Depression


What Every Woman Should Know


of Mental Health 

I NIMI• DEPARTMENT OF HEALTH AND HUMAN SERVICES • PUBLIC HEALTH SERVICE • NATIONAL INSTITUTES OF HEALTH I


National Institute 
L

ife is full of emotional ups

and downs. But when the 

"down" times are long lasting 

or interfere with your ability 

to function, you may be suffering 

from a common, serious illness—depression. Clinical 

depression affects mood, mind, body, and behavior. 

Research has shown that in the United States about 19 

million people—one in ten adults—experience 

depression each year, and nearly two-thirds do not get 

the help they need.9 Treatment can alleviate the 

symptoms in over 80 percent of the cases. Yet, because 

it often goes unrecognized, depression continues to 

cause unnecessary suffering. 

Depression is a pervasive and impairing illness 

that affects both women and men, but women 

experience depression at roughly twice the rate of men.1 

Researchers continue to explore how special issues 

unique to women—biological, life cycle, and psychosocial—may be associated with women’s higher rate 

of depression. 
No two people become depressed in exactly the same way. 

Many people have only some of the symptoms, varying in severity 

and duration. For some, symptoms occur in time-limited episodes; 

for others, symptoms can be present for long periods if no treatment 

is sought. Having some depressive symptoms does not mean a 

person is clinically depressed. For example, it is not unusual for 

those who have lost a loved one to feel sad, helpless, and 

disinterested in regular activities. Only when these symptoms persist 

for an unusually long time is there reason to suspect that grief has 

become depressive illness. Similarly, living with the stress of 

potential layoffs, heavy workloads, or financial or family problems 

may cause irritability and “the blues.” Up to a point, such feelings 

are simply a part of human experience. But when these feelings 

increase in duration and intensity and an individual is unable to 

function as usual, what seemed a temporary mood may have become 

a clinical illness. 

The Types of Depressive Illness 

1. In major depression, sometimes referred to as unipolar or 

clinical depression, people have some or all of the symptoms listed 

below for at least 2 weeks but frequently for several months or 

longer. Episodes of the illness can occur once, twice, or several times 

in a lifetime. 

2. In dysthymia, the same symptoms are present though milder 

and last at least 2 years. People with dysthymia are frequently 

lacking in zest and enthusiasm for life, living a joyless and fatigued 

existence that seems almost a natural outgrowth of their 

personalities. They also can experience major depressive episodes. 

2 
3. Manic-depression, or bipolar disorder, is not nearly as 

common as other forms of depressive illness and involves disruptive 

cycles of depressive symptoms that alternate with mania. During 

manic episodes, people may become overly active, talkative, euphoric, 

irritable, spend money irresponsibly, and get involved in sexual 

misadventures. In some people, a milder form of mania, called 

hypomania, alternates with depressive episodes. Unlike other mood 

disorders, women and men are equally vulnerable to bipolar disorder; 

however, women with bipolar disorder tend to have more episodes of 

depression and fewer episodes of mania or hypomania.5 

Symptoms of Depression and Mania
�

A thorough diagnostic evaluation is needed if three to five or more of


the following symptoms persist for more than 2 weeks (1 week in the


case of mania), or if they interfere with work or family life. An


evaluation involves a complete physical checkup and information


gathering on family health history. Not everyone with depression


experiences each of these symptoms. The severity of the symptoms


also varies from person to person.


