Continued from "Depression and Women - Introduction"
SYMPTOMS OF DEPRESSION AND MANIA
A thorough diagnostic evaluation is needed if three to five or more of the following symptoms persist for more than 2 weeks (1 week in the case of mania), or if they interfere with work or family life. An evaluation involves a complete physical checkup and information gathering on family health history. Not everyone with depression experiences each of these symptoms. The severity of the symptoms also varies from person to person.
- Persistent sad, anxious, or "empty" mood
- Loss of interest or pleasure in activities, including sex
- Restlessness, irritability, or excessive crying
- Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
- Sleeping too much or too little, early-morning awakening
- Appetite and/or weight loss or overeating and weight gain
- Decreased energy, fatigue, feeling "slowed down"
- Thoughts of death or suicide, or suicide attempts
- Difficulty concentrating, remembering, or making decisions
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
- Abnormally elevated mood
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased activity, including sexual activity
- Markedly increased energy
- Poor judgment that leads to risk-taking behavior
- Inappropriate social behavior
CAUSES OF DEPRESSION
There is a risk for developing depression when there is a family history of the illness, indicating that a biological vulnerability may be inherited. The risk is somewhat higher for those with bipolar disorder. However, not everybody with a family history develops the illness. In addition, major depression can occur in people who have had no family members with the illness. This suggests that additional factors, possibly biochemistry, environmental stressors, and other psychosocial factors, are involved in the onset of depression.
Evidence indicates that brain biochemistry is a significant factor in depressive disorders. It is known, for example, that individuals with major depressive illness typically have dysregulation of certain brain chemicals, called neurotransmitters. Additionally, sleep patterns, which are biochemically influenced, are typically different in people with depressive disorders. Depression can be induced or alleviated with certain medications, and some hormones have mood-altering properties. What is not yet known is whether the "biochemical disturbances" of depression are of genetic origin, or are secondary to stress, trauma, physical illness, or some other environmental condition.
Environmental and Other Stressors
Significant loss, a difficult relationship, financial problems, or a major change in life pattern have all been cited as contributors to depressive illness. Sometimes the onset of depression is associated with acute or chronic physical illness. In addition, some form of substance abuse disorder occurs in about one-third of people with any type of depressive disorder.7
Other Psychological and Social Factors
Persons with certain characteristics—pessimistic thinking, low self-esteem, a sense of having little control over life events, and a tendency to worry excessively—are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them or with getting well. Upbringing or sex role expectations may contribute to the development of these traits. It appears that negative thinking patterns typically develop in childhood or adolescence. Some experts have suggested that the traditional upbringing of girls might foster these traits and may be a factor in women's higher rate of depression.
WOMEN ARE 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 10 other countries all over the world.12 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.5
A variety of factors unique to women's lives are suspected to play a role in developing depression. Research is focused on understanding these, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. And yet, the specific causes of depression in women remain unclear; many women exposed to these factors do not develop depression. What is clear is that regardless of the contributing factors, depression is a highly treatable illness.
Continued on "Depression and Women - Dimensions"
National Institute of Mental Health
Public Information and Communications Branch
NIH Publication No. 00-4779