Women suffer from unipolar (as opposed to bipolar or manic) depression in greater numbers than men do; twice as much by most estimates. At one time it was theorized that women didn't actually have depression more than men, but that they were more likely to seek help and therefore have their depression recorded. However, studies have shown that a larger ratio of women to men do have this illness. The APA's Task Force Report on Women and Depression found that women truly are more depressed than men, not primarily due to biological causes, as was once believed, but to a variety of biological, social, and psychological causes. Not only is depression more common in women, but it is often accompanied by other symptoms such as anxiety, sleep disorders, panic attacks, and eating disorders.

In a sense, all women are at risk for depression. Depression cuts across all class, race and social lines. One in four women is likely to experience severe depression. Yet of all women who suffer from depression, only about one-fifth will get the treatment they need.

Few depressed women seek a psychiatrist when symptoms first present. More typically, they arrive in the office of a primary care physician complaining of physical symptoms. Health professionals miss at least half of depressions seen in primary care, even when the symptoms are severe. Thus, if a woman says she is depressed, appears depressed, or complains she is not doing as well as usual, she must be evaluated or referred for evaluation. The feeling of depression can be hard to distinguish from the actual illness of depression, but the difference is worth determining. There is no justification for letting somebody suffer through an untreated depression when there are readily available very good psychotherapies for depression as well as a host of very effective antidepressants that do not cause the same side effects that the older medications do.

The reason or reasons why women have unipolar depression more frequently than men is less definite, due to a great extent to the fact that we don't fully understand what causes depression, whether in men or women. Depression is a highly individual disease. Each case is different. One person's depression may be wholly chemical, while someone else's is brought on by events and stressful factors in her life. Yet another person may suffer depression due to a combination of chemical and environmental factors.
Several theories have been brought forward to explain the greater frequency of depression in women. At this point it is difficult to either completely discount any of them or to point to one and say, "That's it!". There is no question that women have to deal with a greater number of risks to their physical and emotional well-being than men. We have yet to learn to what extent each of these plays a role in depression in women. Until then, it is wise to be aware of these potential risks, in the same way we are aware of risk factors for heart disease or high blood pressure.

With young girls, behavioural changes are felt to be more subtle. At this age, young girls are often naturally quiet. In adolescent girls, signs of depression can include school problems and eating disorders. The girl may have a distorted perception of her own body image, a loss of appetite, a general lack of satisfaction and feelings of unhappiness with herself and life in general.

What Are the Risk Factors for Depression?

Relationships, marriage, and children: The state of our relationships often has much to do with our own emotional state—when things are going well with the people who are important to us, the world tends to look brighter. On the other hand, problems in important relationships can make things look bleak. This can be compounded by factors such as a partner's abuse or lack of fidelity. There is evidence that, in general, married women experience more depression than do single women. In addition, depression is common among young women who stay at home full-time with their small children. Divorce or breakup can also bring on a depressive episode, especially when it involves children and custody battles. Menstruation and pregnancy generally do not lead to depression. Infertility, however, can be a source of depression for women who want children. Miscarriages and surgical menopause can also cause depressive symptoms.

Poverty and minority status: Poverty is a pathway to depression. 75% of people living in poverty in the U.S. are women and children. Women who are minorities experience great stress from discrimination. In addition, poor women or minority women often do not have access to basic mental health care.

Hormonal factors: Hormones have also received attention in the search for causes of depression in women. Researchers have suggested that changes in levels of hormones such as estrogen and progesterone appear to have a strong effect on women's moods. The differences in the rates at which women and men develop depression begin to show up during puberty, a time at which many hormonal changes occur. Throughout a woman's menstrual cycle, levels of hormones constantly change. The link between these changes and the development of depression in women is a topic of current study. Studies show that "premenstrual syndrome" (or PMS), which can often include symptoms of depression, is common among women in the general population. In many cases, symptoms are mild, do not interfere with daily activities, and generally do not require treatment. In some cases, the symptoms may be quite severe and interfere with the woman's ability to function. In those instances, a physician should be consulted.

Depression After Childbirth: Nearly everyone has heard of the "baby blues," in which a new mother experiences strong, fluctuating emotions and depression in the first days and weeks following the birth of the baby. Although researchers have not yet confirmed this is the cause of the accompanying depression, the plummeting levels of the hormones estrogen and progesterone may play a role. This depressed mood occurs with such frequency that it is considered normal, and it usually resolves quickly without treatment. But for some women, depressive feelings may linger and become more severe, and prescription medication and/or counseling may be helpful. Women and their physicians should discuss the implications of taking antidepressant medicines while breast feeding. Women are more likely to experience depression after childbirth if they have experienced depression before. On the positive side, however, pregnant women often have the lowest incidence of depression.

Psychosocial influences on depression: Psychosocial influences, which include life stresses, coping strategies, and the ways in which women have learned to view themselves in society, are topics of current investigation in women's depression. Some Psychosocial factors appear to affect men and women equally, while some apply more specifically to women. Although clear-cut answers have not yet emerged, it seems that some of these psychosocial factors may help to explain why some women are more likely to experience depression than others.

Self-esteem: Many women grow up with a sense of self-confidence and a feeling that they can control their lives and master most situations. Some women, however, because of a number of complex familial and societal factors, may experience feelings of low self-esteem and self-worth. These women may feel that they are not taken seriously, that the contributions they make are not valued, or that they do not have an important role in society or in their family. Others may believe that their worth is based primarily on their physical attractiveness and become depressed if they think they don't measure up" to the standards set by glamorous images of models and actresses. Adolescents, especially, are prone to developing eating disorders, which are often accompanied by depression.

The factors that underlie low self-esteem in women are complicated, and affect different women in different ways. if you think you might have a problem with your own self-esteem, you may find it helpful to explore your feelings with a support group, with a counselor, or with your physician.

For more information, contact:

Your doctor

Your school / university / private practice counsellor

The Mental Health Unit at the hospital

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