Depression

■ Persistent sad, anxious, or "empty" mood 

■ Loss of interest or pleasure in activities, including sex 

■ Restlessness, irritability, or excessive crying 

■ Feelings of guilt, worthlessness, helplessness, hopelessness,


pessimism 

■ Sleeping too much or too little, early-morning awakening 

■ Appetite and/or weight loss or overeating and weight gain 

■ Decreased energy, fatigue, feeling "slowed down" 

■ Thoughts of death or suicide, or suicide attempts 

3 

�
■ Difficulty concentrating, remembering, or making decisions 

■ Persistent physical symptoms that do not respond to 

treatment, such as headaches, digestive disorders, and 

chronic pain 

Mania 

■ Abnormally elevated mood 

■ Irritability 

■ Decreased need for sleep


■ Grandiose notions 

■ Increased talking 

■ Racing thoughts 

■ Increased activity, including sexual activity 

■ Markedly increased energy 

■ Poor judgment that leads to risk-taking behavior 

■ Inappropriate social behavior 

Causes of Depression 

Genetic Factors 

There is a risk for developing depression when there is a family 

history of the illness, indicating that a biological vulnerability may be 

inherited. The risk is somewhat higher for those with bipolar 

disorder. However, not everybody with a family history develops the 

illness. In addition, major depression can occur in people who have 

had no family members with the illness. This suggests that 

additional factors, possibly biochemistry, environmental stressors, 

and other psychosocial factors, are involved in the onset of 

depression. 

4 
Biochemical Factors 

Evidence indicates that brain biochemistry is a significant factor in 

depressive disorders. It is known, for example, that individuals with 

major depressive illness typically have dysregulation of certain brain 

chemicals, called neurotransmitters. Additionally, sleep patterns, 

which are biochemically influenced, are typically different in people 

with depressive disorders. Depression can be induced or alleviated 

with certain medications, and some hormones have mood-altering 

properties. What is not yet known is whether the “biochemical 

disturbances” of depression are of genetic origin, or are secondary to 

stress, trauma, physical illness, or some other environmental 

condition. 

Environmental and Other Stressors 

Significant loss, a difficult relationship, financial problems, or a


major change in life pattern have all been cited as contributors to


depressive illness. Sometimes the onset of depression is associated


with acute or chronic physical illness. In addition, some form of


substance abuse disorder occurs in about one-third of people with


any type of depressive disorder.7


Other Psychological and Social Factors


Persons with certain characteristics—pessimistic thinking, low self-


esteem, a sense of having little control over life events, and a


tendency to worry excessively—are more likely to develop depression. 


These attributes may heighten the effect of stressful events or


interfere with taking action to cope with them or with getting well. 


Upbringing or sex role expectations may contribute to the


development of these traits. It appears that negative thinking


patterns typically develop in childhood or adolescence. Some 


5 
experts have suggested that the traditional upbringing of girls might 

foster these traits and may be a factor in women’s higher rate of 

depression. 

Women Are at Greater Risk for 

Depression than Men 

Major depression and dysthymia affect twice as many women as 

men. This two-to-one ratio exists regardless of racial and ethnic 

background or economic status. The same ratio has been reported in 

ten other countries all over the world.11 Men and women have about 

the same rate of bipolar disorder (manic-depression), though its 

course in women typically has more depressive and fewer manic 

episodes. Also, a greater number of women have the rapid cycling 

form of bipolar disorder, which may be more resistant to standard 

treatments.5 

A variety of factors unique to women's lives are suspected to 

play a role in developing depression. Research is focused on 

understanding these, including: reproductive, hormonal, genetic or 

other biological factors; abuse and oppression; interpersonal factors; 

and certain psychological and personality characteristics. And yet, 

the specific causes of depression in women remain unclear; many 

women exposed to these factors do not develop depression. What is 

clear is that regardless of the contributing factors, depression is a 

highly treatable illness. 

6 
The Many Dimensions of Depression


in Women 

Investigators are focusing on the following areas in their study of 

depression in women: 

