Depression Gets the Better of Women

New report says women more prone to it, more damaged by it

MONDAY, April 1, 2002 (HealthDayNews) -- Women are more than twice as likely as men to experience major depression, and it's a greater threat to a woman's well-being than serious physical illnesses such as hypertension, diabetes or arthritis.

That's one of several conclusions from a panel of more than 35 medical experts who pooled their expertise in a new report from the American Psychological Association.

The panel, which included professors from leading universities around the United States, also found depression in women crosses all racial and ethnic lines, jumping all educational and economic barriers to become a significant cause of both disability and loss of income for women of all ages.

"Major depression presents the greatest disease burden to women throughout the world when compared with other diseases," says Gwendolyn Puryear Keita, director of the Women's Programs Office of the American Psychological Association and a contributor to the new report.

Keita says part of the reason depression affects women to such a degree is they often don't recognize signs early on, or think they should be able to "make themselves feel better." Both problems, she says, can hold women back from seeking treatment soon enough -- before depression takes a dramatic hold on their lives.

Also to blame, Keita says, are primary-care physicians, who "often do not recognize the depression, or [they] treat it inappropriately."

For Dr. Shari Lusskin, a psychiatrist who specializes in treating women with depression, the new report is on target.

"The health-care system is not as attentive to signs of depression in women as it could be or should be, and, as a result, depression is not diagnosed soon enough -- which is one reason it goes on to have all these devastating repercussions in a woman's life," says Lusskin, an associate professor of psychiatry at New York University Medical Center.

What many doctors and other health-care workers don't seem to realize is how great the "ripple effect" of depression can be in a woman's life, she explains.

"Because the woman is often the central caregiver in a family, when she is afflicted with depression, the disease fans out to touch the lives of many of those around her and to affect the family structure in a most profound way," Lusskin says.

In addition to citing the effects of depression on a woman's health, the report also looked at various reasons why women are affected more often than men.

Among the top reasons cited: reproductive hormones, from puberty through menopause and beyond. More specifically, the report identifies changes in reproductive hormones, disturbances in the natural interaction between the hypothalamic and pituitary glands and the ovaries, and the ultimate effect of that interplay on brain chemicals such as serotonin.

"In many ways, a woman's brain chemistry works with her reproductive chemistry. So, when there are changes in one, there can be changes in the other. And how a woman copes with those changes can have a lot to do with both her genetics and her environmental influences," Lusskin says.

In fact, the new report also cites genetic links as one reason women may be more susceptible to depression than men. While research in this area is still new, the panel reports that evidence is beginning to mount showing that genetic links to depression may be different, and perhaps more prevalent, in women than in men.

In addition, the summit also concluded that life stress and trauma play a role in women's depression, particularly childhood sexual abuse and physical or mental abuse as an adult.

Although considered a bit more controversial, the panel also reported that women might have a "different mode of thinking" than men -- one which can contribute to the depressive state of mind. Called "ruminative thinking," it is described by the researchers as "repetitively and passively focusing on symptoms of distress, and their possible causes and consequences." That's something, they say, that men generally don't do.

According to Keita, perhaps the most important parts of the new report are the treatment recommendations, including encouraging women to not only talk to their doctors, but also to seek out psychotherapy and drug therapy -- and not force themselves to "go it alone."

Lusskin agrees: "Women believe they should be able to handle things on their own, but it's important that they understand that depression is an illness and it needs treatment. Women don't need to suffer alone."

Keita says the group is also calling for better efforts to reduce the stigma attached to both the diagnosis of depression and its treatments, as well as greater recognition of the problem by the health insurance industry.

"We need mental health parity, so women can get their mental health care covered by their insurance companies at the same rates they do their physical health needs," Keita says.

What to Do: For more information on women and depression, visit The National Institutes of Mental Health. To learn more about treatments for depression, go to The National Foundation for Depressive Illness.

SOURCES: Gwendolyn Puryear Keita, Ph.D, director, Women's Programs Office, and associate executive director, Public Interest Directorate, American Psychological Association, Washington, D.C.; Shari Lusskin, M.D., associate clinical professor, psychiatry, New York University Medical Center, New York City; April 2002 Summit on Women and Depression: Proceedings and Recommendations, American Psychological Association
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