women and depression
 

discovering hope
 

National Institute of Mental Health 
Contents 

What is depression? 2 

What are the different forms of depression? 3 

What are the basic symptoms of depression? 4 

What causes depression in women? 5 

What illnesses often coexist with 

depression in women? 8 

How does depression affect adolescent girls? 9 

How does depression affect older women? 10 

How is depression diagnosed and treated? 11 

What efforts are underway to 

improve treatment? 21 

How can I help a friend or relative 

who is depressed? 22 

How can I help myself if I am depressed? 23 

Where can I go for help? 24 

What if I or someone I know is in crisis? 25 

Citations 26


For more information 28 
What is depression? 

Everyone occasionally feels blue or sad, but these feelings 

are usually fleeting and pass within a couple of days. When 

a woman has a depressive disorder, it interferes with daily 

life and normal functioning, and causes pain for both the 

woman with the disorder and those who care about her. 

Depression is a common but serious illness, and most who 

have it need treatment to get better. 

Depression affects both men and women, but more women 

than men are likely to be diagnosed with depression in any 

given year.1

 Efforts to explain this difference are ongoing, as 

researchers explore certain factors (biological, social, etc.) 

that are unique to women. 

Many women with a depressive illness never seek treatment. But the vast majority, even those with the most 

severe depression, can get better with treatment. 

Depression affects both men and women... 

...but more women than men are likely to be 

diagnosed with depression in any given year. 

2 National Institute of Mental Health 
What are the different forms of depression? 

There are several forms of depressive disorders that occur in 

both women and men. The most common are major depressive disorder and dysthymic disorder. Minor depression is 

also common. 

Major depressive disorder, also called major depression, is 

characterized by a combination of symptoms that interfere 

with a person’s ability to work, sleep, study, eat, and enjoy 

once-pleasurable activities. Major depression is disabling and 

prevents a person from functioning normally. An episode of 

major depression may occur only once in a person’s lifetime, 

but more often, it recurs throughout a person’s life. 

Dysthymic disorder, also called dysthymia, is characterized 

by depressive symptoms that are long-term (e.g., 2 years or 

longer) but less severe than those of major depression. Dysthymia may not disable a person, but it prevents one from 

functioning normally or feeling well. People with dysthymia 

may also experience one or more episodes of major depression during their lifetimes. 

Minor depression may also occur. Symptoms of minor 

depression are similar to major depression and dysthymia, 

but they are less severe and/or are usually shorter term. 

Some forms of depressive disorder have slightly different 

characteristics than those described above, or they may 

develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms 

of depression. They include the following: 

•	

•	

Psychotic depression occurs when a severe depressive illness is accompanied by some form of psychosis, such as 

a break with reality; seeing, hearing, smelling or feeling 

things that others can’t detect (hallucinations); and having 

strong beliefs that are false, such as believing you are the 

president (delusions). 

Seasonal aff ective disorder (SAD) is characterized by a 

depressive illness during the winter months, when there is 

less natural sunlight. The depression generally lift s during 

spring and summer. SAD may be effectively treated with 

light therapy, but nearly half of those with SAD do not 

respond to light therapy alone. Antidepressant medication 

and psychotherapy also can reduce SAD symptoms, either 

alone or in combination with light therapy.2 

Women and Depression 

Bipolar disorder, 

also called manicdepressive illness, is 

not as common as 

major depression or 

dysthymia. Bipolar 

disorder is characterized by cycling 

mood changes— 

from extreme highs 

(e.g., mania) to 

extreme lows (e.g., 

depression). More 

information about 

bipolar disorder is 

available at http:// 

www.nimh.nih.gov/ 

health/topics/ 

bipolar-disorder/ 

index.shtml. 

3 
What are the basic signs and symptoms of 

depression? 

Women with depressive illnesses do not all experience the 

same symptoms. In addition, the severity and frequency 

of symptoms, and how long they last, will vary depending on the individual and her particular illness. Signs and 

symptoms of depression include: 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Persistent sad, anxious or “empty” feelings 

Feelings of hopelessness and/or pessimism 

Irritability, restlessness, anxiety 

Feelings of guilt, worthlessness and/or helplessness 

Loss of interest in activities or hobbies once 

pleasurable, including sex 

Fatigue and decreased energy 

Difficulty concentrating, remembering details and 

making decisions 

Insomnia, waking up during the night, or excessive 

sleeping 

Overeating, or appetite loss 

Thoughts of suicide, suicide attempts 

Persistent aches or pains, headaches, cramps 

or digestive problems that do not ease even 

with treatment 

National Institute of Mental Health 4 
What causes depression in women? 

Scientists are examining many potential causes for and contributing factors to women’s increased risk for depression. 

It is likely that genetic, biological, chemical, hormonal, 

environmental, psychological, and social factors all intersect to contribute to depression. 

