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Depression in women: Understanding the gender gap

About twice as many women as men experience depression. Hormones, work overload and sexual abuse are among the factors that may increase a woman's risk of depression.

By Mayo Clinic staff

Family. Career. Coping with menstruation, pregnancy and menopause. As a woman, you certainly have plenty of issues to handle. But there's another one you might face that can be especially challenging: depression.

Women are about twice as likely as are men to develop depression and depression-related disorders during their lifetime. As a woman, several factors increase your risk of depression, including:

  • Your unique biology
  • Your life situation
  • Your culture

Explore more about what lies behind this male-female gender gap in depression.

Biological factors affecting depression in women

The female body may influence the development of depression. That's because ovarian hormones and related biological factors may affect your mood through various stages of your life.

Puberty
Before girls and boys reach puberty, they have similar rates of depression. After puberty, though, the gender gap in depression and related disorders becomes pronounced. And because girls typically reach puberty before boys do, they're more likely to develop depression at an earlier age than are boys.

Because this depression gender gap coincides with puberty and disappears after menopause, some researchers say that hormonal factors increase a woman's risk of developing depression. On the other hand, puberty is also often associated with other changes that could play a role in depression, including:

  • Emerging sexuality and identity issues
  • Parental conflicts
  • Evolving social expectations

These factors could interact with hormonal changes during puberty and result in an increased risk of depression among women, especially at an earlier age.

Premenstrual problems
You may know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability and a blue mood herald the notorious symptoms of premenstrual syndrome (PMS). For most women with PMS, the symptoms are minor and short-lived.

But a small percentage of women have such severe and disabling mood-related symptoms that their lives, jobs and relationships are disrupted. At that point, PMS crosses the line into premenstrual dysphoric disorder (PMDD), which may require psychiatric evaluation and treatment.

Although the exact interaction between depression and premenstrual syndrome remains unclear, some researchers say that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals such as serotonin that control mood. Still, because such hormonal changes occur in most women, but not all women develop depression, hormonal changes can't be the only cause of depression in women. Genetic predisposition or other factors also may influence the development of depression.

Pregnancy
Men can develop depression when their partner is pregnant. But in general, women are more likely than are men to develop depression during pregnancy.

Dramatic hormonal changes occur during pregnancy, and these can affect mood. Other issues may also increase the risk of developing depression during pregnancy or during attempts to become pregnant, including:

Lifestyle or work changes

  • Relationship problems
  • Previous episodes of depression, postpartum depression or premenstrual dysphoric disorder
  • Lack of social support
  • Mixed feelings about being pregnant
  • Miscarriage
  • Infertility
  • Unwanted pregnancy
  • Stopping use of antidepressant medications

Postpartum depression
About half of new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings — sometimes called the baby blues — are normal and generally subside within a week or two.

But more serious cases may indicate postpartum depression, particularly if symptoms include:

  • An inability to care for your baby
  • Thoughts of harming your baby
  • Anxiety
  • Low self-esteem
  • Agitation
  • Thoughts of suicide

Postpartum depression is a serious medical condition requiring prompt treatment. It's thought to be associated with major hormonal fluctuations that influence mood as well as with an underlying predisposition to depression.

Perimenopause and menopause
The risk of depression may also be heightened during the transition to menopause, a stage called perimenopause, when hormone levels fluctuate erratically. And the depression risk also may be heightened in early menopause or after menopause, both times when estrogen levels are significantly reduced.

Most women who experience uncomfortable menopausal symptoms don't develop depression. But for women whose sleep is disrupted for long periods of time or who have a history of depression, this is a vulnerable time. Also, hysterectomy with removal of the ovaries can lead to an abrupt onset of menopause with more severe symptoms, including mood changes and sometimes depression.

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Sept. 6, 2008

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