the formulation and implementation of health care policies and enhancing the competence of health care providers in order to address the needs and concerns in different age groups to alleviate depression and improving women’s mental health. The mental health action plan is implemented with the aim of improving mental well-being of the population and concentrating on vulnerable groups, risk behaviors for addressing stigma and discrimination, and attaining highest quality of life.

Furthermore, with the advancement of the technology, there has been development of several cost-effective and often cheap interactive computer interfaces and smartphone applications (digital therapy delivers) for delivering cognitive behavioral therapies. These are called internet-delivered cognitive behavioral therapy (ICBT). Many technology companies are developing mobile-based artificial intelligence (AI) applications for delivering CBT in order to support mental health, to build psychological resilience and to promote emotional well-being (Inkster B, JMIR mHealth and uHealth, 2018).

The Women’s Brain Project (WBP) recognizes that depression is a neurological disease that deserves to be acknowledged and supported. If you think you or someone you know is showing a combination of depressive symptoms, we encourage you or the person in question to seek medical advice.

“Life is too short to be depressed, do not struggle this battle alone, speak up and come forward”.

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