Depression in Women
Clinical depression, or major depressive disorder, is a physical illness of the brain. There is much confusion about this illness because the term "depression" is often confused with the feeling of sadness
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Introduction

Symptoms

Treatment

Introduction

Clinical depression, or major depressive disorder, is a physical illness of the brain. There is much confusion about this illness because the term "depression" is often confused with the feeling of sadness. Actually, sadness is only one of many symptoms associated with this illness.

Depression can appear at any age. It is one of the most common and treatable of all mental illnesses. In any year, 9.6 million adults suffer from this physical disease. One in four women and one in 10 men can expect to develop it during their lifetime.

Women are more susceptible to depression than men for several reasons. Estrogen works in the brain like a mild antidepressant. As levels of estrogen decrease at various times throughout the life cycle, some women are at increased risk for depression:

  • In the week or so prior to menstruation (premenstrual syndrome)
  • Following child birth (postpartum depression)
  • As the estrogen levels drop and menstrual cycles stop (perimenopausal depression)

Many persons fail to recognize that they are suffering from depression and don’t get treatment. More than half of the persons who have had one episode of major depression will have another at some point in their lives.

Many underlying medical illnesses and conditions cause depression. In these circumstances, the official diagnosis is mood disorder due to a general medical condition. Conditions that can cause depression include:

  • Endocrine or metabolic or disease: Thyroid disease, parathyroid disease, diabetes, Cushing’s, Addison’s, kidney failure on dialysis
  • Vitamin deficiency: B12 deficiency
  • Side effects of medication: Steroids, interferon, some chemotherapy agents
  • Substance Induced: Alcohol, opiates or narcotics, amphetamine, cocaine
  • Cancer: Pancreatic, lung, gastrointestinal and cancers spread to the brain (lung, breast, metastatic melanoma, kidney)
  • HIV (Human immunodeficiency virus, the virus that causes AIDS)
  • AIDS (Aquired immune deficiency syndrome)
  • Autoimmune disorder: Lupus
  • Brain injury or illness: Parkinson’s, Huntington’s, stroke, multiple sclerosis, epilepsy

Depression underlies the majority of suicides, is the eighth leading cause of death, and is the third leading cause of death among persons aged 15-24.

Symptoms of Depression

Nearly everyone with this illness has lasting feelings of sadness. They may feel helpless, hopeless, and irritable. A person who experiences four or more of the following symptoms for more than two weeks should seek professional help.

  • Noticeable change of appetite
  • Noticeable change of sleeping patterns
  • Loss of interest in activities formerly enjoyed
  • Loss of energy, feeling of fatigue
  • Feelings of worthlessness
  • Persistent feelings of hopelessness
  • Feelings of inappropriate guilt
  • Inability to concentrate or think; indecisiveness
  • Recurring thoughts of death or suicide
  • Melancholia, defined as overwhelming feelings of sadness and grief, accompanied by waking at least two hours earlier than normal in the morning
  • Disturbed thinking; beliefs not based on reality
  • Physical symptoms (headaches or stomach aches)

Treatment of Depression

It is important to recognize and treat depression. Recently, it has been discovered that major depression as a risk factor for stroke is equivalent to a 40 point increase in systolic blood pressure! The risk of death and complication for depressed individuals with heart disease is increased at least threefold over non-depressed individuals with the same severity of heart disease.

There is a link between infertility and depression. In addition, it has been associated with poor fetal growth and pre-maturity. Depressed pregnant women are at risk for suicide, not caring for themselves adequately, poor nutrition, inadequate sleep and self-medication with drugs, alcohol and tobacco. Depressed mothers have difficulty interacting with their newborns, resulting in slower cognitive development by the baby and less affection between mother and baby.

The risk-benefit ratio of treatment versus non-treatment during pregnancy and lactation must always be taken into account when determining whether to treat a pregnant woman for depression. There are, of course, no controlled studies of antidepressants during pregnancy. Many pharmaceutical companies have unpublished information regarding the safety and efficacy of their medication in pregnant women. The largest data set is kept by the maker of Prozac (Eli Lilly, Inc.) as it is the oldest SSRI. A recent prospective study showed that other selective serotonin reuptake inhibitors (SSRIs) fluvoxamine, paroxetine, and sertraline do not appear to increase the teratogenic risk (birth defects) when used in their recommended doses. Many studies are currently in progress, and the data should appear in the literature in the next few years.

Most depressions are treated with combinations of medication and psychotherapy. Antidepressant medications begin to lift a depression approximately two weeks after daily use. The longer the depression went without treatment, the longer it takes to completely lift. Once an individual feels back to herself, it is important to continue the course of antidepressants for nine to 12 months in order to have the best chance of avoiding relapse. Medication should be decreased slowly, with the woman and her doctor watching for a re-emergence of depressive symptoms. Patients with more than two episodes of depression may require a maintenance medication long term.

Mild levels of depression have been noted to respond to St. John’s Wort, an over the counter non-FDA approved formulation. Recent dangerous drug interactions have been noted with St. John’s as it increases the rate of break down of critical medications (those to fight HIV, to prevent heart transplant rejection and birth control pills). St. John’s Wort has not been found to be safe in pregnancy. Be certain to tell your physician and pharmacist if you are planning to take St. John’s Wort.

Psychotherapy can be used for milder forms of depression and in combination with medication for more severe cases. Psychotherapy involves talking with a trained professional. The therapist’s aim, depending upon the type of therapy, is to help the patient gain insights about herself and thus change thoughts, feelings, and behavior that may contribute to depression. Some studies have shown that cognitive behavioral therapy and interpersonal therapy are as effective as medication for mild to moderate depression.

Electroconvulsive therapy (ECT) is very effective for treating patients who cannot take certain medications due to a heart condition, pregnancy, old age or severe malnourishment, and for patients who are suicidal or who do not respond to antidepressants. Before ECT is administered, patients receive anesthesia and a muscle relaxant to protect them from physical harm and pain. Side effects tend to be brief.

A subtype of depression called seasonal affective disorder results from some people’s sensitivity to seasonal changes in the amount of available daylight. Studies have shown that spending a period of time each day under a "light box" that emits full-spectrum light is an effective treatment.

Should traditional treatment methods be ineffective, keep searching for an unrecognized cause in your life for the depression. In summary, never accept a life of suffering with the emotional pain of depression. Help exists!

Linda L.M. Worley, M.D.,Linda L.M. Worley, M.D., is an associate professor of psychiatry and behavioral sciences at the University of Arkansas for Medical Sciences and a fellow in the Academy of Psychosomatic Medicine. She also is medical director of the UAMS General Hospital Psychiatry Service, Student Mental Health and Arkansas CARES.

 

Related Site
American Psychiatric Association:
www.psych.org

 
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