The Issues of Adolescence 

Before adolescence, there is little difference in the rate of depression 

in boys and girls. But between the ages of 11 and 13 there is a 

precipitous rise in depression rates for girls. By the age of 15, 

females are twice as likely to have experienced a major depressive 

episode as males.2 This comes at a time in adolescence when roles 

and expectations change dramatically. The stresses of adolescence 

include forming an identity, emerging sexuality, separating from 

parents, and making decisions for the first time, along with other 

physical, intellectual, and hormonal changes. These stresses are 

generally different for boys and girls, and may be associated more 

often with depression in females. Studies show that female high 

school students have significantly higher rates of depression, anxiety 

disorders, eating disorders, and adjustment disorders than male 

students, who have higher rates of disruptive behavior disorders.6 

Adulthood: Relationships and Work Roles 

Stress in general can contribute to depression in persons biologically 

vulnerable to the illness. Some have theorized that higher incidence 

of depression in women is not due to greater vulnerability, but to the 

particular stresses that many women face. These stresses include 

major responsibilities at home and work, single parenthood, and 

caring for children and aging parents. How these factors may 

uniquely affect women is not yet fully understood. 

7 
For both women and men, rates of major depression are 

highest among the separated and divorced, and lowest among the 

married, while remaining always higher for women than for men. 

The quality of a marriage, however, may contribute significantly to 

depression. Lack of an intimate, confiding relationship, as well as 

overt marital disputes, have been shown to be related to depression 

in women. In fact, rates of depression were shown to be highest 

among unhappily married women. 

Reproductive Events


Women’s reproductive events include the menstrual cycle, pregnancy,


the postpregnancy period, infertility, menopause, and sometimes, the


decision not to have children. These events bring


fluctuations in mood that for some women include depression. 


Researchers have confirmed that hormones have an effect on the


brain chemistry that controls emotions and mood; a specific


biological mechanism explaining hormonal involvement is not


known, however. 


Many women experience certain behavioral and physical 

changes associated with phases of their menstrual cycles. In some 

women, these changes are severe, occur regularly, and include 

depressed feelings, irritability, and other emotional and physical 

changes. Called premenstrual syndrome�(PMS) or premenstrual 

dysphoric disorder (PMDD), the changes typically begin after 

ovulation and become gradually worse until menstruation starts. 

Scientists are exploring how the cyclical rise and fall of estrogen and 

other hormones may affect the brain chemistry that is associated 

with depressive illness.10 

Postpartum mood changes�can range from transient "blues" 

immediately following childbirth to an episode of major depression to 

severe, incapacitating, psychotic depression. Studies suggest that 

8 
women who experience major depression after childbirth very often 

have had prior depressive episodes even though they may not have 

been diagnosed and treated. 

Pregnancy (if it is desired) seldom contributes to depression, 

and having an abortion does not appear to lead to a higher incidence 

of depression. �Women with infertility problems may be subject to 

extreme anxiety or sadness, though it is unclear if this contributes to 

a higher rate of depressive illness. In addition, motherhood may be a 

time of heightened risk for depression because of the stress and 

demands it imposes. 

Menopause, in general, is not asssociated with an increased 

risk of depression. In fact, while once considered a unique disorder, 

research has shown that depressive illness at menopause is no 

different than at other ages. The women more vulnerable to changeof-life depression are those with a history of past depressive episodes. 

Specific Cultural Considerations 

As for depression in general, the prevalence rate of depression in 

African American and Hispanic women remains about twice that of 

men. There is some indication, however, that major depression and 

dysthymia may be diagnosed less frequently in African American and 

slightly more frequently in Hispanic than in Caucasian women. 

Prevalence information for other racial and ethnic groups is not 

definitive. 

Possible differences in symptom presentation may affect the 

way depression is recognized and diagnosed among minorities. For 

example, African Americans are more likely to report somatic 

symptoms, such as appetite change and body aches and pains. 

In addition, people from various cultural backgrounds may view 

depressive symptoms in different ways. Such factors should be 

considered when working with women from special populations. 

9 
Victimization 

Studies show that women molested as children are more likely to have 

clinical depression at some time in their lives than those with no such 

history. In addition, several studies show a higher incidence of 

depression among women who have been raped as adolescents or 

adults. Since far more women than men were sexually abused as 

children, these findings are relevant. Women who experience other 

commonly occurring forms of abuse, such as physical abuse and sexual 

harassment on the job, also may experience higher rates of depression. 

