One out of eight women will suffer from clinical depression in her lifetime
Kelly Westhoff
After a breakup with a boyfriend, Susannah, a junior at Winona State, had a hard time getting out of bed. "I couldn't get up for classes," she said. "I'd sleep until five or six at night. I'd wake up, and then go back to bed. I couldn't even get up to eat."
This went on for weeks until one day over the phone, her mom suggested she come home. Susannah went. "I just came home, almost on a whim," she recalled. "And I literally spent the next eight months on a couch. I read a book a day. It was a really lethargic period. And I don't remember it. I just remember I was in a haze. I didn't speak to my friends and I just remember I read a book a day."
"I was all the way down. Probably the worst you can get. I mean, I spent days in the dark on that couch," she said. "I went from a size 4 to a 14, that's how lethargic I was."
Susannah, who asked that her last name not be used, was experiencing a major depressive episode, more commonly called clinical depression or major depression. More than a just bad day or a pounding migraine, she felt a persistent gloominess she couldn't shake with a couple of Advil and a weekend away.
She is not alone. According to a 2002 study by the American Psychological Association (APA), major depression affects more than 19 million American adults every year, the majority of whom are women. Women suffer from depression at almost twice the rate of men. Estimates suggest one in eight women will suffer from clinical depression during her lifetime. Depression tends to affect women in their childrearing years most often, and it cuts across educational, economic, racial and national boundaries.
"This is not a U.S. phenomenon," said Emilie Britton, director of programs at Chrysalis, a nonprofit health and human services organization in Minneapolis that serves many women dealing with depression. "Women suffer from depression here and in other cultures. It's worldwide."
Why are women more susceptible to depression? The answer isn't very tidy. Biochemistry, heredity, hormones, life situations and stress can all play a role.
"Depression is biochemical," said Britton. "Your brain chemistry shifts. We understand some of it. For example, we understand the role of serotonin. If the serotonin in your brain is out of balance, you're gonna feel bad. But psychology is a really young science. There's so much we don't know."
What psychologists do know is that depression runs in families. According to the National Alliance for the Mentally Ill (NAMI), an individual born to a parent who has suffered from depression has a 25 percent chance of suffering from depression. Yet depression also affects those with no family history of the disease.
Basic psychology plays a role in determining who will suffer from depression. People with low self-esteem or those who are easily stressed are also at greater risk. But depression is not just a disease of the unsure and unstable.
As much as women may hate to admit it, hormonal changes affect their moods. The APA estimates that as many as 75 percent of women experience some emotional or behavioral symptoms before their periods. Scientists don't fully understand the role changing hormone levels play in triggering depression, but many remain convinced there must be a link, particularly for hormone changes brought on by childbirth.
As many as 80 percent of women experience the "postpartum blues" following childbirth, according to NAMI. Of that 80 percent, 15 percent fall into depression brought on by hormonal and biological changes. Lifestyle changes associated with caring for a child can also trigger the onset of depression.
In fact, raising a family puts an unlikely category of women at a higher risk for depression: married women. "Married women have more stress," Chrysalis' Britton pointed out. "They deal with children and coordinate daycare, teachers and sports. They have jobs. They have laundry. They have a relationship and they have aging parents."
"A marriage," Britton continued, "is just one more thing a woman has to manage. It's one more thing to be on top of. If you want a good one, it needs energy and attention."
Put that way, it seems obvious that married women are overloaded. Statistics from the APA show that married women have higher rates of depression than unmarried women. In fact, when it comes to unhappy marriages, the APA reports that unhappily married women are three times more likely than unhappily married men to suffer from depression.
Many of the women seeking help for depression at Chrysalis are trying to get out of an unhappy marriage, Britton said. "Divorce is huge," Britton stressed. "It is really huge. It's horrible. I don't think anyone understands the magnitude of divorce for women with children, the levels of grief that they have to go through."
"One of the reasons divorce is such a stressor for women is that society now sees divorce as normal," Britton said. In a country in which 50 percent of marriages end in divorce, a woman may feel that she is not allowed to grieve the loss of her marriage. Coworkers may give a woman entering a divorce leeway for a few weeks, friends and family may offer strong support the first couple months, but for many women living through a divorce, the feelings of loss can last a full year or more. For many women in the midst of divorce, depression sets in as they attempt to sort out their anger and hurt.
Social issues surface again and again when surveying the risk factors for depression among women. Women living in poverty are at an increased risk of depression. Women of color are also more likely to suffer from depression, as are homosexual women. Women that have been victims of physical or sexual abuse and women dealing with immigration and assimilation to a new culture are both more susceptible to depression. "Basically, the more barriers you have, the more you have on your plate, the higher the risk of depression," said Britton.
Unfortunately, Britton pointed out, too many women in high-risk categories go untreated for depression because they don't know where or how to seek help. In addition, too many women think depression must be caused by something. "There doesn't have to be a major life event that causes depression," Britton explained. "Sometimes there isn't an event. It just happens."
