Effect of Gender on Depression
Depression, like many other psychiatric illnesses, may present differently in women versus men. These differences go beyond the depressive syndromes unique to women—postpartum and menopausal depression—and often manifest in women with major depressive disorder (MDD).
Studies have shown that the prevalence of depression is about twice as high in women as in men. Several potential biological, psychological, genetic, and social explanations have been given to explain this association. Gender differences have also been noted concerning:
- Comorbid (co-occurring) disorders
- Course of illness
- Response to treatment
Several clinicians have hypothesized that higher rates among women of poverty, sexual harassment, child abuse, and chronic strain due to the limitations in social power and status contribute to higher rates of depression in women than men. Gender differences in depression appear to be at their greatest during reproductive years.
More About the Effects Depression
Various causes of, and factors contributing to, the higher rate of depression in women have been considered. Hormonal fluctuations and their role in depression are a natural starting point for explaining gender differences in this mood disorder.
Estrogen may play some role in differentiating depression in women. The involvement of estrogen becomes evident upon examination. Estrogen influences neurotransmitter turnover and receptor function. This affects serotonin and possibly norepinephrine, two of the three most commonly targeted neurotransmitters in the treatment of depression. Alterations of the activity of estrogen in women may lead to disruptions in these systems which may partially explain the increased rate of depression.
It may not be that a greater number of women are depressed at all. It’s just that a woman is more likely to receive a diagnosis. Research has indicated that women who are depressed are more likely to show recognizable emotional symptoms such as crying. Women also tend to show more symptoms of depression.
This is an example of how social factors influence the way people experience and express their emotions. While there may be a pattern, it’s not a strict relationship: some women struggle to express their feelings while some men may be comfortable doing so.
Symptoms of Depression in Women
Subjective patient symptoms help professionals to identify depressive. To fulfill a diagnosis these symptoms a depressed mood or lack of interest in pleasurable activities for 2 weeks plus an additional five or more symptoms must be present. These include but are not limited to:
- Feelings of guilt
- Changes in weight
- Changes in sleep
- Fluctuation in energy levels
- Changes in concentration abilities
On the surface, men and women may seem to meet these criteria similarly. However, how these symptoms present reveals the differences between genders.
Women were more likely to experience decreased sleep, appetite and energy. They also reported increases in interpersonal sensitivity, extreme fatigue with heaviness in arms in legs, and somatic complaints. Males’ symptoms were just the opposite.
The so-called atypical or reverse vegetative symptoms of depression, excessive sleepiness, excessive eating, carbohydrate craving, and weight gain are seen more often in women than in men. As research has moved from inpatient to ambulatory settings, the average age of onset has decreased into the 20s and these symptoms are no longer considered atypical.
More Information About Depression in Women
Women also tend to exhibit a greater number of depressive symptoms compared with men and, for a particular level of severity, a higher degree of subjective distress. Specifically, women report a greater frequency of symptoms such as sleep disturbance, sluggishness in speech and movements, feelings of the worthlessness of guilt, anxiety, and physical symptoms with no obvious organic cause (somatic).
The association between somatic symptoms of depression and the observed gender difference was analyzed among subjects with Major Depressive Disorder. The patients were divided into those who met the overall standard for major depression and exhibited somatic depression (fatigue, appetite, and sleep disturbance). Those who met the standard for MDD but did not exhibit the somatic criteria. Women exhibited a higher prevalence of somatic depression than men but not a higher prevalence of pure depression.
This is consistent with the theory that gender differences in the prevalence of depressive disorders may result from a difference in the expression of physical symptoms during emotional distress. Also, somatic depression was associated with a high prevalence of anxiety disorder and, among female patients, with body aches and onset of depression during early adolescence.
Suicidality, another indicator of severity, occurs approximately three times as often in women, although men are much more likely to complete the act. Men tend to choose more lethal methods such as the use of firearms or hanging, while women choose less lethal methods such as medication overdoses.
Onset of Depression
Clinical studies have observed mixed results in terms of gender differences in the age of onset of depression. Only a few studies have shown an earlier onset in women. However, some studies have shown that women are more likely to have a chronic and recurrent course of illness.
One specific form of recurrent depression, seasonal affective disorder, appears to be significantly more common among women. There is also evidence to suggest that chronic depression may affect women more seriously than it does men. Specifically, it was reported that women exhibit greater symptom severity and more functional impairment, especially in the areas of marital and family development.
While rates of depression are similar between the sexes during childhood and adolescence, women are twice as likely as men to receive a diagnosis of depression. The 12-month rate for MDD in nonpregnant women aged 18 to 50 years is between 8% and 16%–roughly double the rate observed in men.
Teens and young adults of either sex face a barrage of shifting hormones and social stressors that can contribute to depression. They also face other mental health issues like anxiety, eating disorders, substance use disorders, and suicide
Of great concern is that more than half of women who meet the criteria for MDD do not receive a proper diagnosis.
A new study on MDD finds that people with a history of the condition are more likely to also have a history of substance use disorders than anxiety or personality disorders. The study, published online in JAMA Psychiatry, looked at the occurrence of depression and other psychiatric disorders over the lifetime of more than 36,000 adults.
Among those with a lifetime history of MDD, 57.9% had a history of a substance use disorder, 37.3% had a previous anxiety disorder, and 31.9% had a history of a personality disorder.
Comorbidities that are more frequent in women include anxiety disorders, (especially panic and phobic symptoms) and eating disorders. Alcoholism and other substance abuse disorders occur more frequently in men.
