Signs of depression in women

Depression is a mental health condition that can affect mood, behavior, and functioning. Depression is common among men and women, although women are more often diagnosed with a depressive disorder. Typically, depression can be treated with therapy, medication, and self-care techniques.

What are the symptoms of depression in women?

Symptoms of depression may vary from person to person. Some people may experience many symptoms, while others may experience just a few. In general, women with depression are more likely to present internalized symptoms such as chronic sadness and sleep difficulties, while men tend to display more externalized symptoms such as irritability and aggression. The severity or presentation of symptoms can also vary and affect people differently ^[1].

Some of the common symptoms of depression in women include ^[1][2][3]:

• Low mood
• Feeling empty, hopeless, or helpless
• Feelings of guilt, anxiety, or worthlessness
• Feeling irritable, restless, or angry
• Regularly crying
• Becoming socially withdrawn
• Loss of interest in previously enjoyable activities
• Lacking energy and motivation
• Poor concentration and memory
• Changes in sleep, such as struggling to fall or stay asleep or sleeping far more than usual
• Changes in appetite, such as eating far more than usual or not feeling the need to eat at all
• Thoughts of self-harm or suicide
• Unexplained pain, such as stomachaches, headaches, or backache

What causes depression in women?

There are many potential causes or triggers of depression. It is common for a combination of risk factors to lead to the onset of a depressive episode. Some of these risk factors are only experienced by women, while others can affect people regardless of gender.

Causes and risk factors of depression specific to females include ^[1][4][5]:

• Menstrual cycle: Hormonal changes that occur during the menstrual cycle can cause mood changes and symptoms of depression.
• Pregnancy: During and after pregnancy, it is common for women to experience changes in hormones, sleep patterns, sickness, fatigue, and mood swings. For some women, these experiences can be severe and debilitating, causing symptoms of depression.
• Miscarriage: Similarly, women may undergo physical and emotional changes during pregnancy, then experience a miscarriage or stillbirth. This can cause a great deal of emotional and physical distress and may contribute to the development of depression.
• Menopause: Before and during menopause, women can experience many hormonal, physical, emotional, and life changes, which can cause symptoms of depression.

General causes and risk factors of depression include ^[3][6][7]:

• Genetics: The risk of depression is increased by genetic factors, as evidenced by a higher prevalence amongst those with a family history of depression or other mental illnesses.
• Life stressors: Stressful life events, such as the loss of a loved one, divorce, housing or financial issues, unemployment, and relationship issues, may all contribute to the development or triggering of a depressive episode.
• Trauma: Childhood or recent traumatic events, such as abuse, bullying, life-threatening events, and physical assault, can all trigger or worsen depression symptoms.
• Neurobiology: Depression has been found to be linked to chemical imbalances in the brain, including abnormal levels of neurotransmitters such as serotonin. Additionally, studies have found that depression is also associated with changes in the volume or activity of various areas of the brain, such as the hippocampus and amygdala.
• Illness and medications: Some physical health conditions can contribute to depression symptoms. This may be due to stress related to severe illnesses, ongoing treatment, or chronic pain, or due to physical changes, disrupted sleep, or lifestyle changes. Similarly, some medications could cause side effects that contribute to depression symptoms.
• Substance and alcohol use: Studies show that excessive use of alcohol or drugs can cause a physical and emotional impact that contributes to symptoms of depression.

What are the most common types of depression in women?

Depressive disorders

Major depressive disorder (MDD) and persistent depressive disorder (PDD) are common types of depression that can occur in any age group, gender, or population. Some people experience just one type of depression, while others might experience more than one type of depression in their lifetime ^[3][5].

MDD is characterized by episodes of severe low mood, decline in functioning, and changes in sleep, appetite, and motivation. These episodes typically last for at least two weeks, often reoccur, and may vary in severity.

Symptoms of PDD, also known as dysthymia, are similar to but milder than symptoms of MDD and last at least two years. Although the symptoms are generally not as severe as in MDD, PDD can still cause significant impairments in daily functioning and well-being ^[3][8].

Perinatal depression

Perinatal depression refers to depression that occurs around a pregnancy. Depression during pregnancy is known as prenatal or antenatal depression, and after childbirth is known as postpartum depression. Studies show that 10-20% of women experience one or both types of perinatal depression and may be at higher risk if they have a history of depression before pregnancy ^[2][9].