When depression does happen, getting help does not have to be scary. Most women dealing with depression meet with a therapist regularly and take antidepressant medications. Some also meet with support groups. Even for Susannah, the college student camped out on the couch, there came a point when the haze of depression began to clear and life came back into focus.
"I pulled myself back up," Susannah said. "I wanted to graduate from college. I wanted a good job. I wanted to be happy and I wasn't happy with how things were going."
Susannah took little steps to rejoin the world. First she sought help from a psychiatrist and started a regimen of antidepressants. She worked on her résumé. Then she applied to the University of Minnesota. Now she is back in school and looking forward to graduating soon. Friends she pushed away during her months on the couch are back in her life.
There are days when stress is high and she gets upset, Susannah admitted, but she doesn't dwell on a future that includes depression. Susannah plans to continue taking antidepressants and has come to accept that the medication has a role in her life. "The medicine is a part of my life and I believe it always will be," she said.
"I know myself. I know what I was like before and what I am like now. You know yourself at your best and this is helping me be my best."
Are you clinically depressed?
Major life events such as a divorce, the loss of a job, a death in the family or becoming the victim of a violent crime can lead to an episode of depression. Yet depression is not always triggered by a major life event. Often, a major depressive episode can happen gradually and take place at a time when nothing out of the ordinary happens.
According to the National Alliance for the Mentally Ill, when several of the following symptoms occur at the same time and last longer than two weeks, you should see your doctor.
€ persistent sadness
€ pronounced changes in sleep, appetite and energy
€ difficulty thinking, concentrating, remembering and making decisions
€ restlessness, irritability and excessive crying
€ lack of interest in, or pleasure from, activities once enjoyed, including sex
€ feelings of guilt, worthlessness, hopelessness and emptiness
€ persistent physical symptoms that do not respond to usual treatments, such as headaches, stomach aches and body pain.
€ recurrent thoughts of death or suicide.
Chrysalis director of programs Emilie Britton warned, "Thoughts of suicide or death can be really passive, like, 'If a car hit me, I wouldn't care'."
Chemical causes of depression
While biological, genetic, social and psychological factors can all contribute to depression, clinical depression is a biological brain disorder.
Serotonin, norepinephrine and dopamine are three chemicals in the brain thought to be involved in clinical depression. They are all neurotransmitters, meaning they transmit electrical signals between brain cells. An imbalance in these neurotransmitters leads to a state of depression. All three function in the areas of the brain that regulate emotion, appetite, sleep, libido and reactions to stress.
Antidepressant medications work by increasing levels of serotonin, norepinephrine and dopamine in the brain while also making brain receptors more sensitive to existing neurotransmitters.
Source: All About Depression, a website created by counseling psychologist Prentiss Price, Ph.D. (allaboutdepression.com)
If you think you're depressed
"If you have any doubts or questions about whether or not you are dealing with depression, it is always better to be safe and seek help," said Emilie Britton, director of programs at Chrysalis. Untreated depression can continue for months or even years. The longer depression goes untreated, the more difficult it may become to treat.
As a first step, Britton advised, seek help from a primary care doctor, psychiatrist or a therapist. If you do not have access to a doctor, contact a social services organization.
In the Twin Cities, there are several organizations that can provide support and information:
€ Chrysalis Center for Women, 4432 Chicago Ave., Mpls. 612-871-0118, www.chrysaliswomen.org.
€ National Alliance for the Mentally Ill of Minnesota, a nonprofit support and advocacy organization for people dealing with mental illness and their friends and family. 800 Transfer Road, Suite 7A, St. Paul. 651-645-2948, or toll-free1-888-473-0237, www.nami.org.
€ The Crisis Intervention Center at Hennepin County Medical Center provides crisis-referral services 24 hours a day, seven days a week. 612-873-3161.
€ Metro area residents can call the Crisis Connection at 612-379-6363.
€ First Call For Help offers statewide referral services. Dial 2-1-1 for information about the health and human services in your area. If 211 isn't available yet in your area, dial 1-800-543-7709.
If someone you love suffers from depression
The most important thing you can do for a loved one who suffers from depression is to make sure she or he receives medical attention. This may mean accompanying your loved one to the doctor or ensuring that person is taking prescribed medication.
Once your loved one is receiving help, remain patient. It may take weeks before medication begins to affect change. During that time, do not accuse your loved one of laziness or faking illness. Instead, engage your loved one in conversation and invite him or her for simple outings, like a walk, a coffee date or to rent a movie together. If your invitation is refused, gently insist. Be mindful, however, that too many demands on your loved one's time can increase feelings of failure. Remind yourself and your loved one that, with time, depression will lift.
Source: All About Depression, a website created by counseling psychologist Prentiss Price, Ph.D. (allaboutdepression.com)
