Depression in Women

One in four women will experience an episode of depression at least once in their lives. Depression affects men at a much lower rate. However, many experiences unique to women, such as menstruation, pregnancy, and menopause, trigger depressive episodes.

Depression Caused by Menstruation

Some women experience severe symptoms of depression before they start menstruating each month. This mood disorder, called premenstrual dysphoric disorder (PMDD), may also share symptoms with premenstrual syndrome (PMS), like breast tenderness, bloating, or pain. However, the defining characteristic of PMDD is seemingly uncontrollable feelings of anger or moodiness.

Women with other family members with the disorder are more likely to have PMDD, which indicates that genes may play a role in who suffers from the condition. PMDD, like other mood disorders, may be caused by a problem with the brain’s chemistry. The fluctuating hormones caused by ovulation appear to trigger this condition.

To be diagnosed with the disorder, a woman must have at least five PMDD symptoms after ovulation each month. She must also have seven to ten days of good health, where none of these symptoms are present, each menstrual cycle.

Symptoms include:

• Lack of interest in common activities, such as hobbies
• Moderate to severe feelings of tension or anxiety
• Shifts in mood, such as feeling overly sensitive
• Moderate to severe feelings of hopelessness or depression
• Physical symptoms, such as weight gain, joint or muscle pain, or a headache
• Changes in sleeping patterns, such as sleeping too much or too little
• Changes in eating habits or food cravings
• Problems focusing or concentrating
• Low energy
• Unusual irritability or anger
• Feeling overwhelmed

Women who believe they may have PMDD should make an appointment with their gynecologist and possibly a mental health professional. The woman may be asked to keep a mood journal for at least two months before attempting treatment. However, severe symptoms may warrant an immediate intervention.

Women entering treatment can expect to take antidepressants as well as making behavioral and nutritional changes. Patients should limit their consumption of caffeine, alcohol, and salt. They should also consider lowering their sugar intake and eating more complex carbohydrate. Regular exercise and using relaxation techniques are also recommended. Psychotherapy can also be used to treat the depression often associated with PMDD.

Treating Depression While Pregnant

Women with depression should consider altering their treatment plan if they are pregnant or plan to conceive. If a woman has only mild depression, her doctor will often recommend managing her depression only through therapy while she tries conceive or is pregnant. Patients with severe depression may need to stay on their medication but can also switch to an antidepressant that is believed to be safe for pregnant women.

Women with a history of severe depression should also talk about postpartum depression with their doctors. Sometimes a doctor may advise a woman to start taking antidepressants during her last month of pregnancy, even if she stopped using antidepressants when she conceived. This cautionary measure can prevent these women from developing postpartum depression.

There are no studies on the effects of antidepressants on pregnant women due to ethical concerns. However, drug manufacturers do keep a list of women who use their drugs while pregnant as well as a list of any side effects the women and their children experience. This information helps doctors identify the possible risks to the fetus when determining if antidepressants are necessary.

Postpartum Depression

Most new mothers will have a short period of time where they experience symptoms of moodiness, irritability, or anxiety. These mood swings are known as postpartum blues. Postpartum blues begin after the third or fourth day after delivery, but the symptoms should stop after day 12. Women with symptoms that linger past two weeks are at higher risk for developing postpartum major depression.

Postpartum major depression is a serious mood disorder that causes a depressed mood for the majority of the day for at least two weeks. Some women with postpartum major depression experience fatigue, guilt, insomnia, and suicidal thoughts. Very severe cases can cause delusions or hallucinations, which in rare cases may lead a woman to harm her child.

Postpartum major depression is caused by changes in the body’s brain chemistry and is considered a biological illness. After birth, the amount of progesterone and estrogen in a woman’s body falls, which may trigger depression. Sometimes an underactive thyroid gland causes postpartum major depression, but this cause of depression is more easily treated. The same condition primarily caused by hormone changes is treated through therapy and sometimes medication. However, women breastfeeding their children should discuss the use of antidepressants with their doctor.

Depression Caused by Menopause

While most women will experience some changes in mood, hot flashes, and insomnia during menopause, these symptoms can also progress into major depression. Researchers believe that changes in hormones can trigger major depression, especially in women who have had depression in the past or have family members with depression.

Women with major depression will have one or both of two primary symptoms. They can have a depressed mood for most of the day for at least two weeks, or they may lose interest in treasured activities.

In addition to at least one of these symptoms, women can also experience:

• Lack of energy or fatigue
• Thoughts of suicide or death
• Changes in sleeping patterns
• Lack of concentration
• Persistent thoughts of worthlessness or guilt
• Restlessness

For severe major depression, doctors recommend antidepressants and hormone therapy in addition to psychotherapy. If the major depression symptoms are milder and the woman is still transitioning into menopause, a doctor may recommend trying only hormone therapy, especially if the woman has never experienced depression before. For women with mild symptoms who have fully transitioned into menopause, many doctors believe that antidepressants are more useful than hormone replacement.

In some cases, hormone therapy used to ease the symptoms menopause can trigger depression. In these cases, the hormone therapy may be altered or stopped altogether. Antidepressants may also be prescribed. In all cases, psychotherapy, particularly interpersonal therapy or cognitive-behavioral therapy, is recommended.

Women and Depression

Although two-thirds of patients treated for common depressive disorders are women, there is no comprehensive set of practice guidelines used for treating depressed women. Instead, doctors will try to treat depressed women based on any physical changes that are known to cause depression. In addition to hormone changes unique to women, depression can also be triggered by the same situations, genes, medical conditions, medications, and personality traits that cause depression in men.

• Editors, experts, and contents pages from the guidelines
• Premenstrual Dysphoric Disorder: A Guide for Patients and Families
• Major Depression During Conception and Pregnancy: A Guide for Patients and Families
• Postpartum Depression: A Guide for Patients and Families
• Depression During the Transition to Menopause: A Guide for Patients and Families

View Resources

• NIMH – What causes depression in women?
• Womenshealth.gov – Depression fact sheet
• CDC.gov – Depression Among Women of Reproductive Age and Postpartum Depression
• Depressiontoolkit.org – Depression During Pregnancy