Clinical
Corner Ð Women and Depression
In a
sense, all women are at risk for depression. Depression cuts across all class,
race and social lines.
Women
are at higher risk than men for major depression (although some researchers
maintain that depression is under diagnosed in men.) One in four women is
likely to experience severe depression. Yet of all women who suffer from
depression, only about one-fifth will get the treatment they need.
What
Are The Risk Factors For Depression?
Reproductive
issues: Menstruation and pregnancy generally do not lead to depression.
Infertility, however, can be a source of depression for women who want
children. Miscarriages and surgical menopause can also cause depressive
symptoms.
Personality
styles: Women who are more passive, dependent, pessimistic, or negative in
their attitudes are more likely to become depressed, particularly if they dwell
on their bad feelings.
Sexual
and Physical abuse: At least 37% of women have had a significant experience of
sexual or physical abuse by the age of 21; some experts actually believe that
the rate may be closer to 50%. Violent episodes such as battering and rape may
leave women with Post-Traumatic Stress Disorder (PTSD). Also, undiagnosed head
trauma from battering can cause depressive symptoms.
Marriage
and children: Marriage protects men against depression much more than it does
women. Mothers of young children are very vulnerable to depression, and the
more children a woman has, the more likely it is that she'll be depressed.
Poverty
and minority status: Poverty is a pathway to depression. 75% of people living
in poverty in the U.S. are women and children.
Women
who are minorities experience great stress from discrimination. In addition,
poor women or minority women often do not have access to basic mental health
care.
Other
high-risk groups: lesbians, adolescents, and women who are alcoholics or drug
abusers are all at high risk for depression.
In
short, almost all women are vulnerable to depression, regardless of their
circumstances.
Why
Are Women More Likely To Experience Depression?
The
APA's Task Force Report on Women and Depression found that women truly are more
depressed than men, not primarily due to biological causes, as was once
believed, but to a variety of biological, social, and psychological causes,
such as those discussed above.
One
reason that men may suffer less from depression has to do with different coping
styles. Men are more likely to employ action and mastery strategies, that is,
to involve themselves in activities (work, sports, going out with friends) that
both distract them from their worries and, perhaps more importantly, give them
a sense of power and control. Women, on the other hand, tend to 'brood' and
dwell on their problems, often with other women. This is one reason why many
therapists prescribe exercise (especially aerobic exercise) as a partial
antidote for depression; it gives women an increased sense of self-discipline,
control, and mastery.
This
is also why women who have multiple roles (e.g., a job, children, a marriage,
volunteer work, all at once) may suffer from much less depression. This is
because these women have many different support sources and lots of outlets for
their competence: if things aren't going well in one area, they can compensate by
feeling satisfied with their successes in other areas.
Treatment
And Therapy
When
should I seek therapy?
We
all get 'the blues' now and then. This kind of mild, infrequent depressive mood
often passes quickly, particularly if you employ some reliable strategies to
get through them (going out with friends, settling down into a good book,
whatever works for you.
Sometimes,
however, depression can be severe, and stronger measures may be called for. If
you are experiencing the symptoms shown on page 3 to a marked degree -- i.e. if
they last more than 2-3 days or if they are interfering with you
normal life and your professional help.
In
its most extreme form, depression can lead to suicide. If you have any thoughts
connected to suicide, you should get therapy AT ONCE.
How
Can I Find A Therapist?
Getting
a recommendation for a therapist is not difficult, but finding a good therapist
might take a little more work.
The
recommendations should be from someone you trust. The following people can
probably can probably help:
You
can also check with your state psychological association or your local community
mental health clinic.
How
Do I Know If The Therapist Is Any Good?
The
best indicator of successful therapy is you sense of comfort with the
therapist. You should feel at ease with the person, at the same time
understanding that therapy will often require you to talk about painful or
uncomfortable subjects.
He
or she should have the proper credentials (Ph.D., Psy.D.,
M.F.T., L.C.S.W., or M.D.) and also be state-licensed. Most insurance
companies will only pay for therapy from a licensed practitioner. You have a
right to ask your therapist about his or her credentials, therapeutic
orientation and any other questions that come to mind.
After
your initial consultation, you can decide whether or not you want to see this
particular therapist on a regular basis, or whether you'd go talk to some
others. You are completely entitled to do this 'shopping around' until you find
someone with whom you want to work.
What
Types Of Therapy Are Available?
There
are as many 'styles' of therapy as there are therapists. You
therapist can give you more detailed information about the type he or she is
using. The basic kinds are:
In
addition, there is group therapy, led by a psychotherapist, which provides the
additional support of a group that some people may find especially helpful, and
there are support groups, led either by a therapist or by group members who
take turns as leaders.
The
best short-term therapy for depression is action-oriented. Therapy should be
focused and concrete; you need to know two things - What is making you unhappy?
and What can you do about it? When the therapy includes a clear action plan
(for example, homework assignments such as journal writing or brief art therapy
sessions, the success rate with depression can go up as much as 80-90%.
How
Long Will Therapy Take?
The
good news is that therapy for depression can show results quickly, usually in a
matter of weeks. You may opt for brief therapy, to help you get through a rough
period and learn skills for coping in the future, or you may choose to stay in
therapy as a means of continued personal growth.
What
About Drug Therapy?
Pharmacotherapy
can be useful for people suffering from severe depression (it may even be
necessary in some cases). Caution is needed, however, since drugs are often
overprescribed for women. Women who are drug or alcohol abusers are at risk for
harmful drug interactions, as are the millions of women who take diet pills. In
addition, many of the psychotropic drugs can have serious side effects,
particularly if the patient is taking other prescription medications. Finally,
the rate of noncompliance (patients not taking their medication) is pretty high
-- about 60-70%.
On
the other hand, for people who are so depressed that they cannot function, or
are suicidal, antidepressant drugs can literally be a lifesaver. It is
extremely important that the prescribing doctor be very will trained in
psychopharmacology and fully understand the proper dosages, possible side
effects, and interaction with other drugs, and that he or she explain all of
this very clearly to you.
Special
Issues For Minorities
What
Kind of Therapy Should Minority Women Look For?
Therapy
for women of different ethnic backgrounds must be 'culturally embedded', in
other words, it must translate the concepts into a cultural context that is
meaningful. For example, Asian women are taught to value an indirect approach
to expressing their needs and feelings, thus traditional 'assertiveness
training' will seem strange and inaccessible to them; Latino women often reveal
their depression not in psychological symptoms but by developing chronic
physical illnesses such as headaches, backaches, and so on.
Interpersonal
therapy seems to be an effective type of treatment for minority women since,
for many of them, their personal relationships are extremely important, and
often the focal point of their self-definition. This tends to be true for all
women, but particularly for minority women. In addition, this therapy is often
brief, a factor that many women will appreciate because they may believe that
others rely on them to much to allow for a lot of time away from family and
other responsibilities.
You
should look for a therapist whose training has made him or her culturally
sensitive.
Medication
It
is extremely important that the prescribing physician understand biological
differences in ethnic groups because people from different ethnic backgrounds
metabolize drugs differently. The dosages may need to be quite different. The
doctor in this case must have specialized training and/or experience in
prescribing drugs for different ethnic groups.
Warning
Signs Of Depression:
Symptoms
of Post Traumatic Stress Disorder (PTSD), which sometimes occurs after exposure
to violence, are similar to those for depression and can also include: