What's Behind the Gender Gap in Depression

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JUDITH: I felt totally drawn within myself. I didn't have anything to give anyone. I had no energy, I had nothing. And I physically hurt. I physically and mentally hurt.

DIANE: You feel like you are dead. You have no emotion whatsoever. No feelings. You're just absolutely a walking dead person.

JULIANNE: The pill bottle spilled open, and when I gathered them up I thought you know, I could end it right here and it would probably be better for everyone.

CUDA: These are the voices of women with depression. They experience the same pain and suffering as men with depression. The big difference is women are more than TWICE as likely as men to become depressed. Adelle Vigura who directs the women's mental health center at the Cleveland Clinic says the reasons for this are not completely understood but there are many possible explanations.

VIGUERA: There could be biological reasons, social reasons.

CUDA: Let's consider the social reasons first.

VIGUERA: some of the risk factors include lower socioeconomic status, poverty.

CUDA: Single women with children have one of the highest poverty rates in the United States. Being poor brings many types of stress, not the least of which is a feeling of loss of control over your life. That, in turn, can lead to negativity, passivity and a lack of self-esteem--- and all those feelings increase the risk of depression.

VIGUERA: Actually marriage is a risk factor.

CUDA: Again, Adelle Viguera

VIGUERA: Curiously, for men, men, marriage is protective, but for women, if they're in an unhappy marriage their risk for depression goes up significantly. Also if women have young children at home, they're more at risk for depression and that risk goes up with the number of children

CUDA: Women - especially those who work outside the home - often feel like they work two jobs. Also, they may find themselves caring for their young children as well as for sick or elderly family members. There's no hard scientific evidence linking these factors to depression but experts say vulnerability to depression increases with stress. Men experience stress too - but that's where biological differences come into play in explaining the gender difference in rates of depression. Male and female sex hormones can have a profound impact on the way we respond to stressful situations says McKee of the Cleveland Clinic. For example, the female-reproductive hormone oxytocin promotes nurturing behaviors in women that may seem beneficial at first, but are actually less self-protective than those of men.

MCKEE: So instead of just getting angry, and wanting to fight, or getting afraid and wanting to run when you are faced with a very stressful situation, you may reach out to help others and to have them help you. And I think that when you have that kind of relationship strengths - it also does make you more vulnerable to hurt and a sense of loss when relationships go awry --and hence more vulnerable to depression.

CUDA: Other hormones involved in a woman's reproductive cycle may have a much more direct and profound impact on depression explains Adelle Viguera-- Dramatic changes in reproductive hormones can have mood altering effects that are far more serious than a little irritability or sadness associated with PMS.

VIGUERA: There's a whole group of hormonally related mood disorders. One is called Pre-menstrual Dysphoric Disorder - so some women may become more depressed before their period. Then there are women who are at risk for getting depressed during pregnancy. Then we move on to the post-partum period which is the high risk period for women for getting depressed.

CUDA: Viguera says that although hormones can play a role - they also aren't the whole story. For example, the risk of post-partum depression triples if a woman has a prior history of depression, and women are more at risk for traumatic events like physical or sexual abuse that are known to trigger depressive episodes

In some women, hormone therapy may be used in combination with anti-depressant medications, but more often, says Viguera the BIOLOGY of a woman's depression is just like a man's - it's the causes that are different. And treatment involves targeting those gender-specific experiences, behaviors and social pressures that put women at greater risk.

Gretchen Cuda, 90.3

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