En español | Ask most mental health professionals about the gender mix of their patients with depression and they're likely to report that most are women — who are almost twice as likely as men to be diagnosed with the condition, according to the Mayo Clinic. But ask experts why there's such a disparity between genders, and you'll end up with a complex web of potential reasons, including women's hormonal differences and the fact that they're generally more willing to seek help. The good news is that once depression is diagnosed, it can be treated.
Here's what to know about women and depression — and how to get help.
While depression can occur at any age, and for a variety of reasons (a family history of the disorder can make you more prone), women are particularly vulnerable during times of hormonal fluctuations — typically between the beginning of puberty and menopause. Hormones such as estrogen and progesterone affect serotonin, a feel-good brain chemical that encourages feelings of well-being. When hormone levels drop, serotonin levels drop, sometimes bringing on a maddening shift in mood. The reproductive years are a prime time for depression.
So is the transition into menopause, known as perimenopause. Adding to melancholy mood: hot flashes and night sweats, which can lead to a lack of sleep. According to the Centers for Disease Control and Prevention, not getting enough shut-eye plays a role in mood and may even increase your risk of dementia.
Higher stress levels
But biology alone isn't to blame. Women were almost twice as likely to be affected by anxiety than men, according to a 2016 study, which appeared in the journal Brain & Behavior. Juggling work and household duties or caring for elderly family members can take a toll. (Women make up about 60 percent of family caregivers.)
"Women also live longer and spend a longer period of time alone after losing a loved one, and are at increased rates for financial instability and isolation,” says Helen L. Coons, clinical director for Women's Behavioral Health & Wellness at the University of Colorado School of Medicine's Department of Psychiatry.
If you or someone you care about is considering suicide, call the free 24-hour National Suicide Prevention Lifeline, 800-273-TALK (8255), or text the word “home” to the Crisis Text Line at 741741 to speak with someone who can offer confidential support and resources. Find more information at suicidepreventionlifeline.org.
The Substance Abuse and Mental Health Services Administration also has a helpline (the Treatment Referral Routing Service) offering information on support groups, treatment options and other assistance: 800-662-HELP (4357).
There are also psychosocial issues that affect women, notes Coons. They are more likely to experience abuse — emotional, physical or sexual, which can place them at an increased risk for depression. “Even as adolescent girls. they see more incidences of sadness and self-esteem, which carry across our lifespan,” says Coons. And women are more likely to internalize emotions than their male counterparts. “We tend be more stressed, we tend to worry more, we tend to ruminate a little more,” says Coons. “That destabilizes things like sleep and mood.”
But it may also be that depression simply shows up differently in men, who often appear angry or irritable, rather than sad. According to Brian P. Cole, an assistant professor of counseling psychology at the University of Kansas, this tendency can be traced back to boyhood, a time when many men are socialized to believe that it is unacceptable to show vulnerability. As Cole puts it: Men are encouraged to “play through the pain.”
What's more, according to a series of studies, published by Cole, men tend to view “traditional” symptoms of depression, such as sadness, as less masculine. This difficulty with self-diagnosis has dangerous implications, notes Cole: “If men struggle to identify what they are feeling as depression and attempt to ignore their symptoms because ‘men don't get depressed,’ they are less likely to receive the support that they need.”
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Indeed, research has established that men often are more deeply depressed before they are willing to seek help. “This may explain why men report higher rates of substance abuse when depressed and, more importantly, why men with depression die by suicide at higher rates than women,” says Cole, who notes that this is especially true for older men, who have the highest rate of death by suicide in the U.S. “It is important that we normalize the fact that men get depressed and that it is acceptable to seek help from family, friends and professionals."
Treatment and coping strategies
Depression can be treated with talk therapy, antidepressants, or a combination of the two.
More than 15 percent of women take antidepressants, often selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that includes Prozac and Zoloft. These drugs act on the serotonin system that affects mood and anxiety.
But taming depression is often possible without downing a pill. Milder forms of the disorder, especially, can be managed with coping strategies. A few:
- Get moving. Engaging in healthy behaviors can help to move the depression along, says Bruce Sutor, M.D., a psychiatrist at the Mayo Clinic in Rochester, Minnesota. Probably the simplest, most effective treatment is exercise. A 2016 study in the Journal of Psychiatric Research found that regular moderate intensity aerobic exercise had “a large and significant antidepressant effect in people with depression, (including [major depressive disorder]).” What's more, it appears that even modest levels — say, taking a brisk walk around the neighborhood — may have benefits.
- Stick to a healthy diet. There's evidence that eating healthy (yes, a Mediterranean diet, chockful of fruits, vegetables and whole grains) can help reduce symptoms of depression. It makes sense: About 95 percent of serotonin, a neurotransmitter that helps regulate our moods, is produced in your gastrointestinal tract.
- Avoid alcohol. A depressant, alcohol lowers the levels of serotonin, the feel-good chemical that regulates mood, in your brain. So, overindulging may cause your depression to worsen. The American Heart Association recommends women have only one drink or less per day.
- Practice age-old calming techniques such as meditation, yoga or focused breathing exercises. Lower stress levels can help treat depression. When we slow our breathing, it regulates our heart rate and calms the body down. A study out of Boston University School of Medicine has found evidence that yoga — which incorporates mindful breathing — can provide relief not only while you're doing it, but also cumulatively, over time, as well.
- Reach out. Spend time with friends and family to build social support. And let's not forget the power of interaction. A study in The American Journal of Psychiatry focused on 106 modifiable factors that might affect people's risk of depression and found that, according to a coauthor of the study, “far and away the most prominent of these factors was the frequency of confiding in others.”