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Women are more likely to become depressed than men. Because of this fact,  Psychology Information Online provides information about women and depression, including diagnosis, possible causes and risk factors that might be responsible for the higher rate of depression in women, and what to do if you think you are depressed.

Women suffer from unipolar (as opposed to bipolar or manic) depression in greater numbers than men do; twice as much by most estimates. At one time it was theorized that women didn't actually have depression more than men, but that they were more likely to seek help and therefore have their depression recorded. However, studies have shown that a larger ratio of women to men do have this illness. In addition, women seem to suffer from eating disorders and self-injury in greater numbers than men do.

What Every Woman Should Know About Depression
Life is full of emotional ups and downs. But when the "down" times are long lasting or interfere with an individual's ability to function, that person may be suffering from a common, but serious psychological problem - depression  

Clinical depression affects your physical well-being, resulting in chronic fatigue, sleep problems, and changes in appetite. It affects your mood, with feelings of sadness, emptiness, hopelessness and dysphoria. It affects the way you think, interfering with concentration and decision making. And, it affects your behavior, with increased irritability and loss of temper, social withdrawal, and a reduction in your desire to engage in pleasurable activities. Research indicates that in the United States more than 17 million people experience depression each year, and nearly two thirds do not get the help they need. Proper treatment would alleviate the symptoms in over 80 percent of the cases. Yet, because depression is often unrecognized, depressed individuals often continue to suffer needlessly. 

Women are almost twice as likely as men to experience depression. Research continues to explore how this psychological problem affects women. At the same time, it is important for women to increase their awareness of what is already known about depression, so that they seek early and appropriate treatment.

What is Depression?
Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with depression cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who have depression. 

The symptoms of depression vary from person to person, and the intensity of the symptoms depends on the severity of the depression. Depression causes changes in thinking, feeling, behavior, and physical well-being.

There are three primary types of depression: Major Depression; Dysthymia; and Bipolar Depression.  In addition to these primary depressions, many people also develop a "reactive depression," which may be less severe, but still requires psychological treatment. A reactive depression occurs when you develop many of the symptoms of depression in response to the stress of a major life problem, but they are not severe enough to be considered a major depression. If these milder symptoms of depression occur without a clear life stress as the cause, and the depression has not lasted long enough to by considered dysthymia, then it is called an Unspecified Depression. Other depressions may be caused by the physiological effects of a medical condition, or by substance abuse. The specific depression label, beyond the three primary types of depression and reactive depression, will not be reviewed here.

Major depression - Also known as unipolar or clinical depression, people have some or all of the depression symptoms listed below for at least 2 weeks or as long as several months or even longer. Episodes of the illness can occur once, twice, or several times in a lifetime.

Dysthymia - The same symptoms are present. However they are usually milder, but last at least two years. People with dysthymia also can experience major depressive episodes. 

Manic-depression - This is also called bipolar disorder. This type of depression is not nearly as common as other forms of depression. It involves disruptive cycles of depressive symptoms that alternate with euphoria, irritable excitement, or mania.

The Symptoms of Depression and Mania
You should talk to a psychologist for an evaluation, if you experience several of the following symptom clusters, and the symptoms persist for more than two weeks, or if they interfere with your work or your family life.  However, not everyone with depression experiences all of these symptoms, and the severity of the symptoms also varies from person to person.

Depression

1. Persistent sad, anxious, or "empty" mood
2. Loss of interest or pleasure in your usual activities, including sex
3. Restlessness, irritability, or excessive crying
4. Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
5. Sleeping too much or too little, early morning awakening
6. Appetite and/or weight loss or overeating and weight gain 
7. Decreased energy, fatigue, feeling "slowed down"
8. Thoughts of death or suicide, or suicide attempts 
9. Difficulty concentrating, remembering, or making decisions
10. Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, or chronic pain

Mania 

1. Abnormally elevated mood
2. Irritability
3. Severe insomnia
4. Grandiose notions
5. Increased talking 
6. Racing thoughts 
7. Increased activity, including sexual activity 
8. Markedly increased energy 
9. Poor judgment that leads to risk-taking behavior
10. Inappropriate social behavior

Some people mistakenly try to control their depressive symptoms through alcohol or other mood-altering drugs. While such drugs may provide temporary relief, they will eventually complicate the depressive disorder and its treatment, and can lead to dependence and the life adjustment problems that come with it. Many people with drug and alcohol problems have an underlying depression. Additionally, the chronic substance abuse leads to the development of additional pessimistic perceptions of life, and additional stressors that can create depression.