Genetics 

If a woman has a family history of depression, she may be 

more at risk of developing the illness. However, this is not a 

hard and fast rule. Depression can occur in women without 

family histories of depression, and women from families 

with a history of depression may not develop depression 

themselves. Genetics research indicates that the risk for 

developing depression likely involves the combination of 

multiple genes with environmental or other factors.3 

Chemicals and hormones 

Brain chemistry appears to be a significant factor in depressive disorders. Modern brain-imaging technologies, such 

as magnetic resonance imaging (MRI), have shown that 

the brains of people suffering from depression look different than those of people without depression. Th e parts 

of the brain responsible for regulating mood, thinking, 

sleep, appetite and behavior don’t appear to be functioning normally. In addition, important neurotransmitters— 

chemicals that brain cells use to communicate—appear to 

be out of balance. But these images do not reveal WHY the 

depression has occurred. 

Scientists are also studying the influence of female hormones, which change throughout life. Researchers have 

shown that hormones directly affect the brain chemistry 

that controls emotions and mood. Specific times during a 

woman’s life are of particular interest, including puberty; 

the times before menstrual periods; before, during, and just 

after pregnancy (postpartum); and just prior to and during 

menopause (perimenopause). 

Women and Depression 5 
Premenstrual dysphoric disorder 

Some women may be susceptible to a severe form of 

premenstrual syndrome called premenstrual dysphoric 

disorder (PMDD). Women affected by PMDD typically 

experience depression, anxiety, irritability and mood swings 

the week before menstruation, in such a way that interferes 

with their normal functioning. Women with debilitating 

PMDD do not necessarily have unusual hormone changes, 

but they do have different responses to these changes.4 

They may also have a history of other mood disorders 

and differences in brain chemistry that cause them to be 

more sensitive to menstruation-related hormone changes. 

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.5,6,7 

Postpartum depression 

Women are particularly vulnerable to depression aft er giving 

birth, when hormonal and physical changes and the new 

responsibility of caring for a newborn can be overwhelming. 

Many new mothers experience a brief episode of mild mood 

changes known as the “baby blues,” but some will suff er from 

postpartum depression, a much more serious condition that 

requires active treatment and emotional support for the new 

mother. One study found that postpartum women are at an 

increased risk for several mental disorders, including depression, for several months aft er childbirth.8 

Some studies suggest that women who experience postpartum depression often have had prior depressive episodes. 

Some experience it during their pregnancies, but it often 

goes undetected. Research suggests that visits to the doctor 

may be good opportunities for screening for depression both 

during pregnancy and in the postpartum period.9,10 

Menopause 

Hormonal changes increase during the transition between 

premenopause to menopause. While some women may 

transition into menopause without any problems with 

mood, others experience an increased risk for depression. This seems to occur even among women without a history of 

depression.11,12 However, depression becomes less common 

for women during the post-menopause period.13 

6 National Institute of Mental Health 
Stress 

Stressful life events such as trauma, loss of a loved one, 

a difficult relationship or any stressful situation—whether 

welcome or unwelcome—often occur before a depressive 

episode. Additional work and home responsibilities, caring 

for children and aging parents, abuse, and poverty also may 

trigger a depressive episode. Evidence suggests that women 

respond differently than men to these events, making them 

more prone to depression. In fact, research indicates that 

women respond in such a way that prolongs their feelings 

of stress more so than men, increasing the risk for depression.14 However, it is unclear why some women faced with 

enormous challenges develop depression, and some with 

similar challenges do not. 

Women and Depression 7
What illnesses often coexist with depression 

in women? 

Depression often coexists with other illnesses that may 

precede the depression, follow it, cause it, be a consequence 

of it, or a combination of these. It is likely that the interplay 

between depression and other illnesses differs for every 

person and situation. Regardless, these other coexisting 

illnesses need to be diagnosed and treated. 

Depression often coexists with eating disorders such as 

anorexia nervosa, bulimia nervosa and others, especially 

among women. Anxiety disorders, such as post-traumatic 

stress disorder (PTSD), obsessive-compulsive disorder, panic 

disorder, social phobia and generalized anxiety disorder, 

also sometimes accompany depression.15,16 Women are more 

prone than men to having a coexisting anxiety disorder.17 

Women suffering from PTSD, which can result after a person 

endures a terrifying ordeal or event, are especially prone to 

having depression. 

Although more common among men than women, alcohol 

and substance abuse or dependence may occur at the 

same time as depression.17,15 Research has indicated that 

among both sexes, the coexistence of mood disorders and 

substance abuse is common among the U.S. population.18 

Depression also often coexists with other serious medical 

illnesses such as heart disease, stroke, cancer, HIV/AIDS, 

diabetes, Parkinson’s disease, thyroid problems and 

multiple sclerosis, and may even make symptoms of the 

illness worse.19 Studies have shown that both women and 

men who have depression in addition to a serious medical 

illness tend to have more severe symptoms of both illnesses. 

They also have more difficulty adapting to their medical 

condition, and more medical costs than those who do 

not have coexisting depression. Research has shown that 

treating the depression along with the coexisting illness 

will help ease both conditions.20 

8 National Institute of Mental Health 
How does depression affect adolescent girls? 

Before adolescence, girls and boys experience depression 

at about the same frequency.13 By adolescence, however, 

girls become more likely to experience depression than 

boys. 