Abuse may lead to depression by fostering low self-esteem, a sense of 

helplessness, self-blame, and social isolation. There may be biological 

and environmental risk factors for depression resulting from growing up 

in a dysfunctional family. At present, more research is needed to 

understand whether victimization is connected specifically to depression. 

Poverty 

Women and children represent seventy-five percent of the U.S. 

population considered poor. Low economic status brings with it 

many stresses, including isolation, uncertainty, frequent negative 

events, and poor access to helpful resources. Sadness and low 

morale are more common among persons with low incomes and 

those lacking social supports. But research has not yet established 

whether depressive illnesses are more prevalent among those facing 

environmental stressors such as these. 

Depression in Later Adulthood 

At one time, it was commonly thought that women were particularly 

vulnerable to depression when their children left home and they were 

confronted with "empty nest syndrome" and experienced a profound 

loss of purpose and identity. However, studies show no increase in 

depressive illness among women at this stage of life. 

10 
As with younger age groups, more elderly women than men 

suffer from depressive illness. Similarly, for all age groups, being 

unmarried (which includes widowhood) is also a risk factor for 

depression. Most important, depression should not be dismissed as a 

normal consequence of the physical, social, and economic problems 

of later life. In fact, studies show that most older people feel satisfied 

with their lives. 

About 800,000 persons are widowed each year. Most of them 

are older, female, and experience varying degrees of depressive 

symptomatology. Most do not need formal treatment, but those who 

are moderately or severely sad appear to benefit from self-help groups 

or various psychosocial treatments. However, a third of 

widows/widowers do meet criteria for major depressive episode in the 

first month after the death, and half of these remain clinically 

depressed 1 year later. These depressions respond to standard 

antidepressant treatments, although research on when to start 

treatment or how medications should be combined with psychosocial 

treatments is still in its early stages.4, 8 

Depression Is a Treatable Illness 

Even severe depression can be highly responsive to treatment. 

Indeed, believing one’s condition is "incurable" is often part of the 

hopelessness that accompanies serious depression. Such individuals 

should be provided with the information about the effectiveness of 

modern treatments for depression in a way that acknowledges their 

likely skepticism about whether treatment will work for them. As 

with many illnesses, the earlier treatment begins, the more effective 

and the greater the likelihood of preventing serious recurrences. Of 

course, treatment will not eliminate life’s inevitable stresses and ups 

11 
and downs. But it can greatly enhance the ability to manage such 

challenges and lead to greater enjoyment of life. 

The first step in treatment for depression should be a thorough 

examination to rule out any physical illnesses that may cause 

depressive symptoms. Since certain medications can cause the same 

symptoms as depression, the examining physician should be made 

aware of any medications being used. If a physical cause for the 

depression is not found, a psychological evaluation should be 

conducted by the physician or a referral made to a mental health 

professional. 

Types of Treatment for Depression 

The most commonly used treatments for depression are 

antidepressant medication, psychotherapy, or a combination of the 

two. Which of these is the right treatment for any one individual 

depends on the nature and severity of the depression and, to some 

extent, on individual preference. In mild or moderate depression, one 

or both of these treatments may be useful, while in severe or 

incapacitating depression, medication is generally recommended as a 

first step in the treatment.3 In combined treatment, medication can 

relieve physical symptoms quickly, while psychotherapy allows the 

opportunity to learn more effective ways of handling problems. 

Medications 

There are several types of antidepressant medications used to treat 

depressive disorders. These include newer medications—chiefly the 

selective serotonin reuptake inhibitors (SSRIs)—and the tricyclics and 

monoamine oxidase inhibitors (MAOIs). The SSRIs—and other 

newer medications that affect neurotransmitters such as dopamine or 

norepinephrine—generally have fewer side effects than tricyclics. 

Each acts on different chemical pathways of the human brain related 

12 
to moods. Antidepressant medications are not habit-forming. 

