Women and Depression
A woman's menstrual cycle, birth control method, pregnancy, post-pregnancy period, infertility, menopause and, sometimes, the decision not to have children can trigger mood fluctuations and depression in women who are vulnerable. Hormones have an effect on the brain chemistry that controls emotions and mood.
Many women experience behavioral and physical changes during their menstrual cycle. These can be severe, occur regularly and include depressed feelings, irritability and other emotional and physical changes. Many women with depression experienced worse symptoms before their periods.
With premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), changes typically start after the ovaries produce and discharge eggs and the changes become gradually worse until menstruation starts. Researchers are exploring how the cyclical rise and fall of hormones, including estrogen, may affect the brain chemistry associated with depressive illness.
More on women and depression can be found by visiting the American Psychiatric Association's Web site.
Birth Control Methods
While many women with a history of depression will experience mood improvement while taking the birth control pill, some with a previous history of depression are at an increased risk of developing symptoms. Before beginning a birth control regimen, women should consult with their health care providers about their options and reveal any history of depression or other mental illness. Women and their doctors can work together to determine the best pill or birth control method for them.
Estrogen therapy after a hysterectomy may also result in increased risk of depression.
Pregnant women may be susceptible to depression because of extreme hormonal changes and the natural physiological and psychological stress of pregnancy. About 10-15 percent of women experience clinically significant depressive symptoms during pregnancy, but the majority do not receive adequate treatment. About 5 percent of pregnant women show symptoms of major depression.1
Untreated maternal depression can have adverse effects on the pregnancy and infant health, including low birth weight, fetal growth retardation, premature birth and pregnancy complications. Depression during pregnancy may also be related to infant sleep problems.
The majority of pregnant women who have full-blown major depression do not receive any treatment for the condition, nor do most pregnant women who have signs of milder depression or depression risk, a new University of Michigan Depression Center study finds. (more)
Women with infertility problems may feel extreme anxiety or sadness that persists even after conception. Assisted reproductive therapy, such as In vitro fertilization, may be associated with an increased risk of depression symptoms.
Depression peaks during the years that a woman is most likely to have children, from ages 25-44. Parents are significantly more likely to report depression than their childless counterparts.
Motherhood may be a time of increased risk for depression because of the stress and demands it imposes on women.
Many women experience a temporary mood disturbance after childbirth. But an estimated 9-16 percent of American women will experience post-partum depression, a disorder that occurs after pregnancy. Symptoms may include extreme difficulty in day-to-day functioning due to cognitive impairment and feelings of guilt, anxiety and fear. Women with post-partum depression may experience a loss of pleasure in life, insomnia, bouts of crying and thoughts of hurting themselves or the child. (more)
Menopause in general isn't associated with an increased risk of depression, but those women experiencing early symptoms, or perimenopause (the few years or months years leading up to menopause), may be more vulnerable. To determine if depressive symptoms are a result of hormonal changes, hormone therapy or depression, experienced clinicians, including a gynecologist and mental health professional, should be consulted. Symptoms of depression and perimenopause may have underlying mechanisms causing both.
Talk therapy, antidepressants and/or hormone replacement therapy (HRT) may be suggested as treatment. If HRT contributed to the depressive symptoms, antidepressants may be used alone or in conjunction with HRT.
Hormones may take two to four weeks to show results. Antidepressants take at least one to two months. If one type of antidepressant is ineffective, another may be a better fit.
Research has shown that depression at menopause is no different than at other ages. The women at greater risk are those with previous depressive episodes.
Women with a history of premenstrual dysphoric disorder (PMDD) may also be at an increased risk.
1 O'Hara MW, Zekoski EM, Philipps LH, Wright EJ, "Controlled prospective study of post-partum mood disorders: comparison of childbearing and nonchildbearing women," J Abnorm Psychol 1990; 99:3-15.