Research points to several possible reasons for this 

imbalance. The biological and hormonal changes that occur 

during puberty likely contribute to the sharp increase in 

rates of depression among adolescent girls. In addition, 

research has suggested that girls are more likely than 

boys to continue feeling bad after experiencing difficult 

situations or events, suggesting they are more prone to 

depression.21 Another study found that girls tended to 

doubt themselves, doubt their problem-solving abilities and 

view their problems as unsolvable more so than boys. Th e 

girls with these views were more likely to have depressive 

symptoms as well. Girls also tended to need a higher degree 

of approval and success to feel secure than boys.22 

Finally, girls may undergo more hardships, such as poverty, 

poor education, childhood sexual abuse, and other traumas 

than boys. One study found that more than 70 percent 

of depressed girls experienced a diffi cult or stressful life 

event prior to a depressive episode, as compared with only 

14 percent of boys.23 

The biological and hormonal changes that 

occur during puberty likely contribute to the 

sharp increase in rates of depression among 

adolescent girls. 

Women and Depression 9 
How does depression affect older women? 

As with other age groups, more older women than older 

men experience depression, but rates decrease among 

women after menopause.13 Evidence suggests that 

depression in post-menopausal women generally occurs 

in women with prior histories of depression. In any case, 

depression is NOT a normal part of aging. 

The death of a spouse or loved one, moving from work 

into retirement, or dealing with a chronic illness can leave 

women and men alike feeling sad or distressed. After a 

period of adjustment, many older women can regain their 

emotional balance, but others do not and may develop 

depression. When older women do suffer from depression, 

it may be overlooked because older adults may be less 

willing to discuss feelings of sadness or grief, or they may 

have less obvious symptoms of depression. As a result, their 

doctors may be less likely to suspect or spot it. 

For older adults who experience depression for the fi rst 

time later in life, other factors, such as changes in the 

brain or body, may be at play. For example, older adults 

may suffer from restricted blood flow, a condition called 

ischemia. Over time, blood vessels become less fl exible. 

They may harden and prevent blood from fl owing normally 

to the body’s organs, including the brain. If this occurs, an 

older adult with no family or personal history of depression 

may develop what some doctors call “vascular depression.” 

Those with vascular depression also may be at risk for a 

coexisting cardiovascular illness, such as heart disease 

or a stroke.24 

10 National Institute of Mental Health 
How is depression diagnosed and treated? 

Depressive illnesses, even the most severe cases, are highly 

treatable disorders. As with many illnesses, the earlier that 

treatment can begin, the more effective it is and the greater 

the likelihood that a recurrence of the depression can 

be prevented. 

Th e first step to getting appropriate treatment is to visit a 

doctor. Certain medications, and some medical conditions 

such as viruses or a thyroid disorder, can cause the same 

symptoms as depression. In addition, it is important to 

rule out depression that is associated with another mental 

illness called bipolar disorder. (For more information about 

bipolar disorder, visit the National Institute of Mental 

Health’s (NIMH) Web site at http://www.nimh.nih.gov). 

A doctor can rule out these possibilities by conducting 

a physical examination, interview, and/or lab tests, 

depending on the medical condition. If a medical condition 

and bipolar disorder can be ruled out, the physician should 

conduct a psychological evaluation or refer the person to a 

mental health professional. 

The doctor or mental health professional will conduct a 

complete diagnostic evaluation. He or she should get a 

complete history of symptoms, including when they started, 

how long they have lasted, their severity, whether they have 

occurred before, and if so, how they were treated. He or she 

should also ask if there is a family history of depression. 

In addition, he or she should ask if the person is using 

alcohol or drugs, and whether the person is thinking about 

death or suicide. 

Once diagnosed, a person with depression can be treated 

with a number of methods. The most common treatment 

methods are medication and psychotherapy. 

...the earlier that treatment can begin, 

the more effective it is. 

Women and Depression 11
Medication 

Antidepressants work to normalize naturally occurring 

brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work 

on the neurotransmitter dopamine. Scientists studying 

depression have found that these particular chemicals are 

involved in regulating mood, but they are unsure of the 

exact ways in which they work. 

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors 

(SSRIs) and include: 

•

•

•

•

•

•

fl uoxetine (Prozac) 

citalopram(Celexa) 

sertraline (Zoloft ) 

paroxetine (Paxil) 

escitalopram (Lexapro) 

fl uvoxamine (Luvox) 

Serotonin and norepinephrine reuptake inhibitors 

(SNRIs) are similar to SSRIs and include: 

•

•

venlafaxine (Eff exor) 

duloxetine (Cymbalta) 

SSRIs and SNRIs tend to have fewer side eff ects and are 

more popular than the older classes of antidepressants, such 

as tricyclics—named for their chemical structure—and 

monoamine oxidase inhibitors (MAOIs). However, medications affect everyone diff erently. There is no one-sizefits-all approach to medication. Therefore, for some people, 

tricyclics or MAOIs may be the best choice. 

People taking MAOIs must adhere to significant food and 

medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high 

levels of the chemical tyramine, which is found in many 

cheeses, wines and pickles, and some medications including decongestants. Most MAOIs interact with tyramine in 

such a way that may cause a sharp increase in blood pressure, which may lead to a stroke. A doctor should give a 

person taking an MAOI a complete list of prohibited foods, 

medicines and substances. 