Although some individuals notice improvement in the first couple of 

weeks, usually antidepressant medications must be taken regularly 

for at least 4 weeks and, in some cases, as many as 8 weeks, before 

the full therapeutic effect occurs. To be effective and to prevent a 

relapse of the depression, medications must be taken for about 6 to 

12 months, carefully following the doctor’s instructions. Medications 

must be monitored to ensure the most effective dosage and to 

minimize side effects. For those who have had several bouts of 

depression, long-term treatment with medication is the most effective 

means of preventing recurring episodes. 

The prescribing doctor will provide information about possible 

side effects and, in the case of MAOIs, dietary and medication 

restrictions. In addition, other prescribed and over-the-counter 

medications or dietary supplements being used should be reviewed 

because some can interact negatively with antidepressant 

medication. There may be restrictions during pregnancy. 

For bipolar disorder, the treatment of choice for many years 

has been lithium, as it can be effective in smoothing out the mood 

swings common to this disorder. Its use must be carefully 

monitored, as the range between an effective dose and a toxic one 

can be relatively small. However, lithium may not be recommended 

if a person has pre-existing thyroid, kidney, or heart disorders or 

epilepsy. Fortunately, other medications have been found helpful in 

controlling mood swings. Among these are two mood-stabilizing 

anticonvulsants, carbamazepine (Tegretol®) and valproate 

(Depakote®). Both of these medications have gained wide 

acceptance in clinical practice, and valproate has been approved by 

the Food and Drug Administration for first-line treatment of acute 

mania. Since some studies indicate that valproate can interfere with 

hormonal function in adolescent girls, young girls taking valproate 

13 
should be monitored carefully by a physician. Other anticonvulsants 

that are being used now include lamotrigine (Lamictal®) and 

gabapentin (Neurontin®); their role in the treatment hierarchy of 

bipolar disorder remains under study. 

Most people who have bipolar disorder take more than one 

medication. Along with lithium and/or an anticonvulsant, they often 

take a medication for accompanying agitation, anxiety, insomnia, or 

depression. Some research indicates that an antidepressant, when 

taken without a mood stabilizing medication, can increase the risk of 

switching into mania or hypomania, or of developing rapid cycling, 

in people with bipolar disorder. Finding the best possible 

combination of these medications is of utmost importance to the 

patient and requires close monitoring by the physician. 

Herbal Therapy 

In the past few years, much interest has risen in the use of herbs in 

the treatment of both depression and anxiety. St. John's wort 

(Hypericum perforatum), an herb used extensively in the treatment of 

mild to moderate depression in Europe, has recently aroused interest 

in the United States. St. John's wort, an attractive bushy, lowgrowing plant covered with yellow flowers in summer, has been used 

for centuries in many folk and herbal remedies. Today in Germany, 

Hypericum is used in the treatment of depression more than any 

other antidepressant. However, the scientific studies that have been 

conducted on its use have been short-term and have used several 

different doses. 

Because of the widespread interest in St. John's wort, the 

National Institutes of Health (NIH) is conducting a 3-year study, 

sponsored by three NIH components—the National Institute of 

Mental Health, the National Institute for Complementary and 

Alternative Medicine, and the Office of Dietary Supplements. The 

14 
study is designed to include 336 patients with major depression, 

randomly assigned to an 8-week trial with one-third of patients 

receiving a uniform dose of St. John’s wort, another third an SSRI 

commonly prescribed for depression, and the final third a placebo (a 

pill that looks exactly like the SSRI and the St. John’s wort, but has 

no active ingredients). The study participants who respond positively 

will be followed for an additional 18 weeks. After the 3-year study 

has been completed, results will be analyzed and published. 

The Food and Drug Administration issued a Public Health 

Advisory on February 10, 2000. It stated that St. John’s wort appears 

to affect an important metabolic pathway that is used by many drugs 

prescribed to treat conditions such as heart disease, depression, 

seizures, certain cancers, and rejection of transplants. Therefore, 

health care providers should alert their patients about these potential 

drug interactions. Any herbal supplement should be taken only after 

consultation with the doctor or other health care provider. 

Psychotherapy 

In mild to moderate cases of depression, psychotherapy is also a 

treatment option. Some short-term (10 to 20 week) therapies have 

been very effective in several types of depression. "Talking" therapies 

help patients gain insight into and resolve their problems through 

verbal give-and-take with the therapist. "Behavioral" therapies help 

patients learn new behaviors that lead to more satisfaction in life and 

"unlearn" counter-productive behaviors. 

Research has shown that two short-term psychotherapies, 

interpersonal and cognitive-behavioral, are helpful for some forms of 

depression. Interpersonal therapy works to change interpersonal 

relationships that cause or exacerbate depression. Cognitivebehavioral therapy helps change negative styles of thinking and 

behaving that may contribute to the depression. 

15 
Electroconvulsive Therapy 

For individuals whose depression is severe or life threatening or for 

those who cannot take antidepressant medication, electroconvulsive 

therapy (ECT) is useful.3 This is particularly true for those with 

extreme suicide risk, severe agitation, psychotic thinking, severe 

weight loss or physical debilitation due as a result of physical illness. 

Over the years, ECT has been much improved. A muscle relaxant is 

given before treatment, which is done under brief anesthesia. 

Electrodes are placed at precise locations on the head to deliver 

electrical impulses. The stimulation causes a brief (about 30 

seconds) seizure within the brain. The person receiving ECT does not 

consciously experience the electrical stimulus. At least several 

sessions of ECT, usually given at the rate of three per week, are 

required for full therapeutic benefit. 

Treating Recurrent Depression 

Even when treatment is successful, depression may recur. Studies 

indicate that certain treatment strategies are very useful in this 

instance. Continuation of antidepressant medication at the same 

dose that successfully treated the acute episode can often prevent 

recurrence. Monthly interpersonal psychotherapy can lengthen the 

time between episodes in patients not taking medication. 

The Path to Healing 

Reaping the benefits of treatment begins by recognizing the signs 

of depression. The next step is to be evaluated by a qualified 

professional. Although depression can be diagnosed and treated by 

primary care physicians, often the physician will refer the patient to a 

psychiatrist, psychologist, clinical social worker, or other mental 

health professional. Treatment is a partnership between the patient 

16 
and the health care provider. An informed consumer knows her 

treatment options and discusses concerns with her provider as they 

arise. 

If there are no positive results after 2 to 3 months of 

treatment, or if symptoms worsen, discuss another treatment 

approach with the provider. Getting a second opinion from another 

health or mental health professional may also be in order. 

Here, again, are the steps to healing: 

■ Check your symptoms against the list on page 3. 

■ Talk to a health or mental health professional. 

■ Choose a treatment professional and a treatment approach 

with which you feel comfortable. 

■ Consider yourself a partner in treatment and be an informed 

consumer. 

■ If you are not comfortable or satisfied after 2 to 3 months, 

discuss this with your provider. Different or additional 

treatment may be recommended. 

■ If you experience a recurrence, remember what you know 

about coping with depression and don’t shy away from 

seeking help again. In fact, the sooner a recurrence is treated, 

the shorter its duration will be. 

Depressive illnesses make you feel exhausted, worthless, 

helpless, and hopeless. Such feelings make some people want to give 

up. It is important to realize that these negative feelings are part of 

the depression and will fade as treatment begins to take effect. 

Along with professional treatment, there are other things you 

can do to help yourself get better. Some people find participating in 

support groups very helpful. It may also help to spend some time 

with other people and to participate in activities that make you feel 

17 
better, such as mild exercise or yoga. Just don’t expect too much 

from yourself right away. Feeling better takes time. 

Where to Get Help 

If unsure where to go for help, ask your family doctor, OB/GYN 

physician, or health clinic for assistance. You can also check the 

Yellow Pages under "mental health," "health," "social services," 

"suicide prevention," "crisis intervention services," "hotlines," 

"hospitals," or "physicians" for phone numbers and addresses. In 

times of crisis, the emergency room doctor at a hospital may be able 

to provide temporary help for an emotional problem and will be able 

to tell you where and how to get further help. 

