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What You Should Know about Women and Depression
Mental illnesses can be treated successfully
Facts about Women and Depression
Who is at Risk for 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 underdiagnosed 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 An 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, primarily due to the experience of being female in
our contemporary culture. In other words, depression in women is not due
primarily 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 more stress but, on the other hand,
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.
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 below to a marked degree - i.e. if
they last
more than 2-3 days or if they are interfering with your normal life and your
personal
relationships--you should seek professional help.
In it’s more 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 help:
o A friend or relative who has been in therapy
o Your doctor
o Your priest, rabbi or pastor
o A guidance counselor at your school or at a nearby college or university
You can also check with your state psychological association or your local
community
mental health clinic.
How Do I Know If the Therapist ls Any Good?
The best indicator of successful therapy is your 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.
If you are going to a psychologist or psychiatrist, he or she should have the
proper
credentials (Ph.D., Psy.D., Ed.D, or M.D.) and also be State-licensed. A social
worker
(M.S.W. or L.C.S.W) should also be state-licensed. (Most insurance companies, in
fact, 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 rather 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. Your therapist
can give
you more detailed information about the type he or she is using. The basic kinds
are:
Behavioral therapy: seeks to change behavior rather than underlying personality,
teaches new "coping" techniques.
interpersonal psychotherapy: focuses on interpersonal relationships and coping
with
conflicts in relationships.
Feminist therapy: views symptoms as the response to cultural oppression, focuses
on
"empowering" the client.
Cognitive-behavioral therapy: in addition to correcting behavior, seeks to
correct
negative thinking patterns.
Psychodynamic therapy: focuses on underlying drives and desires that determine
behavior.
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 over- prescribed 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 well 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; Latina 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 too 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
o Depressive mood; feelings of helplessness and pessimism
o Sleep disturbance - inability to sleep, or sleeping too much; irregular sleep
patterns
o Appetite disturbance, eating far less or far more than usual
o Social withdrawal; refusal to go out, to see friends
o Blaming yourself for your problems, or feeling that you're worthless
o Inability to concentrate, even on routine tasks
o Substance abuse - alcohol or drugs
Symptoms of Post-Traumatic Stress Disorder (PTSD), which sometimes occurs after
exposure to violence, are similar to those for depression and can also include:
o Nightmares or flashbacks of the terrifying past events
o Increased aggression, and feelings of uncontrollable anger
o Emotional numbing
o Avoidance of the outside world, especially of anything that reminds you of
past traumas
Special thanks to the following APA members who made this brochure possible:
Lillian Comas-Diaz, Ph.D., Executive Director, Transcultural Mental Health
Institute; member. Task Force on Women and Depression
Ellen McGrath, Ph.D., senior editor, Final Report of the Task Force on Women and
Depression
Public Information Committee of the American Psychological Association
Brochure written by Chi Chi Sileo. Produced by the APA Office of Public Affairs
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