The Woman’s Guide For Depression

The Woman’s Guide For Depression

Depression affects 20 million people in any given year and is a serious enough disorder to compromise one’s ability to function normally day to day. Find out if you’re just blue or if you might be clinically depressed.Women are 2-3 times more likely than men to develop depression or an anxiety disorder. Blame hormones, genetics and stress, experts say. Find out how being female affects mental health, what kinds of questions are asked to diagnose illness and which treatments are available…

Like their bodies, men’s and women’s brains and minds are mostly alike, but they do differ in some significant ways.


These brain differences arise from both our genes and from environmental factors that include family, culture and experience. There is no neat line between biology and psychology.


When our brains undergo change, because of an experience or medication, our thoughts and feelings change as well. When our thoughts and feelings change, as a result of life experience or psychotherapy, our brains undergo change.


Culture also interacts with our biology and psychology.


For example, different cultures have different traditions about how they understand menopause, and those traditions influence the way symptoms are expressed.


Why Your Sex Matters

Sex differences in the brain and the evidence of mental illness on brain scans help to steer research in the most promising directions, but brain scans cannot yet make a diagnosis.Mental disorders are diagnosed on the basis of feelings, thoughts and behaviors.


Therefore, our ideas about normal feelings, thoughts and behaviors play an important role in our concept of some mental disorders. What we view as normal is often closely related to our gender.


For example, we generally expect women to be more passive and dependent than men, and we are more tolerant of men’s anger and aggression than we are of women’s.


When men or women deviate from expected behaviors, even when they are fully able to function and are not troubled by symptoms, there is a tendency to consider them abnormal.

Women’s mental and physical symptoms are often taken less seriously than men’s.


Women who have alcohol problems tend to drink quietly at home rather than getting drunk and violent in a tavern. A belligerent alcoholic man attracts more attention than a depressed and withdrawn woman.


Women are more likely to receive prescriptions for psychiatric medications, perhaps because they make more visits to health care providers and suffer more chronic illnesses during their longer life spans.


It is important to remember that medication can be used both too often and not often enough. Some prescriptions are written before a thorough diagnosis is made. Alternatively, many people who could benefit from medication are not being treated with it.


Mental Health and Women

Women suffer from depression and anxiety disorders two or three times more often than men. The differences are due to a combination of genetics, hormones and stressful experiences. Stress is a universal human experience that can be positive and negative.

The Woman’s Guide For DepressionMany life changes, like getting married or having a baby, are both stressful and positive. Stress causes changes in our behavior, thoughts and feelings, as well as in our body functions: heart rate, digestion and breathing.


Stress that is not overwhelming can be beneficial to our growth and creativity, but stress that is overwhelming can make us vulnerable to mental and other illnesses.


Some forms of stress are more common in women than in men: poverty, sexual abuse and assault, and domestic violence. Jobs traditionally filled by women, such as secretarial work, nursing and teaching, that have a high level of responsibility and a low level of power, raise a person’s risk of depression.



Women are also more likely to experience sexual harassment, which can increase their risk of anxiety and depression. Stressful experiences like illness, abandonment and disasters cause bodily changes, sadness, irritability, relationship problems and, sometimes, mental disorders.


Mental disorders can also occur for no apparent reason.Domestic violence is a factor in many kinds of mental illnesses. Women have often been blamed for their own victimization. One would hear questions like, “Why didn’t she leave?” or “What did she do to deserve it?”


As a society, we have begun to recognize the criminal nature of domestic violence and to develop legal and other support systems that recognize its impact. Doctors need to be aware of domestic violence and ask appropriate questions at every visit.


Women are often ashamed of being victims, and it may take several visits before a woman feels comfortable enough to reveal her situation to her health care provider. These questions have to be asked in private because abusers often stick close to their victims during medical visits and punish them if they reveal the truth.


We have also learned a great deal about coping with stress, particularly through social support networks. Women who suffer from infertility, depression or cancer are less likely to become depressed when they have strong support systems and/or they can join a group of others with similar experiences.


A natural disaster is often easier to bear than a rape or assault because others are present and there is mutual support. Being active and helping others is the best way to overcome feelings of helplessness and powerlessness.


People with mental illnesses suffer more discrimination and have more difficulty obtaining health care than people with other kinds of illnesses. This is particularly true of schizophrenia, alcohol and substance abuse, and depression.There is a tendency to believe that these conditions can be overcome by determination and prayer. While both determination and prayer can be very useful in overcoming diseases, they are not treatments. A person with a disease should not be blamed for his or her own suffering.


For example, some states in the United States have put pregnant women with alcohol and substance abuse problems in jail, ignoring the fact that many of them desire treatment. As a result, women with these treatable medical conditions are afraid to seek prenatal care for fear of punishment.

Diagnosing Mental Illness

An accurate diagnosis is the basis for successful treatment of any disorder. A health provider should ask, and a patient should be prepared to report:

1. What are your symptoms now?


2. What is the history of your symptoms?

  • Under what circumstances did they start?
  • How long have you had them?
  • How have they changed?
  • What has made them worse or better?
  • What treatments have you had, and how did they work?