Women at Greater Risk for Depression than Men
Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in eleven other countries all over the world. Men and women have about the same rate of bipolar disorder (manic depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments. 

Many factors unique to women are suspected to play a role in developing depression. Research is focused on understanding these factors, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. But, the specific causes of depression in women remain unclear. Many women exposed to these stress factors do not develop depression. Remember, depression is a treatable psychological problem, and treatment is effective for most women

Causes of depression

The reason or reasons why women have unipolar depression more frequently than men is less definite, due to a great extent to the fact that we don't fully understand what causes depression, whether in men or women. Depression is a highly individual disease. Each case is different. One person's depression may be wholly chemical, while someone else's is brought on by events and stressful factors in her life. Yet another person may suffer depression due to a combination of chemical and environmental factors.

Several theories have been brought forward to explain the greater frequency of depression in women. At this point it is difficult to either completely discount any of them or to point to one and say, "That's it!". There is no question that women have to deal with a greater number of risks to their physical and emotional well being than men. We have yet to learn to what extent each of these plays a role in depression in women. Until then, it is wise to be aware of these potential risks, in the same way we are aware of risk factors for heart disease or high blood pressure.

• Biology  Women experience several major biological changes in their lives; onset of menstruation, pregnancy, postpartum and menopause. They also go through a hormonal metamorphosis every month. The menstruation is also a form of physical stress and thus play a part in depression in women.
  
  Girls entering puberty are twice as prone to depression as boys, and it is possible that this is due to the hormonal changes brought on by the onset of menstruation. This is a time at which they are vulnerable to internal and external conflicts and pressures which would be more likely to contribute to depression than changing hormones.
  
  Despite the image many people have of a pregnant women being emotional and prone to crying jags, pregnancy depression is rare, even among women who have suffered bouts of depression before becoming pregnant. Postpartum depression (different from the "baby blues"), however, affects as many as one in four first-time mothers in one form or another. Interestingly, menopause, which many people assume is a time of potential depression for women, does not seem to put them at a greater risk for depression than men of the same age.
  
  The question of whether premenstrual syndrome leaves women more open to depression, or is in itself a form of depression, has no easy answers. Certainly PMS and depression share some characteristics: irritability, appetite change, listlessness, crying jags. However, one thing to bear in mind is that when some women think they are suffering from PMS, they may actually be going through depression. When the above-mentioned symptoms starts taking over a good part of each month, she should talk to a psychiatrist about the possibility that she is actually experiencing depression.
• Role in Society   Studies have shown that because of social conditioning, women have a lower sense of their own self-worth and competence than men do. This is often reinforced in the workplace in the form of lower pay and discrimination in hiring and promotion. Add to this the fact that women still do most of the housework and child-rearing, and you have not only problems with self-image, but also multiple stresses. They are the person who had to adjust at every step to make the things go on working smoothly .It is possible that these are both factors in greater prevalence of depression in women. 
• Rape and Abuse   Women (and girls) are much more likely than men to be raped and physically or sexually harassed/abused. These experiences factor into many cases of depression. Low self-esteem, feelings of helplessness and self-blame are by-products of any form of abuse, and these can either cause or exacerbate depression. A woman who is the victim of any type of abuse should consider herself at risk for depression. 
• Special Considerations; Pregnancy and Depression
  When it comes to whether or not depression is present during pregnancy, women's experiences had shown wide variations. Some women who have had lifelong depression find that it eases off during pregnancy, and they have no need of their medication. However, some women who have never experienced depression find that they are vulnerable to it for the first time when they become pregnant.

The Dimensions of Depression in Women

1. Adolescence 
2. Life Role Conflicts
3. Reproduction
4. Personality Issues
5. Victimization
6. Poverty
7. Life Stage Issues

Adolescence  Studies show that the higher incidence of depression in females begins in adolescence, when roles and expectations change dramatically. The stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. Some researchers have suggested that men and women differ in their expression of emotional problems. In adolescence, boys are more likely to develop behavioral and substance abuse problems, while girls are more likely to become depressed.

Adulthood: relationships and work roles Stress can contribute to depression in many people.  The higher incidence of depression in women may not be due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. Social expectations play a role here as well. In two career families, women are more likely to have responsibility for a greater share of child care and household responsibilities.  Role conflict is also an issue, as debate continues regarding whether women need to choose between family and work responsibilities, and about which choice is the "proper" one.

Reproductive events  Women's reproductive events include the menstrual cycle, pregnancy, the post pregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on brain chemistry. Changes in emotions and mood often result. The specific biological mechanism explaining hormonal involvement in depression is not known.

Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome, its relation to depressive disorders is not yet understood. Some have questioned whether it is, in fact, a disorder. Further research will eventually add to our understanding of this condition.

Postpartum depressions can range from transient "blues" following childbirth to severe, incapacitating, psychotic depressions. Studies suggest that women who experience depression after childbirth very often have had prior depressive episodes. However, for most women, postpartum depressions are transient, with no adverse consequences. 

Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, young motherhood may be a time of heightened risk for depression, due to the increased stress.

Personality and psychology Studies show that individuals with certain characteristics-- pessimistic thinking, low self-esteem, a sense of having little control over life events, and proneness to excessive worrying-- are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them. Some experts have suggested that the traditional upbringing of girls might foster these traits and that may be a factor in the higher rate of depression in women. 

Other researchers have suggested that women are not more vulnerable to depression than men, but simply express or label their symptoms differently. Women may be more likely to admit feelings of depression, brood about their feelings, or seek professional assistance. Men, on the other hand, may be socially conditioned to deny such feelings or to bury them. Men also have a greater tendency to "act out"  when they are under stress. This results in higher rates of alcoholism in men, and higher rates of physical violence.

Victimization  Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who were raped as adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. At present, more research is needed to understand whether victimization is connected specifically to depression. 

Poverty Women and children represent seventy-five percent of the US. population considered poor. Some researchers are exploring the possibility that poverty is one of the "pathways to depression." Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depression is more prevalent among those facing environmental stressors such as these. One very large study has shown that depression tends to equally effect the poor and the rich.

Depression in later adulthood Once, depression at menopause was considered a unique illness known as "involutional melancholia." Research has shown, however, that depressive illnesses are no different, and no more likely to occur, at menopause than at other ages. In fact, the women most vulnerable to change-of-life depression are those with a history of past depressive episodes. An old theory, the "empty nest syndrome", stated that when children leave home, women may experience a profound loss of purpose and identity that leads to depression. However, studies show no increase in depressive illness among women at this stage of life.

As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Despite this, depression should not be dismissed as a normal consequence of the physical, social and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.

About 800,000 persons are widowed each year, most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or psychotherapy. Remarkably, a third of widows/widowers meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to psychotherapy and standard antidepressant medications. 

Treatment for Depression
Even severe depression can be highly responsive to treatment. Indeed, believing one's condition is "incurable" is often part of the hopelessness that accompanies serious depression. Information about the effectiveness of modern treatments for depression is clear. As with other psychological problems, the earlier treatment begins, the more effective it is. Of course, treatment will not eliminate life's inevitable stresses and ups and downs. But it can greatly enhance your ability to manage such challenges and lead to greater enjoyment of life.

Types of treatment for depression 
The most commonly used treatments for depression are psychotherapy and antidepressant medication,  or a combination of the two. Which of these is the right treatment for an individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, psychotherapy is most likely the most appropriate treatment But, in severe or incapacitating depression, medication is generally recommended, in addition to psychotherapy. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows you to learn more effective ways of handling your problems. 

Psychotherapy Psychotherapy is used to treat depression in several ways. First, supportive counseling can help to ease the pain of depression, and can address the hopelessness of depression. Second, cognitive therapy works to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in resolving relationship problems. Research has shown that these psychotherapies are particularly helpful for treating depression. 

Medications  Except in the more severe depressions, and bipolar depression, medication is usually an option, rather than a necessity. Antidepressant medication does not cure depression, it only helps you to feel better by controlling certain symptoms. If you are depressed because of life problems, such as relationship conflicts, divorce, loss of a loved one, job pressures, financial crises, serious medical problems in yourself or a family member, legal problems, or problems with your children, taking a pill will not make those problems go away. 

The medications used to treat depression include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), serotonin reuptake inhibitors (SRIs), and bupropion. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit-forming. To be effective, medications must be taken for about 4-6 months (in a first episode), carefully following the doctor's instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects.

Your prescribing doctor will provide information about possible side-effects and/or dietary restrictions. Always remember that all prescription drugs have potential side effects. In addition, other medically prescribed medications being used should be reviewed because some can interact negatively with antidepressant medication.

 Pregnant, Nursing, or Childbearing-Age Women

 In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried. 
A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:

1) Lithium is not recommended during the first 3 months of pregnancy. 

2) Benzodiazepines are not recommended during the first 3 months of pregnancy.

The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby.  Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed.

A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, for example increasing side effects of some antianxiety medications and/or reducing their efficacy to relieve symptoms of anxiety.

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