Feeling occasionally sad is normal, but Major Depressive Disorder, the official diagnosis for what we call “depression,” is more than occasional. It is a pattern of experiencing symptoms over time to the detriment of daily life. Hormones, biology, and societal pressure all contribute to women struggling with depression at a significantly higher rate than men. However, with psychotherapy, learning regulation skills, and/or medication, depression can be managed.
While having a good physical exam and assessment is important to rule out organic causes of any mental distress, this is especially true when experiencing symptoms of depression. Common medical conditions, such as hypothyroidism, affect energy, appetite, and sleep patterns, can all produce symptoms that overlap with common symptoms of depression. Consulting with your doctor about these concerns can assure that medical issues are not overlooked.
Most Common Symptoms of Depression in Women
Diagnoses are made by psychiatric providers and therapists, but also by primary care providers and women’s health providers (OB/GYNs).
Depression symptoms and severity will vary, but according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), common symptoms of depression in women include:1
- Persistent feelings of sadness, emptiness, or hopelessness
- Inability to enjoy things
- Significant weight changes and/or appetite changes
- Sleeping too much or not sleeping enough
- Fatigue
- Trouble concentrating
- Feeling worthless or overly guilt-ridden
- Thoughts of death or dying, suicidal thoughts or a suicide attempt
The Type of Depressive Disorder Can Impact Symptoms
Depression does not look and feel the same for everyone. Sometimes the differences in symptoms actually indicate different types of depression. Distinguishing the types of depression can help to receive the best possible treatment.
Common types of depression include:
Seasonal Affective Disorder or Seasonal Depression
This distinction describes how depression can have a seasonal pattern. Specifically, winter can cause an increase in depressive episodes. Shorter daylight hours and inclimate weather that prohibits outdoor activities lead people to have less outlets to cope with their symptoms of depression.
Adjustment Disorder
When there is a life stressor or crisis, depression may occur as a response to that stress. In depression associated with adjustment disorder, the symptoms are temporary to the point that they only are present for up to 6 months following a specific and identifiable stressor.
Grief/Bereavement
Grief is not a mental illness, but sometimes the normal feelings that accompany a loss can be confused for depression. Grief is a normal process but if you are concerned your grief may be moving into depression, seeking help from a therapist can still help.
Dysthymia
Dysthymia is also known as Persistent Depressive Disorder and is considered a more chronic condition, lasting more than 2 years for adults.
Substance/Medication-Induced Depression
Certain medications and/or substances can cause symptoms of depression, either in times of use or when withdrawing from the medication.
Types of Depression Unique to Women
Hormonal and lifestyle changes occuring during menstruation, pregnancy, and menopause are to thank for specific depressive episodes that only affect women. These types of hormonal change can also exacerbate existing episodes of depression or anxiety. Consulting with a medical specialist (such as an ob/gyn) about symptoms associated only with hormonal changes is suggested in order to get the best possible treatment.
Types of depression unique to women include:
Premenstrual Dysphoric Disorder (PMDD)
Most women experience some form of premenstrual syndrome (PMS) in the days before or during their period. PMDD is marked by significant mood, physical, and behavioral changes that are so severe that daily life is affected. PMDD is also different from depression in that symptoms are minimal or resolved in the week post-menses.1
Postpartum Depression
Pregnancy and the birth of a child cause a massive shift in hormones as well as lifestyle. Most women experience times of sadness or fluctuating mood in the weeks following delivery, often known as “baby blues.” While the baby blues is an expected phenomena, postpartum depression occurs when those symptoms increase or fail to resolve over time.
Perimenopausal Depression
Due to the vast hormonal changes during perimenopause (the time of transition women experience prior to menopause), many women find that their moods become erratic and depressive symptoms and/or episodes increase.
Is Depression More Common in Women Than Men?
In 2019, 21.8% of women experienced depressive symptoms in a two week time period.2 Women are consistently shown to have higher incidences of depression than men. A CDC survey of adult Americans stated “Overall, women (10.4%) were almost twice as likely to have depression as men (5.5%).”3
There is no one agreed-upon reason for this difference, but instead multiple theories and factors that could influence it. One theory is that women who choose to work and have families often serve as both a primary caregiver to children and aging parents while also working to advance a profession and/or provide financial security. Carrying the load of family and career can be overwhelming and lead to feelings of resentment or shutting down.
Another theory is “Mom Guilt.” While women are more educated than ever, they still often find themselves being expected to fulfill traditional expectations. Social media leaves women feeling judged for every decision they make regarding their parenting and life choices. Guilt and shame for not being able to be at every school event or organize the perfect themed birthday party can lead to other symptoms of depression. Women are also more likely to be victims of violence and abuse, which are factors that contribute to depression.
Additionally, there remains a gender gap regarding wealth and power, meaning that women continue to earn less money than men and are far less likely to be in a position of power. The emotional and financial burdens of this can lead to emotional distress and depression.
Hormonal shifts due to menses, pregnancy, and menopause can all trigger depressive symptoms. Some scholars believe that internalizing/shutting down behaviors were safer for our female Homo sapien ancestors than acting out behaviors and therefore became coded into the human genotype over centuries.4
Signs of Depression in Women
Depression can feel incredibly isolating and lonely to a person in the middle of it. If you notice someone may be feeling depressed, don’t be afraid to check in with them. If someone shares with you that they are suicidal, contact 911 immediately. Local law enforcement can perform wellness checks on a person if they have concerning behaviors and statements.
