Think depression is depression and affects us all the same way? Think again. Did you know that women are almost two times more likely to be diagnosed with depression than men? Research is also revealing that men and women experience the symptoms of depression very differently. The trouble is, up until fairly recently, many medical and scientific research studies only included males as research subjects. That means that women were being treated for diseases under the assumption that they are affected in the same way and that the same treatment will be just as effective. But as it happens, treatment shouldn’t be a one-size-fits-all approach.
Thankfully, more and more scientific research is focusing on how men and women are affected differently. In 1993, the U.S. government mandated that women and minorities be represented in clinical trials that are funded by the government. This mandate has helped drive research that has revealed just how much women and men differ when it comes to a host of diseases and issues ranging from sleep, anxiety, Alzheimer’s, pain tolerance, and yes, depression.
According to Mental Health in America, approximately one in eight women will be diagnosed with clinical depression in their lifetime. That’s about twelve million women each year. Additionally, 10 to 15 percent of women who give birth are diagnosed with postpartum depression.
But the question remains: Why are women more likely than men to face clinical depression during their lifetime? While there’s no single reason, researchers believe there are several different factors including developmental, reproductive, hormonal, genetic, biological, and social factors.
Our culture can be quick to label women as “moody,” almost as if mood swings are an expected part of being a woman and that depression is just an exaggerated period of moodiness due to female hormones. Of course, clinical depression is more than just being “moody,” and this confusion perpetuates the misunderstanding around the origins and severity of depression.
Harvard Health reports that there is some evidence that hormones may play a role in the higher rates of depression in women, and recent research has confirmed that males and females respond differently to the presence of stress hormones. The period of time after childbirth and the transition to menopause, for instance, are two hormonal changes that affect women and are times that can increase a woman’s vulnerability to developing depression. However, the same report cautions that these hormonal changes are more likely relevant on an individual level and interact with stress—not simply that being a woman means inevitable moodiness and susceptibility to mental disease.
Harvard Health also cites stress as a potentially significant symptom trigger for women, noting that women are more likely to report being under stress and to develop depressive symptoms following stress. Stress can come from a variety of sources and range in severity. For example, work and family are potential sources of stress, as are housing, medical, and safety issues. Science Daily cites a study which found that women report experiencing stressful events more frequently before the onset of a disorder and theorized that because women are more likely to report experiencing stressful events and more likely to report experiencing depression, these external stressors may trigger the onset of depression.
Other research, like that of Nolen-Hoeksema, compiled by the British Journal of Psychiatry, points to how the two genders respond to the initial decreased mood as one of the reasons why women may be more vulnerable to developing depression. The research found that women tend to ruminate over the causes and effects of their symptoms, whereas men tend to distract themselves through physical activity. For example, women may find themselves asking over and over, “Why do I feel this way? Did I do something wrong?” Ruminating, the researchers theorize, can extend the life of the depressed mood because it keeps the focus on the negative emotions being experienced rather than engaging in active problem solving.
Men and women also respond to their depressive symptoms differently. The Wall Street Journal reported that women tend to focus on the emotional symptoms of depression, such as experiencing feelings of hopelessness and worthlessness. Men, in contrast, tend to focus on the physical symptoms of depression, which include low energy, sleep disturbances, stress, irritability, and anger. Women tend to internalize their experience of depression, whereas men tend to externalize it. Women are more likely to report feeling depressed or seek treatment for depression, but men are less likely to report it or seek treatment.
Why do more women report experiencing depressive symptoms and seek treatment than men? Some theorize that there is a stigma against seeking treatment for men because it is seen as a sign of weakness, psychiatrist Jeffrey Borenstein told the Wall Street Journal. For women, seeking treatment does not carry as much of a stigma. In fact, the World Health Organization notes that women are more likely to seek help and discuss mental health concerns with their primary care physicians. That means women are more likely to feel comfortable initiating a dialogue about their concerns and treatment, which can increase the likelihood of effective treatment.
However, that doesn’t mean women face their own obstacles when it comes to seeking treatment for depression. For example, Mental Health in America reports that more than 50 percent of women surveyed believed that a depressed mood during menopause was “normal” and that seeking treatment was not necessary. More than 50 percent also said that they believed depression is a normal part of aging and that it is normal for mothers to experience depression for at least two weeks after giving birth. Other barriers to treatment included denying their symptoms and embarrassment. Again, our cultural assumption that being “moody” is part of being a woman can hold women back from seeking effective treatment.
Depression is not a “one-size-fits-all” mental illness when it comes to the way women and men experience and respond to it. The growing body of research reveals that these gender differences can help address gender biases that currently exist in diagnosis and treatment. For example, the World Health Organization reports that doctors are more likely to diagnose depression in women, even when compared to men who score the same on assessments of depression or present with the same symptoms.
While more research is certainly needed before exact causes of depression are known for both men and women, the research so far has already proven valuable. Not only has it highlighted the differences between genders when it comes to depression, but it also points to the importance of gender-specific treatment options. For example, a study cited by the Wall Street Journal found that the drugs typically used to treat depression work differently in a female body than in a male's. Hormones and other factors contribute to the different way a woman’s body breaks down the drugs compared to a man's. For these reasons, Science Daily advocates for gender-specific approaches to treatment of depression in psychotherapy. Treatment for women could focus on processing the issue while decreasing unhealthy rumination and encouraging problem solving. And these research findings are something both men and women can celebrate as positive steps forward in furthering mental health for both genders.
Photo Credit: The Kitcheners