By Carole B. Okun, MSW, LCSW-R
 

	Introduction
	What Is Depression?
	Reproductive Cycles Influencing Vulnerability to Depression
	Other Factors Leading to Women’s Vulnerability to Depression
	Action Plan for Suicidal Thoughts
	Cognitive Therapy Treatment for Depression
	Conclusion

 

Introduction

Did you know that depression is about twice as common in women than in men? This article will discuss the significant role  women’s reproductive cycles play in depression rates, other factors that contribute to women’s vulnerability to depression, and will provide an action plan for suicidal thoughts. Current treatment options for depression will also be addressed.

What Is Depression?

Feelings of depression are much more serious a case of “the blues” or sadness. Depression is a serious medical condition where a person may feel “down” or “hopeless” for weeks or more.

According to the National Institute of Mental Health, the signs and symptoms of depression include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss, or overeating and weight gain
• Thoughts of death or suicide, suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Reproductive Cycles Influencing Vulnerability to Depression

Researchers have shown that there is evidence that hormone levels related to the reproductive cycle play a role in increased vulnerability to depression in women. The major reproductive cycles of a woman’s life are  puberty, childbirth and menopause, which  will be discussed here.

The average age of onset of depression in adolescents is about 15. After age 15, girls are twice as likely to become depressed than boys.  Approximately 5% of the teenage population suffers from depression.

Common symptoms of adolescent depression include: irritability, hopelessness, changes in sleep and appetite, academic decline, lack of interest, somatic symptoms and suicidal ideation. Several factors may predispose teenage girls to depression: an increase in hormones associated with puberty, changes in body shape and emerging sexual identity, family stressors such as divorce, and peer pressure.

Hormone levels increase significantly during adolescence. Research findings are however mixed regarding whether hormone levels alone account for the increase in reports of teenage girl depression.  Some researchers believe that adolescent girls are vulnerable to depression because they are more dependent on social relationships than boys and in turn more sensitive to disappointments in relationships or loss of relationships.

The childbirth period – during pregnancy and after the birth of a child – is another time that depression occurs in women. It includes the following:

• Prenatal Depression – 10-20 percent of pregnant women experience this phase which may include crying or weepiness, sleep problems, fatigue, appetite disturbance, loss of the enjoyment of formerly pleasurable activities, anxiety, irritability.
• Postpartum Blues – 80 percent of new mothers experience minor mood changes that usually resolve two weeks after delivery. Symptoms may include feeling overwhelmed, frustrated, exhausted, elated one minute, crying the next, having difficulty falling or staying asleep.
• Postpartum Depression – 25 percent of new mothers develop this. Symptoms may include crying or weepiness, sadness, fatigue, feeling inadequate or guilty, mood instability, worrying about the baby, difficulty making decisions, lack of interest in the baby, minimal bonding, feeling overwhelmed, thoughts of death or suicide. It is postpartum depression if symptoms last more than 14 days.
• Postpartum Psychosis – occurs in 1-2 per 1000 new mothers. This is the most serious form of perinatal depression and always requires in-patient hospitalization and treatment. Symptoms may include auditory and visual hallucinations, insomnia, feeling agitated, angry, anxious, paranoid, delirious (appearing normal one moment, psychotic the next), confused, having suicidal/homicidal thoughts, bizarre delusions, commands to harm the infant.

Treatment for maternal depression is usually in the form of psychotherapy in combination with taking medications, most likely an antidepressant. The type of treatment will depend on the severity of the depression. Support groups are also beneficial in that they provide a safe place where women can talk with other women who are having similar experiences.

The third phase of a woman’s reproductive cycle life is menopause. There are three phases:  perimenopause, menopause, and postmenopause. An increase in depression has been reported in women during the perimenopausal phase. A variety of physical and psychological symptoms are commonly experienced including hot flashes and night sweats, insomnia, depression, mood swings, headache, memory loss and decreased sexual drive.

The three phases include:

• Perimenopause – this phase has often been described as the years surrounding menopause. 65% of women experience perimenopause beginning in their late 40’s. An increase in depression has been reported in women during this phase. This is the transitional period from having menstrual periods to having no periods at all. This phase could last up to ten years. Hormone levels are very unstable during this phase. Symptoms include irregular periods, hormonal shifts that affect mood, hot flashes, night sweats, forgetfulness, memory problems, insomnia, and mood swings.
• Menopause – Signals the time when menstrual periods have stopped for one year. Average age of menopause is 51. Approximately 8%-15% of women experience some form of depression during this phase. Many symptoms of menopause overlap with symptoms of depression including problems with sleep, hot flashes, vaginal dryness, night sweats, fatigue, irritability, anxiety, and difficulty concentrating.
• Postmenopause –  Postmenopause is defined formally as the time after which a woman has experienced twelve (12) consecutive months of amenorrhea (lack of menstruation) without a period. The average length of the postmenopause has been increasing. With greater longevity, a woman will soon be postmenopausal on the average a third of her life.

