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Depression and Women: Answers to Common Questions

Women suffer from depression at roughly twice the rate as men, and one in every four women will experience the illness at some point in her lifetime. Biology, genetics, emotional makeup and environmental factors (such as prolonged stress or a life crisis) often play roles in the onset of clinical depression. The importance of these factors (both independently and in relation to each other) is yet to be identified. However, it has been determined that men are more likely to ignore their symptoms or try to cope with emotional pain by using/abusing alcohol or illicit drugs.

Are constant aches and pains that my doctor can't attribute to any illness a sign of depression?

Aches and pains with unknown causes or those that don't respond to treatment can be a symptom of depression. If unexplainable aches and pains occur in conjunction with at least four other symptoms of depression for a minimum of two weeks, you may be suffering from clinical depression. The best thing to do is to see a physician or mental health professional who can assess the problems and make a diagnosis.

Should my feelings of sadness and irritability related to premenstrual syndrome (PMS) last throughout the entire month?

If you are experiencing symptoms of depression most of the month, it is probably not PMS. PMS usually begins within a few days after ovulation - roughly two weeks prior to menstruation - and ends within a few days after the start of the menstrual period.

Some women do experience sadness, irritability and other emotional and physical symptoms of depression during their menstrual cycle, and these symptoms resemble depression. But if the symptoms never lessen or go away, you may be suffering from something other than PMS and you should visit your physician or a mental health professional for a proper diagnosis. Even if the symptoms are limited to the premenstrual period, if they are severe a woman should seek professional help.

Is postpartum blues the same thing as clinical depression?

Postpartum blues is not the same thing as clinical depression. The key difference between postpartum blues (the feelings of sadness and inability to cope that some women experience after childbirth) and clinical depression is the severity of the symptoms and the length of time they persist. Some women do experience postpartum blues, and the vast majority of these women have symptoms that last only several days.

However, some women after giving birth experience clinical depression. Studies indicate that women experiencing depression after childbirth are likely to have experienced clinical depression earlier in their lives but were not properly diagnosed or treated. If you are experiencing symptoms of postpartum depression that become severe or last more than two weeks, discuss this with your gynecologist or primary physician, or see a mental health professional. What you're experiencing may actually be clinical depression, and should be treated.

Are women more vulnerable to depression at menopause?

Depression is not linked to the hormonal changes of menopause. This does not mean that women experiencing menopause can't become depressed. It means menopause does not cause depression. Women most vulnerable to the illness at this stage in their lives are those with a history of clinical depression, and therefore should be treated.

Do people of different races, ethnicity, ages, incomes and religions differ in their rates of depression?

No one is immune - people of all races, ethnicity, ages, incomes and religions suffer from depression. We do know that women in their reproductive years (typically ages 24 to 44) are most vulnerable and that environmental factors, such as undue stress, also can contribute to the onset of depression. Possible differences among races and ethnic groups related to depression are now beginning to be researched.

Is depression just a normal result of growing older?

Depression is not a normal part of the aging process. Older adults should still find their lives fulfilling. This does not mean elderly women don't get clinically depressed. The rate of depression among older people actually is lower than among the general population. Although older adults may experience many losses later in life, changes in health status or relocation of loved ones, the majority can cope with these losses without becoming depressed. Clinical depression is treatable at any age.

Is suicide linked to depression?

Unfortunately, yes. The feelings of hopelessness, helplessness and pain that are symptomatic of depression can lead to despair and thoughts of suicide. If you (or someone you know) are having suicidal thoughts, talk with a doctor or mental health professional immediately for advice and referral. Remember, clinical depression can be treated effectively, which could save one's life.

Is depression the disease-of-tbe-month (i.e., a fad)?

No. The fact is, awareness of depression is growing because new medications and talking therapy are making its treatment easier and more successful. Clinical depression has always existed. Unfortunately, in the past, people had little recourse. Now, through medication and psychotherapy, the vast majority of people with clinical depression recover to live productive and fulfilling lives.

What is manic depression?