National Institute of Mental Health 12 
For all classes of antidepressants, people must take regular 

doses for at least 3 to 4 weeks, sometimes longer, before 

they are likely to experience a full effect. They should 

continue taking the medication for an amount of time 

specified by their doctor, even if they are feeling better, to 

prevent a relapse of the depression. The decision to stop 

taking medication should be made by the person and her 

doctor together, and should be done only under the doctor’s supervision. Some medications need to be gradually 

stopped to give the body time to adjust. Although they are 

not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a 

relapse. Some individuals, such as those with chronic or 

recurrent depression, may need to stay on the medication 

indefi nitely. 

In addition, if one medication does not work, people should 

be open to trying another. Research funded by NIMH 

has shown that those who did not get well after taking a 

first medication often fared better after they switched to a 

different medication or added another medication to their 

existing one.25,26 For the latest information on medications 

used to treat depression, see the U.S. Food and Drug 

Administration Web site at http://www.fda.gov. 

Sometimes other medications, such as stimulants or antianxiety medications, are used in conjunction with an antidepressant, especially if the person has a coexisting illness. 

However, neither antianxiety medications nor stimulants 

are effective against depression when taken alone, and both 

should be taken only under a doctor’s close supervision. 

...people who did not get well 

after taking a first medication often 

fared better after they switched 

to a different medication, or added 

another medication to their existing one. 

Women and Depression 13 
Is it safe to take antidepressant medication 

during pregnancy? 

At one time, doctors assumed that pregnancy was accompanied by a natural feeling of well being, and that depression during pregnancy was rare, or never occurred at all. 

However, recent studies have shown that women can have 

depression while pregnant, especially if they have a prior 

history of the illness. In fact, a majority of women with a 

history of depression will likely relapse during pregnancy 

if they stop taking their antidepressant medication either 

prior to conception or early in the pregnancy, putting both 

mother and baby at risk.27,12 

However, antidepressant medications do pass across the 

placental barrier, potentially exposing the developing fetus 

to the medication. Some research suggests the use of SSRIs 

during pregnancy is associated with miscarriage and/or 

birth defects, but other studies do not support this.28 Some 

studies have indicated that fetuses exposed to SSRIs during 

the third trimester may be born with “withdrawal” symptoms such as breathing problems, jitteriness, irritability, 

difficulty feeding, or hypoglycemia. In 2004, the U.S. Food 

and Drug Administration (FDA) issued a warning against 

the use of SSRIs in the late third trimester, suggesting that 

clinicians gradually taper expectant mothers off SSRIs in 

the third trimester to avoid any ill effects on the baby.29 

Although some studies suggest that exposure to SSRIs in 

pregnancy may have adverse effects on the infant, generally they are mild and short-lived, and no deaths have been 

reported. On the flip side, women who stop taking their 

antidepressant medication during pregnancy increase their 

risk for developing depression again and may put both 

themselves and their infant at risk.28,12 

In light of these mixed results, women and their doctors 

need to consider the potential risks and benefi ts to both 

mother and fetus of taking an antidepressant during pregnancy, and make decisions based on individual needs and 

circumstances. In some cases, a woman and her doctor 

may decide to taper her antidepressant dose during the last 

month of pregnancy to minimize the newborn’s withdrawal 

symptoms, and after delivery, return to a full dose during 

the vulnerable postpartum period. 

National Institute of Mental Health 14 
Is it safe to take antidepressant medication while 

breastfeeding? 

Antidepressants are excreted in breast milk, usually in very 

small amounts. The amount an infant receives is usually so 

small that it does not register in blood tests. Few problems 

are seen among infants nursing from mothers who are 

taking antidepressants. However, as with antidepressant use 

during pregnancy, both the risks and benefits to the mother 

and infant should be taken into account when deciding 

whether to take an antidepressant while breastfeeding.30 

Women and their doctors need to 

consider the potential risks and benefits 

to both mother and fetus of taking an 

antidepressant during pregnancy... 

Women and Depression 15 
What are the side effects of antidepressants?
 

Antidepressants may cause mild and often temporary side 

effects in some people, but usually they are not long-term. 

However, any unusual reactions or side effects that interfere with normal functioning or are persistent or troublesome should be reported to a doctor immediately. 

The most common side effects associated with SSRIs 

and SNRIs include: 

•	 

•	 

•	 

•	 

•	 

Headache – usually temporary and will subside. 

Nausea – temporary and usually short-lived. 

Insomnia and nervousness (trouble falling asleep or 

waking often during the night) – may occur during the 

first few weeks but often subside over time or if the dose 

is reduced. 

Agitation (e.g., feeling jittery). 

Sexual problems – women can experience sexual problems 

including reduced sex drive and problems having and 

enjoying sex. 

Tricyclic antidepressants also can cause side effects 

including: 

•	 

•	 

•	 

•	 

•	 

•	 

Dry mouth – it is helpful to drink plenty of water, chew 

gum, and clean teeth daily. 

Constipation – it is helpful to eat more bran cereals, 

prunes, fruits, and vegetables. 

Bladder problems – emptying the bladder may be 

difficult, and the urine stream may not be as strong as 

usual. 