Effect of Gender on Antidepressant Treatment
Although antidepressants have been used for the treatment of depressive disorders for more than 40 years, the issue of whether there are differences in response between men and women did receive serious attention until the mid-1990s.
The causes of depression in women may sometimes be distinct and women may present differently from men. So, many professionals propose that effective addiction treatments may differ by gender.
A 2019 study published in the journal Progress in Neurobiology proposed that biological sex differences could influence not just how depression manifests in men and women, but also how it responds to treatment. The researchers paid attention to the effect of pregnancy and the postpartum period on the depression risk for biologically female subjects. The results of the study provided evidence that a person who is biologically female is more at risk for depression directly after giving birth than at any other period in their life.
One of the leading questions for researchers is whether studies on the effect of biological sex and gender could lead to improved treatment for everyone with depression. While each person’s experience with depression depends on many factors, identifying important differences could help doctors prescribe treatments or even lead to new treatments.
Many medications (including those commonly prescribed to treat mental illness) are dosed according to weight. Female bodies tend to have a higher body fat percentage than male bodies, which can affect how medications are metabolized. Hormonal fluctuations that occur throughout the biologically female lifespan can also influence how medications work.
The Importance of Hormones
It’s likely that the hormonal changes of pregnancy, childbirth, and lactation, combined with the stress of becoming a parent, increase one’s vulnerability to depression. Similarly, menopause– another time of hormonal change—is also associated with an increased risk of depression.
Some data indicate that women may respond more robustly to selective serotonin reuptake inhibitors, where men may favor tricyclic antidepressants. Additional treatment considerations include variability in the movement of drugs within the body, effects on bone density, and key drug interactions more likely in women.
It is unclear why women have a better response to SSRI therapy but one theory is the interaction between estrogen and serotonin activity.
Cardiovascular disease, osteoporosis, and autoimmune disease are a few of the conditions in which clinicians consider gender when making a diagnosis or selecting therapy. One of the most common examples of gender variation in psychiatric disorders is MDD. MDD and similar depressive disorders do not necessarily manifest identically in men and women.
Comorbid disorders and optimal therapy may differ between men and women. Depressive symptoms occurring during the perinatal and postmenopausal periods or as part of severe premenstrual syndrome are, obviously, unique to women. Clinicians should be aware of the differences seen outside of these specific conditions.
For these reasons, the clinician must anticipate and recognize gender distinctions when evaluating female patients at risk for, or diagnosed with, depression.
The implication of different risk factors for men and women remains elusive. For all patients, especially those with young children, the urgency of prompt, rapid, and sustained remission, whether by medication or psychotherapy or both, to benefit the patients and their children are obvious. Recent efforts to develop target personalized treatment should help eventually to speed remission. The exact cause of this difference is unclear but social factors and the nervous system and other biological factors contribute.
Therapists should consider gender differences in the direct consciousness and direct experience of depression and response to antidepressant treatment when screening for depressive illness, selecting treatment and assessing therapeutic response. Treatment considerations should include gender, age, and, in women, menopausal status. This also includes the use of HRT (hormone replacement therapy).
Some people with depression prefer non-drug approaches to help them manage their symptoms. Research shows that approximately 30-40% of patients with depression have only a partial response to drug and psychotherapeutic interventions.
Complementary and alternative medicine (CAM) can combine with traditional medicine approaches or on their own to target symptoms of depression. There is a lack of sufficient research (and varying results) on various natural remedies for depression. So, it’s a good idea to focus on a team approach to treatment, which can include CAM.
Non-drug methods for treating depression, such as exercise and psychotherapy, are key components of a treatment plan for patients with depression. With these methods, there does not seem to be a difference in response rate between the genders.
Herbal extracts are gaining popularity as natural alternatives to SSRIs. Herbs such as Saffron, St. John’s Wort, Curcumin, and Sam-e are somewhat effective for mild mood regulation in mild cases of depression.
St. John’s Wort, in particular, has some serious side effects. Side effects range from upset stomach to major and life-altering effects, like confusion, muscle stiffness, drop in body temperature, and psychosis. Results are inconclusive and it is not FDA approved for the treatment of depression.
Meditation and Yoga
By reducing perceived stress and anxiety, yoga practice can modulate stress response systems by reducing heart rate, lowering blood pressure, and easing respiration. One study on the benefits of hatha yoga found that yoga does alleviate symptoms of depression, and the effects were long term.
Meditation is an active training of the mind and involves 30-40 minutes per day of acceptance of feelings and thoughts without judgment and relaxation of the mind and body. Researchers and Johns Hopkins found that meditation can help reduce symptoms of anxiety and depression.
Daily exercise can help lower stress, increase relaxation, and decrease symptoms of depression. It has the added benefits of improving balance, energy levels, and flexibility. According to the American Psychological Association, daily exercise eases symptoms of depression by increasing levels of serotonin and helps normalize sleep patterns.
Many complementary and alternative treatments require further study to determine the benefits over time. It would help to bring some of these options to your treatment team to help ease your symptoms.
Waiting Doesn’t Help
You have probably been waiting to feel better. Maybe you tried herbs, meditation, and yoga. That is a place to start if you have. Maybe people have asked you “What have you got to be depressed about?” And that question just makes you feel more hopeless.
Crest View Recovery Center can provide you with a customized, comprehensive health and wellness plan including yoga classes and meditation therapy. Call (866) 327-2505 now to speak to one of our specialists. Start enjoying your life now.