3. What is your personal history?

  • Who is in your family?
  • How was it for you growing up? Any problems?
  • What and how did you do in school?
  • What kinds of relationships have you had?

4. What is your sexual history?

  • What were you taught?
  • What do you know?
  • What are your past and current sexual practices and concerns?

5. What is your family history, especially of similar symptoms?

  • If others in your family had them, what, if anything, helped them?

6. What is your social history?

  • Jobs?
  • Personal habits like smoking, drinking, drugs?
  • Marital/relationship status?
  • Religion and spirituality?

7. What is your medical history?

Reproductive history:

  • When you started menstruating, any problems?
  • Birth control?
  • Conceptions?
  • Abortions?
  • Miscarriages?
  • Pregnancies and deliveries?
  • Sexually transmitted diseases?
  • Illnesses?
  • Surgeries?
  • Hospitalizations?
  • Past and current medications?
A complete mental health examination also includes a brief test of your mental functions: alertness, memory, concentration, abstraction, and level of general knowledge.

Depression Treatments

Drugs Drugs

Several types of medications are used to treat depression. Common antidepressants include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and anti-anxiety drugs. You may need to try different antidepressants to find one that works for you.

Alternative Therapies Alternative Therapies

Psychological counseling is a key part of depression treatment. Natural remedies such as St. John’s wort, fish oil and ginkgo may also help relieve depression symptoms, while yoga and magnetic stimulation can improve mood. Find out which therapy is right for you.

Lifestyle Changes Lifestyle Changes

Making positive lifestyle changes can help ease the emotional and physical toll that depression takes on a person. Exercise, eating healthy foods and participating in activities are a few ways to manage the condition.

Your Health Team Your Health Team

To make smart healthcare choices, it’s important to become knowledgeable about each aspect of your care. Of course, most people use a physician as their primary care doctor who helps manage their healthcare. But sometimes a person develops a medical problem that requires a physician with a more narrow focus.

Overall, mental health care is as effective as other kinds of medical care. All health care providers should spend time talking with patients, but in mental health, talking therapy – or psychotherapy – has developed into a specialized skill.

For most mental illnesses, a combination of psychotherapy and medication works best. Several different types of clinicians – psychiatrists, social workers, psychologists, counselors – provide several kinds of psychotherapy: supportive, psychodynamic, interpersonal and cognitive-behavioral.   Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research. To learn more about the Society for Women’s Health Research, visit their website.

Could You Be Depressed?


The Woman’s Guide For Depression


Depression can leave you feeling hopeless or embarrassed. But help for depression is out there – including new medicines, talk therapies and natural remedies. Read on for key questions to ask your doctor for beating the blues…
When you’re depressed, just getting out of bed can be a struggle. And feelings of guilt and shame can be overwhelming.But “you don’t have depression because you did something wrong,” says Gregory Simon, M.D., psychiatrist at Group Health Cooperative in Seattle and chair of the scientific advisory board at the Depression and Bipolar Support Alliance.
Discussing symptoms and treatments with a doctor or mental health professional is the first step to beating this disorder.

Here are the top questions to ask your doctor to get help for depression.

1. What causes depression?

Scientists think this disorder is caused by a combination of genetics and stress, says Matthew Rudorfer, M.D., associate director for treatment research at the National Institute of Mental Health (NIMH) in Bethesda, Md.People with depression have abnormal levels or functioning of the neurotransmitters serotonin, norepinephrine and dopamine, chemicals in the brain that affect mood.Before puberty, the rate of depression is about the same in boys and girls. But depression is twice as common in women as in men, according to the National Alliance on Mental Illness (NAMI). As many as one in eight women experience depression in their lifetime.

2. Why does gender matter?

Researchers aren’t sure. It may be due to hormones or life stresses, or because women are more likely to suffer physical and sexual abuse, explains Jennifer Payne, M.D., director of the Women’s Mood Disorders Center at Johns Hopkins Hospital in Baltimore, Md.
The Woman’s Guide For Depression
If you have experienced abuse, tell your doctor or contact an organization that can provide help, such as the National Domestic Violence Hotline or the Rape, Abuse & Incest National Network.

3. Did I do something to cause these feelings?

No. “You were probably born with a tendency toward depression,” Dr. Simon says. “And with proper treatment, you can bring it under control.” Other health conditions may also be contributing to your mood. The most common is thyroid disorder. Before starting a depression treatment, ask your doctor to do a blood test to rule this out.Also, tell your doctor if you take any medications or supplements, because some can cause or contribute to depression, including steroids, blood pressure drugs and hormones.

4. How do I know which medication is best for me?

There are more than 20 drug options for patients with depression. Doctors can’t predict which will be most effective for you, says Dr. Simon. “It may take trial and error to find the correct medication and dose.”


5. What are my options?

They include:

  • Selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels in the brain. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox).


  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), which raise both serotonin and norepinephrine levels. They include venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).



  • Norepinephrine and dopamine reuptake inhibitors (NDRIs), which increase both dopamine and norepinephrine levels. They’re sold under the brand name Wellbutrin (bupropion).