Sexual problems – sexual functioning may change, and 

side effects are similar to those from SSRIs and SNRIs. 

Blurred vision – often passes soon and usually will not 

require a new corrective lenses prescription. 

Drowsiness during the day – usually passes soon, but 

driving or operating heavy machinery should be avoided 

while drowsiness occurs. These more sedating antidepressants are generally taken at bedtime to help sleep and 

minimize daytime drowsiness. 

National Institute of Mental Health 16 
FDA warning on antidepressants 

Despite the relative safety and popularity of SSRIs and other 

antidepressants, some studies have suggested that they may 

have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and 

unpublished controlled clinical trials of antidepressants that 

involved nearly 4,400 children and adolescents. Th e review 

revealed that 4 percent of those taking antidepressants thought 

about or attempted suicide (although no suicides occurred), 

compared to 2 percent of those receiving placebos. 

This information prompted the FDA, in 2005, to adopt a 

“black box” warning label on all antidepressant medications 

to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking 

antidepressants. In 2007, the FDA proposed that makers of 

all antidepressant medications extend the warning to include 

young adults up through age 24. A “black box” warning is the 

most serious type of warning on prescription drug labeling. 

The warning emphasizes that patients of all ages taking 

antidepressants should be closely monitored, especially during 

the initial weeks of treatment. Possible side effects to look 

for are worsening depression, suicidal thinking or behavior, 

or any unusual changes in behavior such as sleeplessness, 

agitation, or withdrawal from normal social situations. Th e 

warning adds that families and caregivers should also be told 

of the need for close monitoring and report any changes to 

their physician. The latest information from the FDA can be 

found on their Web site at www.fda.gov. 

Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefi ts 

of antidepressant medications likely outweigh their risks to 

children and adolescents with major depression and anxiety 

disorders. The study was funded in part by the National Institute of Mental Health.31 

Also, the FDA issued a warning that combining an SSRI 

or SNRI antidepressant with one of the commonly-used 

“triptan” medications for migraine headache could cause a 

life-threatening “serotonin syndrome,” marked by agitation, 

hallucinations, elevated body temperature, and rapid changes 

in blood pressure. Although most dramatic in the case of the 

MAOIs, newer antidepressants may also be associated with 

potentially dangerous interactions with other medications. 

Women and Depression 17 
What about St. John’s wort? 

The extract from the herb St. John’s wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal 

remedies. Today in Europe, it is used extensively to treat 

mild to moderate depression. In the United States, it is a 

top-selling botanical product. 

To address increasing American interest in St. John’s wort, 

the National Institutes of Health (NIH) conducted a clinical trial to determine the effectiveness of the herb in treating adults suffering from major depression. Involving 340 

patients diagnosed with major depression, the 8-week trial 

randomly assigned one-third of them to a uniform dose of 

St. John’s wort, one-third to a commonly prescribed SSRI, 

and one-third to a placebo. The trial found that St. John’s 

wort was no more effective than the placebo in treating 

major depression.32 Another study is underway to look 

at the effectiveness of St. John’s wort for treating mild or 

minor depression. 

Other research has shown that St. John’s wort can interact 

unfavorably with other drugs, including drugs used to control HIV infection. On February 10, 2000, the FDA issued a 

Public Health Advisory letter stating that the herb appears 

to interfere with certain drugs used to treat heart disease, 

depression, seizures, certain cancers, and organ transplant 

rejection. The herb also may interfere with the eff ectiveness 

of oral contraceptives. Because of these and other potential interactions, people should always consult their doctors 

before taking any herbal supplement. 

18 National Institute of Mental Health 
Psychotherapy 

Several types of psychotherapy—or “talk therapy”— 

can help people with depression. 

Some regimens are short-term (10 to 20 weeks) and 

other regimens are longer-term, depending on the needs 

of the individual. Two main types of psychotherapies— 

cognitive-behavioral therapy (CBT) and interpersonal 

therapy (IPT)—have been shown to be effective in treating 

depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking 

and behaving that may contribute to their depression. IPT 

helps people understand and work through troubled personal relationships that may cause their depression or make 

it worse. 

For mild to moderate depression, psychotherapy may be 

the best treatment option. However, for major depression 

or for certain people, psychotherapy may not be enough. 

Studies have indicated that for adolescents, a combination 

of medication and psychotherapy may be the most eff ective approach to treating major depression and reducing 

the likelihood for recurrence.33 Similarly, a study examining depression treatment among older adults found that 

patients who responded to initial treatment of medication and IPT were less likely to have recurring depression 

if they continued their combination treatment for at least 

two years.34 

Several types of psychotherapy— 

or “talk therapy”— can help people 

with depression. 

Women and Depression 19
Electroconvulsive Therapy
 

For cases in which medication and/or psychotherapy does 

not help alleviate a person’s treatment-resistant depression, 

electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” used to have a negative 

reputation. But in recent years, it has greatly improved and 

can provide relief for people with severe depression who 

have not been able to feel better with other treatments. 