If you are experiencing depression during these phases, you should seek help immediately. A number of options are available that may help to reduce your symptoms and help you get to enjoying life again.

Treatment for all phases should be discussed with your Primary Care Physician or gynecologist. They include hormone replacement therapy, antidepressants and psychotherapy, as well as use of alternative medicines, herbal remedies and dietary supplements. Along with these various treatments, there are several other things you can do to help yourself feel better: get support for yourself, exercise, practice stress management, make dietary changes, spend time with others, make time to do what you enjoy and most of all give yourself a break.

Other Factors Leading to Women’s Vulnerability to Depression

Researchers have suggested that women are more vulnerable to mental health issues because of their restricted social roles, high demands placed on them and economic hardships.

Surprisingly, married women have higher rates of depression than their single counterparts. Research has shown that if a woman has a satisfying job, it decreases the intensity of her depression. Having young children at home is a risk factor especially if she works outside the home and has difficulty finding childcare.

The socioeconomic status of women has been proposed as another probable factor leading to higher rates of depression. More women live in poverty and many are single mothers.

Action Plan for Suicidal Thoughts

Everyone gets the ‘blues’ now and then. The ‘blues’ usually do not last longer than a few days. If you are starting to feel increasingly more depressed and hopeless about your life and starting to think about ways to end it, that is the time for immediate professional help.

Women are three times more likely to attempt suicide than men although men are more likely to complete suicide. The following action plan has helped countless women with suffering with suicidal thoughts rethink their situation.

1. Make a list of people in your life whom would be most affected if you were to commit suicide – include pets on the list.
2. Think of the legacy you are leaving your family – children, grandchildren and those that follow. Did you know that relatives of those who commit suicide are at higher risk for suicide than the general population?
3. Set up a safety plan that includes your warning signs. For instance, the warning signs of a cold are sore throat and a runny nose. What are warning signs that you are becoming depressed? Do you become irritable, isolative, withdrawing from friends and family? Do you have a sad mood, crying spells, decreasing interest in once pleasurable activities?
4. Write down affirmations on an index card that you can keep in your wallet, on your nightstand, your refrigerator or bathroom mirror. Affirmations are powerful. Some examples are “I am a good person. I am a kind person.”
5. Keep a journal and make a daily list of your negative thoughts. See if there is any evidence for your negative thoughts. If you feel like a failure, make a list of your accomplishments however small you think they are. Many times when we are depressed, we see only the negative and minimize the positive.
6. Know that hurting yourself is NOT an option.

Cognitive Therapy Treatment for Depression

Cognitive therapy is a widely used form of psychotherapy that has been proven to be effective in the treatment of depression and anxiety-related disorders. Aaron T. Beck, M.D. was instrumental in developing cognitive therapy.

Usually cognitive therapy is a short-term treatment lasting from 5-15 sessions. When people are depressed, their thoughts tend to be negative, illogical, irrational and distorted. The cognitive therapy trained therapist works together with the client to form a good working relationship, and then on teaching the basic principles of this treatment approach.

The therapy is mostly focused on ‘here and now’ situations rather than situations or events that happened in the past. Together both therapist and client identify negative or distorted automatic thoughts (thoughts that occur rapidly while the client is in the midst of a situation). People with depression have more negative or fearful automatic thoughts.

In cognitive therapy, clients learn to recognize their pattern of negative thinking and to replace them with realistic and rational thoughts.

There is effective and safe treatment for depression. Well-intentioned people may say ‘snap out of it’ or ask ‘how could you be depressed, you have everything?’ Since it is a clinical medical condition, appropriate medical treatment is needed for recovery. A depressed person cannot just “snap out of it”.

Conclusion

Speak first with your primary care physician to rule out other medical conditions that could cause depression, i.e., an abnormal thyroid. If, after consultation with a physician, the depression is not linked to a medical condition, you can discuss further treatment options.

Depression is treatable. There is no reason to suffer alone or for long.

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