Depression - Gender differences

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Many experts believe that clinical depression is one of the most important health issues facing women of all ages today -- from teenagers to women who have passed their menopause.

The rates for a major depressive episode are two to three times higher for women than for men in almost all of the countries and cultures which have been studied. In addition, many women experience mild-to-moderate depression, anxiety, and irritability during the premenstrual phase of their cycle.

Women are also much more likely to develop a full-blown anxiety disorder than men are. Depressed women make more suicide attempts than men, and they report more sleep disturbance, more bodily and health problems, and more severe symptoms. Women with bipolar disorder tend to have more depressions and more rapid cycling episodes than men.

Why are women at such high risk for depression? Why are their depressions more severe?

Biological factors

Hormonal fluctuations
Interestingly, preadolescent girls have the same or even lower rates of depression as preadolescent boys; however, once girls hit puberty, their risk for depression increases dramatically. Evidence suggests that some biological aspects of being female make women more prone to depression. The normal fluctuations in female sex hormones (estrogen and progesterone) which occur from puberty to menopause have an effect on mood stability, at least for some women.

High risks for depression are also observed when the levels of these hormones change significantly, such as occurs after giving birth and around menopause (and to a milder degree, during the premenstrual phase). Estrogen treatment can help lift depressed mood in women who are heading into menopause.

Likewise, women are more likely to develop thyroid problems than men, and since the thyroid hormone is involved in the regulation of mood and metabolism, this may make them more vulnerable to depressive disorders. Women produce less than half the amount of the brain chemical serotonin that men do, and serotonin is critical to mood and appetite. (Antidepressants such as Prozac, Paxil, and Zoloft, which are called SSRIs or serotonin selective reuptake inhibitors, help to maintain levels of serotonin.)

Brain structure
The overall structure and function of the brain differ between men and women, from before birth and throughout the lifespan. This difference is partly due to the effect of the two X chromosomes which females carry in their cells and which guide development, partly due to the different effects of female sex hormones on the brain, and partly due to the way different kinds of life experiences affect the brain (being exposed to a lot of indoor activities as opposed to outdoor sports, for example).

For instance, women process language tasks on both sides of their brains, while men tend to use one side only. When asked to imagine sad experiences, women activate more brain regions than men do, including the parts of the brain which process emotions. One researcher has said, half-jokingly, that women's brains seem built to process information, especially emotional information, in multiple regions on both the left and right sides, while men's brains seem built to process information in a more limited and sequential manner, on one side of the brain only, and without as much access to emotional or verbal aspects of the task. (A lot of wives and girlfriends would probably agree with this!)

These findings may explain why we see a lot of empathy, intuition, nurturing behavior, verbal ability and emotional sophistication in women -- and may explain why women often find it easy to be tuned in to the needs and feelings of others. But they also suggest that women are more "tied in" to their mood states, and thus more prone to clinical depression.

Social, cultural, and psychological factors
Even though our society has made significant advances in promoting equal opportunities and equal status for women, there are still many countries where women are nothing more than property, where abortions are performed when the ultrasound shows a female baby, and where girls are routinely denied access to education, health care and adequate nutrition in favor of their brothers -- or are sold into child prostitution or child labor. Some ethnic and religious groups in our own country have very specific roles spelled out for women: Be subservient, get married, bear lots of children.

Even in the general American culture, females are given mixed messages. Though we are told we can achieve anything we want, our youth and beauty are prized beyond all else. We grow up on stories of Prince Charming and happily-ever-after, in which a wedding day is our greatest day of glory. Images of pretty, sexy, smiling young women in very tight clothes are pasted all over billboards, magazines, movies and TV in order to attract men's attention and sell something. At the same time, you can hardly open a newspaper without reading about some heinous act of sexual violence being committed against a girl or woman.

Women are thus repeatedly given a number of subtle and not-so-subtle messages: Only a man can make everything okay. You have to play your cards right in order to get one to take care of you. Men see you as a sexual being, with a role that is passive and meant for display. Your primary job in life is to please others. You are physically weaker than men, and you are at the mercy of their violent impulses.

This may account for the fact that many women feel they need to work extra hard to figure out ways of being independent, autonomous, strong, assertive -- and to find ways of not worrying so much about what others will think.

The sociobiological perspective
Some theorists believe that all of these biological, social, cultural, and psychological factors are related to our sociobiology -- that is, to aspects of our survival as a human race throughout our evolution.

They theorize that because women are the ones who get pregnant and bear children, and because this was so physically difficult and risky in primitive times, our species survived by developing mating strategies that gave preference to young, healthy, fertile women (as indicated by their breasts, buttocks, etc.). Conversely, a male who was older, powerful, well off, and of high status could protect and provide for the mother and child when they were at their most vulnerable. At the same time, males wouldn't need to be monogamous, since they could potentially father several children at a time.

According to this view, evolution has "programmed" women to be focused on the complexities of childrearing, on finding a permanent mate, and on taking care of others. Thus, women have evolved throughout the ages to be very aware of a potential mate's wealth and status, in order to secure the best chance at survival for themselves and their children. Meanwhile, men will be ready to impregnate anything that moves, especially if it is young and attractive.

Finally, evolutionary psychology suggests that in primitive times, when humans lived in tribes with rigid dominance hierarchies, women had lower status, were physically vulnerable, and were dependent on the males for survival. As a result, they became good at keeping the peace and at being attuned to the moods and needs of others -- even to the detriment of their own psychological health. If these habits helped them to survive, they might also have made women prone to low self-esteem, depression and anxiety.