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. She does not consciously feel the electrical impulse that is administered. A 

person typically will undergo ECT several times a week, 

and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and 

prevent relapse. Although some people will need only a few 

courses of ECT, others may need maintenance ECT, usually 

once a week at first, then gradually decreasing to monthly 

treatments for up to 1 year. 

ECT may cause some short-term side effects, including 

confusion, disorientation and memory loss. But these side 

effects typically clear shortly after treatment. Research 

has indicated that after 1 year of ECT treatments, patients 

showed no adverse cognitive effects.35 A person should 

weigh the potential risks and benefits of ECT and discuss 

them with her doctor before deciding to undergo ECT 

treatment. 

20 National Institute of Mental Health 
What efforts are underway to improve 

treatment? 

Researchers are looking for ways to better understand, 

diagnose and treat depression among all groups of people. 

New possible treatments, such as faster-acting antidepressants, are being tested that give hope to those who live with 

difficult-to-treat depression. Researchers are studying the 

risk factors for depression and how it affects the brain. NIMH 

continues to fund cutting-edge research into this debilitating 

disorder. For more information on NIMH-funded research 

on depression visit http://www.nimh.nih.gov. 

Women and Depression 21 
How can I help a friend or relative who is 

depressed? 

If you know someone who has depression, the first and 

most important thing you can do is to help her get an 

appropriate diagnosis and treatment. You may need to 

make an appointment on her behalf and go with her to see 

the doctor. Encourage her to stay in treatment, or to seek 

different treatment if no improvement occurs after 6 to 

8 weeks. 

In addition, you can also: 

•	 

•	 

•	 

•	 

•	 

•	 

Offer emotional support, understanding, patience and 

encouragement. 

Engage her in conversation, and listen carefully. 

Never disparage feelings she expresses, but point out 

realities and off er hope. 

Never ignore comments about suicide, and report them 

to your friend’s or relative’s therapist or doctor. 

Invite your friend or relative out for walks, outings and 

other activities. Keep trying if she declines, but don’t 

push her to take on too much too soon. Although diversions and company are needed, too many demands may 

increase feelings of failure. 

Remind her that with time and treatment, the depression 

will lift . 

22 National Institute of Mental Health 
How can I help myself if I am depressed? 

You may feel exhausted, helpless and hopeless. It may be 

extremely difficult to take any action to help yourself. But 

it is important to realize that these feelings are part of the 

depression and do not reflect actual circumstances. As you 

recognize your depression and begin treatment, negative 

thinking will fade. In the meantime: 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

Engage in mild activity or exercise. Go to a movie, a 

ballgame, or another event or activity that you once 

enjoyed. Participate in religious, social or other activities. 

Set realistic goals for yourself. 

Break up large tasks into small ones, set some priorities 

and do what you can as you can. 

Try to spend time with other people and confide in a 

trusted friend or relative. Try not to isolate yourself, and 

let others help you. 

Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of ” your 

depression. Often during treatment for depression, sleep 

and appetite will begin to improve before your depressed 

mood lift s. 

Postpone important decisions, such as getting married 

or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have 

a more objective view of your situation. 

Be confident that positive thinking will replace negative 

thoughts as your depression responds to treatment. 

Women and Depression 23 
Where can I go for help?
 

If you are unsure where to go for help, ask your family
 

doctor. Others who can help are: 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

•	 

Mental health specialists, such as psychiatrists, 

psychologists, social workers, or mental health 

counselors. 

Health maintenance organizations (HMOs). 

Community mental health centers. 

Hospital psychiatry departments and outpatient clinics. 

Mental health programs at universities or medical 

schools. 

State hospital outpatient clinics. 

Family services, social agencies or clergy. 

Peer support groups. 

Private clinics and facilities. 

Employee assistance programs. 

Local medical and/or psychiatric societies. 

You can also check the phone book under “mental health,” 

“health,” “social services,” “hotlines,” or “physicians” for 

phone numbers and addresses. An emergency room doctor 

also can provide temporary help and can tell you where 

and how to get further help. 

24 National Institute of Mental Health 
What if I or someone I know is in crisis? 

Women are more likely than men to attempt 

suicide. If you are thinking about harming yourself 

or attempting suicide, tell someone who can help 

immediately. 

• 

• 

• 

• 

Call your doctor. 

Call 911 for emergency services. 

Go to the nearest hospital emergency room. 

Call the toll-free, 24-hour hotline of the 

National Suicide Prevention Lifeline at 

1-800-273-TALK (1-800-273-8255); 

TTY: 1-800-799-4TTY (4889) to be connected 

to a trained counselor at a suicide crisis center 

nearest you. 

Women and Depression 25 
Citations 

1. 	 Kessler RC, Berglund P, Demler O, Jin R, 

Koretz D, Merikangas KR, Rush AJ, Walters 

EE, Wang PS. The epidemiology of major 

depressive disorder: results from the National 

Comorbidity Survey Replication (NCS-R). 

Journal of the American Medical Association. 

2003; 289(3): 3095-3105. 

2. 	 Rohan KJ, Lindsey KT, Roecklein KA, Lacy 

TJ. Cognitive-behavioral therapy, light 

therapy and their combination in treating 

seasonal affective disorder. Journal of Affective 

Disorders. 2004; 80: 273-283. 