Common signs of depression in women include:1
- Significant weight loss or gain
- Social Isolation
- Lethargy or increased fatigue
- Lack of participation or enjoyment in activities that they once enjoyed
- Seeming to move more slowly than is usual
- A change in hygiene and/or appearance
- Negative statements about self
- Talk of death or dying
- Suicidal threats
Causes & Risk Factors of Depression in Women
While the causes of depression are still being actively researched and debated, there are some issues that are known to increase the risk of developing symptoms of depression.
Hormonal changes associated with menstruation, pregnancy, childbirth, and menopause cause changes in brain chemistry that can be associated with depressive episodes.5
One study showed that 12.4% of women studied had a Major Depressive Episode during pregnancy.6 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress.7
Genetics may also be a factor.. One meta-analysis showed that “heritability of major depression is likely to be in the range of 31%–42%,” though they noted that this was likely to be on the low end of the spectrum.8
Research demonstrates that exposure to adverse experiences in childhood increases the risk of depressive disorders even decades after the events occur.9 Trauma, loss, violence, and other life crises can trigger the onset of depression. Depressive symptoms that present only after a stressful event may also be signs of PTSD, acute stress disorder, or adjustment disorder.
When & How to Get Help for Depression
Choosing to get help with depression is not easy. Often, people do not admit how badly they are feeling until things get unbearable. The sooner a person can begin to admit their symptoms to a professional, the sooner an accurate medical and psychological assessment can be made, and then treatment can begin. Ruling out medical causes of depression like a thyroid imbalance is incredibly important, especially for women, who experience significantly more thyroid problems than men.
Reaching out to a primary care physician or Ob-Gyn can be the first step in seeking treatment. Likewise, finding a therapist can also begin the healing process. Your medical provider can often refer to a therapist they are familiar with, and likewise asking trusted friends can lead to therapist referrals. Also, if you would like to find a therapist who accepts your insurance, you can call the number on your insurance card to get a list of mental health providers who are contracted with your insurance. Using a therapist directory can help you find qualified therapists as well.
OB-GYNs Often Detect Signs of Depression & Recommend Therapy
Choosing Therapy conducted a survey of 135 OB-GYNs on Sermo, a global data collecting platform of over 800,000 anonymous, verified physicians, about the mental health of their patients. The OB-GYNs reported that about 31% of their patients present with depression. Of those surveyed, 73% say that they’d ideally like the patients they recommend speak with a therapist have their first session within a week. However, the majority say that of the patients they recommend speak to a therapist, 30% or less actually make it to a first therapy session.
How Depression Is Treated
Antidepressants such as SSRIs and SNRIs are widely prescribed by psychiatrists and primary care physicians alike. However, long term healing is best achieved through a combination of therapy and medication, if medication is needed. Medication is necessary for many people in order to provide enough energy, motivation and hope to engage in the therapeutic process. Some people find that medication needs to remain a constant in their lives, while others are able to work with their doctor to decrease their medication needs as their ability to cope and manage their depression increases.
Common treatments of depression in women include:
Therapy
A number of therapy models effectively address depression, including Interpersonal Therapy, Psychodynamic Therapy, and Cognitive Behavioral Therapy (CBT). Many therapists will utilize a blended approach of talk therapy with regulation skill building to allow the client to develop strategies to manage symptoms of depression.
Medication
Psychotropic medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin–norepinephrine reuptake inhibitors) are often prescribed to treat symptoms of depression in women. These medications allow for an increase in certain chemicals in the brain that facilitate healthy mood stabilization.
The National Suicide Prevention Lifeline at 1-800-273-TALK is available 24/7 to anyone experiencing emotional distress or suicidal thoughts. They also have an internet chat feature available.
Do’s & Don’ts for Women With Depression
Depression can feel miserable, but change can feel completely overwhelming. Fortunately, there are some things that can help, as well as some things that should be avoided.
Do:
- Seek professional and medical help: Sometimes just talking to someone can help alleviate the feelings of loneliness that accompany depression. Also, a medical professional can help you determine if there is an underlying medical condition that could be causing mood disruptions.
- Connect with others: Connection with others is incredibly difficult when in a depressive episode, but it is vital to mental health. Finding a way to catch up with a friend or intentionally spend time with a family member can help.
- Get outside: Getting even a few minutes of fresh air can help your body and brain experience different sensations (wind, hot or cold, sun or rain) that can help decrease depressive feelings.
- Move your body: Walking, yoga, or any kind of exercise that gets your body moving can help adjust your brain chemistry and alleviate symptoms.
- Make a routine: Having a solid routine can build a habit of engaging in healthy behaviors, like exercise and eating at regular intervals, that combat depression.
- Take care of your body: Try to notice when you are hungry or full. Eat at regular intervals and attempt to listen to your body for cues around food. Try to eat food that is healthy and avoid excessive alcohol and sugar.
Dont:
- Self-diagnose: It is almost impossible to objectively see yourself and your behaviors.
- Blame yourself for feeling down or sad: We have very little control over what we feel, we can only work to change how we respond to those feelings.
- Isolate: Isolation feeds feelings of depression and continues a negative cycle.
- Self-Medicate: Yes, that glass of wine or new sweater may make you feel better for a moment, and there is nothing wrong with treating yourself within reason, but if you are using food, alcohol, substances, shopping, sex, or any other compulsive behavior to distract from depression, that strategy will not work in the long term and can often lead to significant future stress or even addiction.
- Ignore thoughts of self-harm: Thoughts do not have to control actions, but if you have thoughts of self-harm or suicide, talk to someone immediately.