Manic depression, also known as bipolar disorder, is a mental illness that causes a person to go through episodes of depression, then episodes of high elation (or mania). Sometimes these mood switches, from terrible lows to outrageous highs, occur in a roller coaster fashion. During the manic or high episodes, individuals may act inappropriately, have grandiose thoughts and poor judgment, and become very overactive.

Is depression in teenagers to be expected since adolescence is a time of physical and psychological change, for both girls and boys?

Depression is not the norm for adolescence. It is not "just a phase" of growing up. Adolescence can have its moments of trauma and moodiness. Developmentally, adolescence is a time of growing emotionally independent and of separation, as well as physical and hormonal changes.

Beginning in adolescence, young women have higher rates of depressive, anxiety and eating disorders, while young men have higher rates of disruptive behavior disorders. Teenagers don't grow out of clinical depression. They can't because there's no cause-and-effect relationship between being a teenager and experiencing the illness. So, if you know a teenager suffering from symptoms of depression, urge her/him to talk to her/his parents and to see a medical or mental health professional for an evaluation and possibly treatment.

My elderly mother lost her husband more than a year ago, and she’s still withdrawn and unhappy. Is it normal to grieve over the loss of a loved one this long?             

Death can precipitate depression. Grieving is a normal part of recovering from loss. But, experts agree that the depression that accompanies the loss of a loved one usually begins to lessen after several months. If your mother continues to be withdrawn and disinterested in activities that used to give her pleasure before her husband's death, she may be suffering from depression and should be encouraged to see her physician or mental health professional for a proper diagnosis and possibly treatment.

How do I get help for depression?

The very first step is to talk with your primary physician or a mental health professional. Share your screening test results with your doctor and explain the symptoms you have been experiencing. He/she may recommend a physical checkup to determine if any underlying physical cause for the depressive symptoms exists. If clinical depression is diagnosed, then your physician, health maintenance organization (HMO) or a local mental health association may make referrals to a mental health specialist.

What are my options in seeking treatment?

Clinical depression is one of the most highly treatable illnesses, and getting treatment can truly save lives. The most commonly used treatments are antidepressant medication and psychotherapy. In many cases a combination of the two treatments is recommended. The choice of treatment depends on the severity of the depressive symptoms and your history of the illness. When you talk to your physician or mental health professional, make sure he/she discusses all of these treatment options with you.

While primary physicians can diagnose and treat clinical depression, psychiatrists are medical doctors who specialize in the treatment of mental illness and can prescribe antidepressant drugs. Mental health professionals who are not physicians can provide psychotherapy and often will collaborate with physicians to ensure their patients receive appropriate medication whenever necessary.

Psychologists, clinical social workers, licensed counselors and pastoral counselors can provide psychotherapy (talking therapy) either alone or in combination with medication prescribed by a doctor. Patients can be referred to a therapist by a primary physician; mental health center; or a psychiatric, psychological, social worker or pastoral counselor association.

What medications are available to treat clinical depression? How do they work?

Recent research strongly supports the use of medication for moderate and severe episodes of clinical depression. Many highly effective antidepressants are available. The two most common types are selective serotonin reuptake inhibitors (SSRIS) and tricyclic antidepressants (TCAs).

Scientists believe depression occurs when an alteration in brain chemicals, called neurotransmitters, takes place. Antidepressants work by acting on the chemical pathways of the brain related to moods.

A physician knowledgeable and experienced in the treatment of clinical depression should monitor patients taking antidepressants to ensure the best treatment with the fewest side effects. The use of antidepressant medication should not be discontinued without first talking with your prescribing physician, since some medications have side effects if stopped abruptly.

How long does it take for antidepressants to take full effect?

Individuals all respond at different rates to medications. Generally, antidepressants must be taken daily for two to four weeks before they are fully effective - although some improvements in sleep and other symptoms of depression may occur sooner. Your doctor can give you details on what to expect from the specific medication you are prescribed.