3. 	 Tsuang MT, Bar JL, Stone WS, Faraone SV. 

Gene-environment interactions in mental 

disorders. World Psychiatry. 2004 Jun; 3(2): 

73-83. 

4. 	 Schmidt PJ, Nieman LK, Danaceau MA, 

Adams LF, Rubinow DR. Differential 

behavioral effects of gonadal steroids 

in women with and in those without 

premenstrual syndrome. New England Journal 

of Medicine. 1998 Jan 22; 338(4): 209-216. 

5. 	 Rubinow DR, Schmidt PJ, Roca CA. Estrogenserotonin interactions: Implications for 

affective regulation. Biological Psychiatry. 1998; 

44(9): 839-850. 

6. 	 Ross LE, Steiner M. A Biopsychosocial 

approach to premenstrual dysphoric disorder. 

Psychiatric Clinics of North America. 2003; 

26(3): 529-546. 

7. 	 Dreher JC, Schmidt PJ, Kohn P, Furman D, 

Rubinow D, Berman KF. Menstrual cycle 

phase modulates reward-related neural 

function in women. Proceedings of the National 

Academy of Sciences. 2007 Feb 13; 104(7): 

2465-2470. 

8. 	 Munk-Olsen T, Laursen TM, Pederson CB, 

Mores O, Mortensen PB. New parents and 

mental disorders. Journal of the American 

Medical Association. 2006 Dec 6; 296(21): 

2582-2589. 

9. 	 Chaudron LH, Szilagyi PG, Kitzman HJ, 

Wadkins HI, Conwell Y. Detection of 

postpartum depressive symptoms by 

screening at well-child visits. Pediatrics. 2004 

Mar; 113(3 Pt 1): 551-558. 

10. Freeman MP, Wright R, Watchman M, 

Wahl RA, Sisk DJ, Fraleigh L, Weibrecht JM. 

Postpartum depression assessments at wellbaby visits: screening feasibility, prevalence 

and risk factors. Journal of Women’s Health. 

2005 Nov 10; 14(10): 929-935. 

11. Freeman EW, Sammel MD, Lin H, Nelson 

DB. Associations of hormones and 

menopausal status with depressed mood 

in women with no history of depression. 

Archives of General Psychiatry. 2006 Apr; 

63(4): 375-382. 

12. Cohen L, Altshuler L, Harlow B, Nonacs 

R, Newport DJ, Viguera A, Suri R, Burt 

V, Hendrick AM, Loughead A, Vitonis AF, 

Stowe Z. Relapse of major depression 

during pregnancy in women who maintain or 

discontinue antidepressant treatment. Journal 

of the American Medical Association. 2006 Feb 

1; 295(5): 499-507. 

13. Bebbington PE, Dunn G, Jenkins R, Lewis 

G, Brugha T, Farrell M, Meltzer H. The 

influence of age and sex on the prevalence 

of depressive conditions: report from the 

National Survey of Psychiatric Morbidity. 

International Review of Psychiatry. 2003 FebMay; 15(1-2): 74-83. 

14. Nolen-Hoeksema S, Larson J, Grayson C. 

Explaining the gender difference in depressive 

symptoms. Journal of Personality and Social 

Psychology. 1999; 77(5): 1061-1072. 

15. Regier DA, Rae DS, Narrow WE, Kaebler 

CT, Schatzberg AF. Prevalence of anxiety 

disorders and their comorbidity with mood 

and addictive disorders. British Journal of 

Psychiatry. 1998; 173(Suppl. 34): 24-28. 

16. Devane CL, Chiao E, Franklin M, Kruep EJ. 

Anxiety disorders in the 21st century: status, 

challenges, opportunities, and comorbidity 

with depression. American Journal of Managed 

Care. 2005 Oct; 11(Suppl. 12): S344-353. 

17. Kessler RC, Barker PR, Colpe LJ, Epstein JF, 

Gfroerer JC, Hiripi E, Howes MJ, Normand 

SL, Manderscheid RW, Walters EE, Zaslavsky 

AM. Screening for serious mental illness in 

the general population. Archives of General 

Psychiatry. 2003 Feb; 60(2): 184-189. 

18. Conway KP, Compton W, Stinson FS, Grant 

BF. Lifetime comorbidity of DSM-IV mood 

and anxiety disorders and specific drug 

use disorders: results from the National 

Epidemiologic Survey on Alcohol and Related 

Conditions. Journal of Clinical Psychiatry. 2006 

Feb; 67(2): 247-257. 

19. Cassano P, Fava M. Depression and public 

health, an overview. Journal of Psychosomatic 

Research. 2002 Oct; 53(4): 849-857. 

20. Katon W, Ciechanowski P. Impact of major 

depression on chronic medical illness. Journal 

of Psychosomatic Research. 2002 Oct; 53(4): 

859-863. 

26 National Institute of Mental Health 
21. Hankin BL, Abramson LY. Development 

of gender differences in depression: an 

elaborated cognitive vulnerability-transactional 

stress theory. Psychological Bulletin. 2001 Nov; 

127(6): 773-796. 