Listed below are the types of people and places that will make 

a referral to, or provide, diagnostic and treatment services. 

■ Family doctors 

■ Mental health specialists such as psychiatrists, psychologists, 

social workers, or mental health counselors 

■ Health maintenance organizations 

■ Community mental health centers 

■ Hospital psychiatry departments and outpatient clinics 

■ University- or medical school-affiliated programs 

■ State hospital outpatient clinics 

■ Family service/social agencies 

■ Private clinics and facilities 

■ Employee assistance programs 

■ Local medical and/or psychiatric societies 

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For Further Information 

National Institute of Mental Health


Information Resources and Inquiries Branch


6001 Executive Boulevard


Room 8184, MSC 9663


Bethesda, MD 20892-9663


Telephone: 1-301-443-4513


FAX: 1-301-443-4279


Depression brochures: 1-800-421-4211


TTY: 1-301-443-8431


FAX4U: 1-301-443-5158


Website: http://www.nimh.nih.gov


E-mail: nimhinfo@nih.gov


National Alliance for the Mentally Ill


2107 Wilson Boulevard, Suite 300


Arlington, VA 22201-3042


Telephone: 1-703-524-7600; 1-800-950-NAMI


Website: http://www.nami.org


A support and advocacy organization of consumers, families, and 

friends of people with severe mental illness—over 1,200 state and 

local affiliates. Local affiliates can often give guidance to finding 

treatment. 

National Depressive and Manic Depressive Association


730 N. Franklin, Suite 501


Chicago, IL 60601-3526


Telephone: 1-312- 642-0049; 1-800-826-3632


Website: http://www.ndmda.org


Purpose is to educate patients, families, and the public concerning the 

nature of depressive illnesses. Maintains an extensive catalog of 

helpful books. 

19 
National Foundation for Depressive Illness, Inc.


P.O. Box 2257


New York, NY 10016 


Telephone: 1-212-268-4260; 1-800-239-1265


Website: http://www.depression.org


A foundation that informs the public about depressive illness and its 

treatability and promotes programs of research, education and 

treatment. 

National Mental Health Association


1021 Prince Street


Alexandria, VA 22314-2971


Telephone: 1-703-684-7722; 1-800-969-6642


FAX: 1-703-684-5968


TTY: 1-800-433-5959


Website: http://www.nmha.org


An association that works with 340 affiliates to promote mental 

health through advocacy, education, research, and services. 

References 

1 Blehar MC, Oren DA. Gender differences in depression. Medscape 

Women’s Health, 1997;2:3. Revised from: Women’s increased 

vulnerability to mood disorders: Integrating psychobiology and 

epidemiology. Depression, 1995;3:3-12. 

2 Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of

the gender difference in lifetime rates of major depression. Archives 

of General Psychiatry, 2000; 57:21-27. 

3 Frank E, Karp JF, and Rush AJ. Efficacy of treatments for major

depression. Psychopharmacology Bulletin, 1993;29:457-75. 

20 
4 Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF,


Alexopoulos GS, Bruce ML, Conwell Y, Katz IR, Meyers BS, Morrison


MF, Mossey J, Niederehe G, and Parmelee P. Diagnosis and


treatment of depression in late life: Consensus statement update. 


Journal of the American Medical Association, 1997;278:1186-90.


5 Leibenluft E. Issues in the treatment of women with bipolar


illness. Journal of Clinical Psychiatry (supplement 15), 


1997;58:5-11.


6 Lewisohn PM, Hyman H, Roberts RE, Seeley JR, and Andrews JA. 


Adolescent psychopathology: 1. Prevalence and incidence of


depression and other DSM-III-R disorders in high school students. 


Journal of Abnormal Psychology, 1993;102:133-44.


7 Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, and

Goodwin FK. Comorbidity of mental disorders with alcohol and other 

drug abuse: Results from the epidemiologic catchment area (ECA) study. 