Medical research shows that people respond best to antidepressants when they are taken for four to nine months after the symptoms of depression have subsided. The prospect of relapse is greater among people who have experienced several bouts of depression, and they may take antidepressants for years, under the supervision of a physician, to prevent further episodes. It's important to consult with your physician to determine how long to continue medications. Do not discontinue use of medication before consulting with your doctor.

Are some antidepressants more effective than others? Are antidepressants addictive? What are the side effects of antidepressants?

The new antidepressant medications are as effective as the old antidepressants, and are reported to have fewer side effects. Because the new antidepressants have fewer side effects, people with depression are more likely to continue taking their medication as directed. And, antidepressant medications are not habit-forming.

Among the different classes of antidepressants, each has its own set of potential side effects. If you are prescribed an antidepressant, your doctor and pharmacist can discuss the side effects that may be associated. Response to anti-depressant therapy varies from individual to individual. Factors that can contribute include the nature of the problem(s) an individual is battling and the type of therapy being provided.

If I'm not clinically depressed but generally feel "blah" or low, will antidepressants give me a lift and make me feel better?

If you've had the "blahs" for a relatively short period of time but have been diagnosed as not being clinically depressed, an antidepressant will not lift your mood. Antidepressants are only effective if there is an imbalance in neurotransmitters - the chemicals in our brains that affect mood. Psychotherapy, also known as talking therapy, may, however, be helpful in understanding and overcoming the causes of feeling "low."

There are several types of clinical depression, such as dysthymia and seasonal affective disorder (SAD), which are less severe yet debilitating forms of depression. Dysthymia is marked in part by feelings of low self-esteem and low energy or fatigue that last two years or longer. If you are suffering from dysthymia, your physician may prescribe an antidepressant. While dysthymia can occur at any time, SAD usually hits during the winter months when there's less daylight. SAD can be successfully treated with artificial-light therapy and sometimes antidepressants.

How is psychotherapy beneficial? How long does it take before psychotherapy works?

Psychotherapy, or talk therapy, is offered by various mental health professionals, including psychiatrists, psychologists, clinical social workers, marriage and family therapists, mental health counselors and pastoral counselors. Talking with a trained mental health professional can help teach patients better ways to handle and cope with problems and life circumstances.

Some short-term (10 to 20 week) courses of therapy can be effective in treating clinical depression, especially depression that is less severe. Cognitive/behavioral therapy helps alter negative thought and behavioral patterns that may contribute to clinical depression. Interpersonal therapy focuses on dealing more effectively with other people and working to change relationships that may be causing or worsening the depression. A combination of both medication and psychotherapy is often the most effective treatment for clinical depression.

Can support groups help people who are depressed?

Yes, many people with clinical depression find that patient support groups provide acceptance and encouragement in overcoming this illness. Referrals to support groups can be found through such organizations as the local Mental Health Association, Alliance for the Mentally Ill, National Depressive and Manic-Depressive Association and community mental health centers.

When is ECT treatment recommended?

Electroconvulsive therapy (ECT) may be recommended primarily for people who cannot take or do not improve with medication, in cases of extreme suicide risk, or with debilitation due to an unrelated physical illness or to the severe depression itself. In recent years, ECT has been improved and is now considered a safe and effective treatment.

How do l pay for treatment?

If you participate in a private insurance or HMO plan, your costs for treatment may be covered. A mental health benefit may be included in your overall health benefit. Contact your health insurance provider for details on your coverage for treatment of clinical depression.

If you do not have insurance or are unable to afford treatment, your community may have publicly funded mental health centers and other mental health programs that calculate the cost of many services according to what you can afford to pay. This is called adding-scale or sliding-fee basis of payment. So, even if you're financially constrained, services may still be available. Some mental health professionals in private practice or at clinics affiliated with medical schools may also accept patients on a sliding-fee basis.

This educational information is provided to you by the
Depression Education Committee at Mental Health America of Eastern Missouri, a United Way agency

1905 South Grand
St. Louis, MO 63104
314-773-1399
www.mhagstl.org

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