Perinatal depression can cause women to struggle with self-care during and after childbirth, which may also impact their ability to care for their baby. Some women with postpartum depression may experience feelings of guilt or anxiety about their mothering skills or may find it difficult to bond with their newborn because of their symptoms ^[9][10].

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) occurs one to two weeks before menstruation and affects around 5% of women. PMDD symptoms are similar to premenstrual syndrome (PMS) symptoms but much more severe. This includes intense and extreme mood swings, sadness, anxiety, and anger ^[1][11].

PMDD likely occurs due to the hormonal changes of the menstrual cycle and may also be linked to serotonin levels. However, it is unclear why some women are more affected by these changes than others. It may be more likely in those with pre-existing conditions such as depression and anxiety ^[11].

Perimenopausal depression

Perimenopause refers to the transition between the reproductive stage of a woman’s life and the menopause. During this time, hormone levels significantly fluctuate, and several physical and emotional changes can occur ^[1].

As the body transitions to menopause, estrogen levels fluctuate, which has a significant impact on mood. Estrogen also impacts the brain, including serotonin levels, further affecting mood regulation ^[12].

During the perimenopausal stage, it is common for women to experience symptoms such as hot flashes, decline in concentration, sleep disturbances, fatigue, irregular bleeding, mood changes, and anxiety. However, for some women, these symptoms can become more severe, leading to an onset of depression ^[1][12].

Is depression more common in women than men?

Studies show that women are around twice as likely to be diagnosed with depression than men. This may be due to several factors. For example, women experience more hormonal changes due to the menstrual cycle, pregnancy, and menopause, and thus are at risk of more types of depression than men ^[5][13].

However, it may also be because men are less likely to seek professional help for their symptoms, so they are potentially underdiagnosed. Similarly, men often experience different types of symptoms during a depressive episode, so they may not meet the diagnostic criteria ^[3].

For example, females are more likely to experience internalized symptoms, such as persistent sadness, low self-esteem, and negative thought patterns. In contrast, men are more likely to experience externalized symptoms, such as anger, aggression, addictive behaviors, and hyperactivity ^[5][13].

Additionally, women are more likely to be sensitive to issues within interpersonal relationships, while men are more susceptible to career, goals, and daily functioning problems ^[13].

Treatment for women with depression

There are no gender-specific treatments for depression, although treatment may vary depending on the individual. Treatment depends on the type of depression, the severity of symptoms, and the individual’s response to treatment. Often, depression is treated with a combination of therapy and medication and can be improved with self-care techniques ^[3].

Therapy

Psychotherapy can be very beneficial in the treatment and management of depression symptoms. There are several types of therapy, which support individuals in interpersonal relationships, recognizing and altering negative thoughts and behaviors, managing relationships with the family or marriage, and learning how to cope with emotional distress ^[3][6].

Some of the available therapy options for treating depression include ^[1][4][6]:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Mindfulness-based cognitive therapy (MBCT)
• Marriage or family therapy

Medication

It can be helpful to use an antidepressant medication alongside therapy. There are several types of antidepressants, and they may affect people differently. As such, trying more than one medication may be necessary before finding one that is effective ^[1].

Generally, antidepressants take several weeks to become effective and may cause some initial side effects. It is essential to take medications exactly as prescribed, to prevent adverse effects and to ensure they can work effectively.

Types of antidepressant medications include ^[3][6]:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and citalopram
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine
• Tricyclic antidepressants (TCAs), such as imipramine, nortriptyline, and desipramine
• Other types of antidepressants, such as mirtazapine and bupropion

Antidepressant medications can be taken during pregnancy, although this will depend on the advice of a professional, the mother’s preference, and the severity of symptoms. Some studies indicate that medications could causes harm to the fetus, although this is debated amongst researchers, and the risk is considered minimal ^[10].

Medication may be the best route because untreated depression can cause significant harm to the mother and baby, especially if symptoms are severe. Similarly, if a medication has already been prescribed before pregnancy, it should be continued throughout the pregnancy and postpartum to prevent unnecessary fetal harm unless advised otherwise ^[10].

Some women with perimenopausal depression find that antidepressants are ineffective. Research suggests that hormonal therapy with estrogen can help to reduce depression symptoms ^[12].

Self-care

Symptoms of depression can also be reduced or managed with self-care techniques, including ^[3][4][6]:

• Eating a healthy diet
• Getting plenty of sleep
• Relaxation exercises
• Mindfulness
• Yoga and meditation
• Regular exercise
• Avoiding drugs and alcohol