  • Mirtazapine (Remeron), which increases the activity of the brain circuits that react to neurotransmitters.



  • Aripiprazole (Abilify), an antipsychotic sometimes prescribed along with antidepressants to increase their effectiveness. It’s approved by the Food and Drug Administration for this use.



6. What if those medications don’t work?

Your doctor may recommend two older types of drugs: tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs).Like SNRIs, TCAs increase serotonin and norepinephrine levels. This group includes amitriptyline (Elavil), amitriptyline and chlordiazepoxide (Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor, Aventyl) and protriptyline (Vivactil). But they can cause side effects including drowsiness and weight gain.MAOIs boost norepinephrine, serotonin and dopamine. This group includes phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate) and selegiline (Emsam).People who take them should avoid foods and drugs with high levels of the chemical tyramine, such as cheese, wine and pickles, and over-the-counter cold medicines and decongestants. Mixing MAOIs and tyramine causes high blood pressure and can lead to stroke.

7. How long will it take me to feel better?

It can take weeks or months to feel the full effects, Dr. Payne says.Early results of an ongoing, large-scale study by NIMH, called STAR*D, show it takes 6-8 weeks before antidepressants kick in.But changes in medication and dosage can increase that period, says Dr. Payne.For example, one-third of people in the STAR*D study who didn’t get better with a first treatment had all symptoms reduced with the addition of a second medication. Another one-fourth of patients improved when they switched medications.

8. Which side effects do I need to watch for?

About half of people taking antidepressants report some side effects in the first weeks of treatment. Among the most common are nausea, diarrhea, headaches and decreased libido. Rare, but serious, side effects include fainting, heart problems, seizure, anxiety and increased suicidal thoughts or actions. These issues may subside as you adjust to the medication, but tell your doctor about any unusual symptoms you notice. They can often be treated by changing the dose or medicines.

9. Can I drink when taking antidepressants?

It’s not advisable because alcohol can worsen side effects or decrease the drugs’ effectiveness. Also, since alcohol is a central nervous system depressant, it slows brain activity. This decreases anxiety, but can also lead to greater feelings of depression, says Michelle Riba, M.D., professor at the University of Michigan Depression Center in Ann Arbor. And alcohol interferes with sleep, which exacerbates depression.Still, moderate alcohol use is OK for some people with depression, says Dr. Rudorfer. Your weight and age can affect your response to alcohol, so it’s best to consult your doctor about how often and how much you can drink. “It’s important to tailor it to your own circumstances,” Dr. Riba says.

10. How does therapy help?

“The chemical changes in the brain that cause depression create negative thought patterns. One way to change those is with psychotherapy” Dr. Riba says. Some psychiatrists practice psychotherapy, but you can also see a psychologist or social worker. Plan on weekly sessions if you can afford it.

11. What type of therapy should I look for?

Two types of therapy are especially helpful in treating depression: cognitive behavioral therapy and interpersonal therapy. “Cognitive therapy is aimed at correcting negative thoughts,” Dr. Rudorfer says. Interpersonal therapy focuses on disturbed relationships with others, he adds.

12. How long will I need therapy?

Working together, you and your therapist should determine how long to continue. “When people are depressed, they usually develop other issues,” Dr. Rudorfer says. “Their relationships are affected, or they may be having problems at work.”Over time, a good therapist will help you develop coping skills so you can deal with typical life stressors without triggering your depression, Dr. Rudorfer says.

13. Are alternative treatments effective?

A recent study by a task force of the American Psychiatric Foundation found that alternative treatments for depression had promising results and should be studied further to determine their effectiveness and safety. The more promising treatments include:
  • Omega-3 fatty acids: A supplement that seems beneficial when used with antidepressants, but not as the sole treatment for depression.


  • St. John’s wort (hypericum): An herbal dietary supplement most effective for mild to moderate depression, less so for severe depression. However, it may interfere with medications used to treat heart disease, depression, seizures, cancers and organ transplant rejection, as well as oral contraceptives.


  • Folate (folic acid): A seemingly effective and well-tolerated B vitamin; it hasn’t been adequately tested for correct dose and form.



  • S-adenosyl-L-methionine (SAMe): A supplement for treating major depression with low risk of side effects.



  • Light therapy (also known as phototherapy): Most effective for seasonal depression. For major depression, it may be useful when combined with an antidepressant.


14. What lifestyle changes should I make to manage my condition?

Avoid drinking too many caffeinated beverages, because they can trigger anxiety. Add aerobic exercise or resistance training to your workout routine. An APA task force reviewed several depression studies and found that “patients who continued to exercise following study participation had a lower risk of relapse over several months to years.” This was especially true for those who exercised from 180-210 minutes a week; they showed a 47% reduction in symptoms.

15. How should I explain my depression to family and friends?

Patients with the best recovery rates have good support and involvement from loved ones, Dr. Payne says. “It’s important for them to understand this is a chemical disorder in your brain that requires medication.” She suggests bringing a close friend or family member to a doctor’s appointment, or asking your doctor to hold a family meeting.


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The Woman’s Guide For Depression

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