Journal of the American Medical Association, 1993;264:2511-8. 

8 Reynolds CF, Miller MD, Pasternak RE, Frank E, Perel JM, Cornes C, 

Houck PR, Mazumdar S, Dew MA, and Kupfer DJ. Treatment of 

bereavement-related major depressive episodes in later life: A 

controlled study of acute and continuation treatment with 

nortriptyline and interpersonal psychotherapy. American Journal of 

Psychiatry, 1999;156:202-8. 

9 Robins LN and Regier DA (Eds). Psychiatric Disorders in America,

The Epidemiologic Catchment Area Study. New York: The Free Press, 

1990�

21 
10 Rubinow DR, Schmidt PJ, and Roca CA. Estrogen-serotonin 

interactions: Implications for affective regulation. Biological 

Psychiatry, 1998;44(9):839-50. 

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Rubin-Stiper M, Wells JE, Wickramaratne PJ, Wittchen H, and Yeh EK. 

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Helpful Books 

Many books have been written on major depression and bipolar 

disorder. The following are a few that may help you understand 

these illnesses better. 

Andreasen, Nancy. The Broken Brain: The Biological 

Revolution in Psychiatry. New York: Harper & Row, 1984. 

Carter, Rosalyn. Helping Someone With Mental Illness: A 

Compassionate Guide for Family, Friends and Caregivers. New York: 

Times Books, 1998. 

Duke, Patty and Turan, Kenneth. Call Me Anna, The 

Autobiography of Patty Duke. New York: Bantam Books, 1987. 

Dumquah, Meri Nana-Ama. Willow Weep for Me, A Black 

Woman’s Journey Through Depression: A Memoir. New York: W.W. 

Norton & Co., Inc., 1998. 

Fieve, Ronald R. Moodswing. New York: Bantam Books, 1997. 

Jamison, Kay Redfield. An Unquiet Mind, A Memoir of Moods 

and Madness. New York: Random House, 1996. 

22 
The following three booklets are available from the Madison Institute 

of Medicine, 7617 Mineral Point Road, Suite 300, Madison, WI 

53717, telephone 1-608-827-2470: 

Tunali D, Jefferson JW, and Greist JH, Depression & 

Antidepressants: A Guide, rev. ed. 1997. 

Jefferson JW and Greist JH. Divalproex and Manic Depression: 

A Guide, 1996 (formerly Valproate guide). 

Bohn J and Jefferson JW. Lithium and Manic Depression: A 

Guide, rev. ed. 1996. 

____________________________ 

Depression: What Every Woman Should Know was originally developed for 

the Depression Awareness, Recognition, and Treatment (D/ART) program. 

The brochure has been revised by Margaret Strock, staff member in the 

Information Resources and Inquiries Branch, Office of Communications and 

Public Liaison, National Institute of Mental Health (NIMH). Expert 

assistance was provided by Mary Blehar, PhD, Matthew Rudorfer, MD, 

Melissa Spearing, and Clarissa Wittenberg, NIMH staff members, and by 

Ellen Frank, MD, Western Psychiatric Institute, University of Pittsburgh 

Medical Center. Their help in assuring the accuracy of this brochure is 

gratefully acknowledged. Editorial assistance was provided by Lisa Alberts, 

NIMH staff member. 

All material in this publication is free of copyright restrictions and may be 

copied, reproduced, or duplicated without permission from NIMH; citation of 

the source is appreciated. 

23 
For more information on research into the brain, behavior, and mental


disorders contact:


National Institute of Mental Health


Information Resources and Inquiries Branch


6001 Executive Boulevard, Room 8184, MSC 9663


Bethesda, Maryland 20892-9663


Telephone: 1-301-443-4513


TTY: 1-301-443-8431


FAX: 1-301-443-4279


Mental Health FAX 4U 1-301-443-5158


E-mail: nimhinfo@nih.gov


Website: http://www.nimh.nih.gov


NIH Publication No. 00-3679 

August 2000 

24