22. Calvete E, Cardenoso O. Gender differences 

in cognitive vulnerability to depression and 

behavior problems in adolescents. Journal of 

Abnormal Child Psychology. 2005 Apr; 33(2): 

179-192. 

23. Cyranowski J, Frank E, Young E, Shear K. 

Adolescent onset of the gender difference in 

lifetime rates of major depression. Archives of 

General Psychiatry. 2000 Jan; 57(1): 21-27. 

24. Krishnan KRR, Taylor WD, McQuoid DR, 

MacFall JR, Payne ME, Provenzale JM, Steffens 

DC. Clinical characteristics of magnetic 

resonance imaging-defined subcortical 

ischemic depression. Biological Psychiatry. 2004 

Feb 15; 55(4): 390-397. 

25. Rush JA, Trivedi MH, Wisniewski SR, Stewart 

JW, Nierenberg AA, Thase ME, Ritz L, Biggs 

MM, Warden D, Luther JF, Shores-Wilson 

K, Niederehe G, Fava M. Bupropion-SR, 

Sertraline, or Venlafaxine-XR after failure of 

SSRIs for depression. New England Journal of 

Medicine. 2006 Mar 23; 354(12): 1231-1242. 

26. Trivedi MH, Fava M, Wisniewski SR, Thase 

ME, Quitkin F, Warden D, Ritz L, Nierenberg 

AA, Lebowitz BD, Biggs MM, Luther JF, 

Shores-Wilson K, Rush JA. Medication 

augmentation after the failure of SSRIs for 

depression. New England Journal of Medicine. 

2006 Mar 23; 354(12): 1243-1252. 

27. Marcus SM, Flynn HA, Blow F, Barry K. A 

screening study of antidepressant treatments 

and mood symptoms in pregnancy. Archives of 

Women’s Mental Health. 2005 May; 8(1): 25-27. 

28. Austin M. To treat or not to treat: maternal 

depression, SSRI use in pregnancy and adverse 

neonatal effects. Psychological Medicine. 2006 

Jul 25; 1-8. 

29. U.S. Food and Drug Administration (FDA). 

FDA Medwatch drug alert on Effexor and 

SSRIs, 2004 Jun 3. Available at (www.fda.gov/ 

medwatch/safety/2004/safety04. 

htm#effexor). 

30. Weissman AM, Levy BT, Hartz AJ, Bentler S, 

Donohue M, Ellingrod VL, Wisner KL. Pooled 

analysis of antidepressant levels in lactating 

mothers, breast milk and nursing infants. 

American Journal of Psychiatry. 2004 Jun; 

161(6): 1066-1078. 

31. Bridge JA, Iyengar S, Salary CB, Barbe RP, 

Birmaher B, Pincus HA, Ren L, Brent DA. 

Clinical response and risk for reported suicidal 

ideation and suicide attempts in pediatric 

antidepressant treatment, a meta-analysis of 

randomized controlled trials. Journal of the 

American Medical Association. 2007; 297(15): 

1683-1696. 

32. Hypericum Depression Trial Study Group. 

Effect of Hypericum perforatum (St. John’s 

wort) in major depressive disorder: a 

randomized controlled trial. Journal of the 

American Medical Association. 2002 Apr 10; 

287(14): 1807-1814. 

33. March J, Silva S, Petrycki S, Curry J, Wells K, 

Fairbank J, Burns B, Domino M, McNulty S, 

Vitiello B, Severe J, Treatment for Adolescents 

with Depression Study (TADS) team. 

Fluoxetine, cognitive-behavioral therapy, 

and their combination for adolescents with 

depression: Treatment for Adolescents 

with Depression Study (TADS) randomized 

controlled trial. Journal of the American Medical 

Association. 2004 Aug 18; 292(7): 807-820. 

34. Reynolds CF III, Dew MA, Pollock BG, 

Mulsant BH, Frank E, Miller MD, Houck 

PR, Mazumdar S, Butters MA, Stack JA, 

Schlernitzauer MA, Whyte EM, Gildengers 

A, Karp J, Lenze E, Szanto K, Bensasi S, 

Kupfer DJ. Maintenance treatment of major 

depression in old age. New England Journal of 

Medicine. 2006 Mar 16; 354(11): 1130-1138. 

35. Rami L, Bernardo M, Boget T, Ferrer J, 

Portella M, Gil-Verona JA, Salamero M. 

Cognitive status of psychiatric patients under 

maintenance electroconvulsive therapy: a 

one-year longitudinal study. The Journal of 

Neuropsychiatry and Clinical Neurosciences. 

2004 Fall; 16(4): 465-471. 

Women and Depression 27 
For more information on 

women’s mental health 

and depression 

Visit the National Library of Medicine’s MedlinePlus 

http://medlineplus.gov


 En Español, http://medlineplus.gov/spanish
 

For information on clinical trials for depression 

NIMH supported clinical trials 

http://www.nimh.nih.gov/health/trials/index.shtml 

National Library of Medicine Clinical Trials Database: 

http://www.clinicaltrials.gov 

Clinical trials at NIMH in Bethesda, MD 

http://patientinfo.nimh.nih.gov 

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28 National Institute of Mental Health 
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U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES 

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NIH Publication No. 09 4779 

Revised 2009