Is it the “Blues” or Depression?

Factors Affecting Women

Women are twice as likely to experience depression as men. This risk can be attributed to a combination of biology and life circumstances. Many women work full time, care for children, have responsibilities at home, and may even have the added stress of caring for an elderly parent. This does not leave much time to care for themselves thus increasing their risk for depression.

What is Depression?

Depression is more than feeling “blue” or “down” or just sad for a few days. It’s also different than experiencing sadness over the loss of a loved one, or after a trauma or difficult event. 

Depression is a mood disorder affecting how a person feels, thinks, and handles daily activities like sleeping, eating, or working. It affects changes in mood causing feelings of sadness, emptiness, and hopelessness most of the time, and lasts 2 or more weeks. Depression affects relationships with friends, family, and even children. This combination of symptoms is called Major Depressive Disorder (MDD) and affects both men and women. 

Prevalence of Depression in Women:

As many as 1 in 10 women in the United States are affected by depression every year. Many factors contributing to depression in women include hormone changes, inherited traits, personal life experiences, and culture.

Types of Depression Unique to Women:

Premenstrual Dysphoric Disorder (PMDD)

Women deal with Premenstrual Syndrome (PMS) every month. For most women, the symptoms are mild and include bloating, cramping, breast tenderness, headache, anxiety, and irritability. Some women may experience a mild case of “the blues” for a short period of time. 

For a small number of women, these symptoms can become severe and disabling disrupting their schoolwork, jobs, and relationships. When this happens, premenstrual syndrome becomes Premenstrual Dysphoric Disorder (PDD). 

The link between PDD and depression is not known however, it is thought the cyclic change in hormones plays a role. It is believed that this change in hormones may disrupt chemicals in the brain, like serotonin, which affect mood. 

Postpartum Depression

Some women may feel sad, worried, or tired within a few days after giving birth, this is commonly called the “baby blues.” These feelings are normal and usually go away in a week or two. If these feelings continue or you begin to feel extreme sadness, hopeless, or anxious for longer than 2 weeks, you may have postpartum depression, especially if the symptoms include:

• Uncontrollable crying
• Extreme sadness
• Mood swings
• Anxiety or panic attacks
• Irritability and anger
• Extreme fatigue
• Headaches and body aches or pains
• Unable to sleep or sleeping too much.
• Problems with daily functioning
• Low self-esteem or feeling like you are not a good mother.
• Inability to care for your baby.
• Fear of harming your baby
• Feelings of guilt 
• Thoughts of suicide

Postpartum depression is a serious medical condition requiring treatment. Postpartum depression occurs in 10 to 15 percent of new mothers. All women are at risk, but women with the following are at higher risk (6):

• Hormonal fluctuations causing mood changes (i.e., menstrual cycle or birth control medications: pills, patches, injections, or intrauterine devices (IUDs) containing hormones)
• The responsibility of taking care of a newborn
• Having prior problems with mood, depression, or anxiety disorders
• Family history of depression
• Significant life stressors (i.e., marital problems, stressful events in the last year, financial problems, being a single parent, having a partner with depression)
• Lack of support from partner or family (financial or childcare)
• Complications during pregnancy and birth (i.e., previous miscarriage, preterm delivery)
• Unplanned or unwanted pregnancy
• Infant complications or special needs
• Difficulty breastfeeding
• Not feeling connected to the baby

The symptoms of postpartum depression usually develop slowly over about 3 months; however, it can start suddenly. These symptoms interfere with the woman’s ability to take care of herself and the baby. 

Women with postpartum depression may not bond with their baby causing emotional, social, and learning problems in the child as he or she grows up. 

For the best possible outcome, postpartum depression should be treated early. While postpartum depression can resolve without treatment, there is the risk that it may become chronic depression.

Biology, life circumstances, and culture play a role in women having an increased risk of depression. Traditionally women have been expected to raise the children and manage the household, now the added expectation of having a full-time job compounds the daily stress women feel. Additionally, women are more likely to be single parents working multiple jobs to make ends meet. Uncertainty about the future and lack of resources further increases the risk of depression. 

Recognizing and Diagnosing Depression:

Knowing the symptoms and recognizing them is the first step in getting help. Some women may have only a few symptoms of depression while others will have many. Any of the above symptoms lasting longer than 2 weeks should be addressed. The criteria for diagnosing depression are experiencing 5 or more symptoms nearly every day for 2 or more weeks. Depression is treatable and early treatment is key to improving results.

Treatment of Depression:

Seeking treatment for depression can seem overwhelming. If you are concerned about depression schedule an appointment with your family doctor, nurse practitioner, internist, obstetrician, or gynecologist. Any of these providers can review your symptoms with you and recommend treatment if it is needed. Treatments for depression consist of therapy, medications, or a combination of the two. 

If your provider does not have a list of recommended therapists, most therapists do not require a referral and there are some good resources online. If your symptoms are severe and you are concerned you may harm yourself please call Suicide and Crisis Lifeline at 988 for help.