Treating Depression in Women

Thorough discussion of treating depression in women, the different types of treatments, and treatment of depression during pregnancy and postpartum.

Although having depression has become more acceptable, many women still feel stigmatized by the disorder and do not seek treatment. Others don't recognize the symptoms of depression in themselves.

Symptoms of Depression in Women

• No interest or pleasure in things you used to enjoy
• Feeling sad or empty
• Crying easily or crying for no reason
• Feeling slowed down or feeling restless and unable to sit still
• Feeling worthless or guilty
• Weight gain or loss
• Thoughts of death or suicide
• Trouble thinking, recalling things, or focusing on what you're doing
• Trouble making everyday decisions
• Problems sleeping, especially in the early morning, or wanting to sleep all of the time
• Feeling tired all the time
• Feeling numb emotionally, perhaps even to the point of not being able to cry
• Persistent headaches, digestive disorders, chronic pain, or other physical symptoms

When seeing your doctor or mental health therapist for a diagnosis of depression, it is important for the specialist to try and identify any relationship between depression and menstruation, pregnancy, the postpartum period or the perimenopausal period. A possible relationship between depression and medications such as birth control pills or agents used in hormone replacement therapy must also be explored. If there is a link to any treatable cause of depression, it should be addressed first. If your depression does not respond to this intervention, further treatment is required.

Treating Depression in Women

If you are depressed, it is important to seek treatment from your doctor other other mental health professional. There are many effective treatments for depression. The goals of the treatment of depression include treating the symptoms as well as addressing the psychological, social, and physical issues that may have contributed to its development.

The two most common approaches to treating depression are psychological treatments and antidepressant medications. If your depression is mild, psychological treatment alone may improve symptoms. However, in most cases a combination of therapy and antidepressant medication is recommended. Exercise and relaxation therapies, for example, yoga, Tai chi, and meditation will be also helpful in recovering from depression.

Psychological Therapy for Depression

There are various types of psychological treatments that your healthcare professional can discuss with you. The treatments will involve seeing a trained therapist for several sessions over a period of time. Some people may feel uncomfortable about this form of treatment as it involves revealing personal details to a healthcare professional and it carries a certain social stigma in our society. However, psychological treatments have been proven very beneficial in treating depression and reducing the risk of relapse.

The two most common types of psychological treatment for depression are:

Cognitive-behavioral therapy

Cognitive behavioral therapy involves seeing a therapist to understand how your thoughts and behaviors are linked. In cognitive behavioral therapy, techniques such as goal setting, problem solving, and keeping a diary of thoughts and emotions are used. Such techniques help you learn about your thought processes and how to change them as well as your response to them.

Interpersonal psychotherapy

This type of therapy involves seeing a trained psychotherapist in order to gain an increased understanding of your relationships and how they affect your life.

Antidepressant Medications

Medications to relieve symptoms of depression are called antidepressants. They work by altering levels of certain neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. A neurotransmitter is a brain chemical that enables messages to pass from nerve cell to nerve cell in the central nervous system. Many people with depression have low levels of one or more of these neurotransmitters and antidepressant medications help to boost levels.

Selective serotonin reuptake inhibitors are the most commonly prescribed medication in the U.S. for depression, because their side effects are more tolerable and they are safe if taken accidentally in excessive quantities. SSRIs include Prozac, Lexapro, , and Celexa.

Antidepressants sometimes cause mild side effects, some of which may be transient. Common antidepressants side effects include diarrhea, nausea, insomnia, headache, and feeling jittery. Often these side effects are temporary and will resolve within a few days of commencing treatment. One troublesome side effect is sexual problems, whereby people can experience a reduced libido. Bupropion (Wellbutrin XL/XR), which belongs to another class of antidepressants, has common side effects that include headache and an appetite-suppressing effect caused by a stimulant ingredient. It is much less likely to cause sexual dysfunction that selective serotonin reuptake inhibitors. Bupropion is not to be used in people with anorexia nervosa or bulimia.

See your healthcare professional to discuss any side effects you may experience or that interfere with your normal functioning, because stopping your antidepressant medication abruptly will worsen side effects.

Self-Help and Lifestyle Changes for Treatment of Depression

Taking care of yourself and making some lifestyle changes may be effective in reducing your symptoms of depression and helping you recover. Some suggested lifestyle and self-care approaches include:

• Eating a healthful balanced diet
• Exercising daily
• Meditation
• Breathing exercises to reduce stress
• Avoiding smoking, drugs and excessive alcohol
• Surrounding yourself with a supportive friends and family
• Making sure you get enough sleep
• Planning pleasant events into your day

Treatment for Depression During Pregnancy and Postpartum Depression

As with nonpregnant women, mild depression in pregnancy and postpartum can be treated with psychological therapies.

If antidepressant medication is required and a woman is pregnant, she should discuss this with her healthcare provider, as some medications carry a risk of affecting the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness after delivery. However, mothers who stop medications can be at increased risk for a relapse of their depression. This risk needs to be weighed against the risk of the mother's depression symptoms being untreated or getting worse.

Postpartum depression is usually treated with a mixed approach including psychological treatment, antidepresssant medication, and addressing specific issues in the postpartum period, such as sleep deprivation and family stressors. Psychological treatment can be given in group settings as well as individually. Education on looking after the newborn is useful, too.

When deciding on an antidepressant medication, it is important to remember that some medications can be secreted into breast milk and, therefore, may not be the first choice for a breastfeeding woman. However, a number of research studies indicate that certain antidepressants, such as some of the selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants for treating depression and anxiety disorders that includes medications such as Prozac, Celexa, and , have been used relatively safely during breast-feeding. You should discuss with your healthcare provider whether breast-feeding is an option or whether you should plan to feed your baby formula. Although breast-feeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

Dealing with Chronic Symptoms of Depression and Relapse

There are various factors that will influence how well a person with depression is treated will respond to treatment and what his or her chances of relapse. Generally, after one episode of depression there is a 50% chance of relapse.

The following factors are important in predicting how well someone will respond to antidepressant treatment.

• Ongoing life stressors as an adult such as relationship or marital difficulties will place an increased burden on the recovery process and will need to be addressed with psychological therapy.
• Major childhood stressors, such as experiences of child abuse, need to be addressed with psychological therapy at the same time as depression is treated with medication to help improve a child's coping abilities and recovery.
• Alcohol abuse and/or drug abuse may need to be treated separately from the symptoms of depression. This can be achieved by seeking specialized drug and alcohol counseling and treatment programs. Alcohol and/or drug abuse is a common comorbidity with depression and the prognosis of depression with this comorbidity is not good.
• Psychiatric comorbidities may be treated in addition to the symptoms of depression itself. Common comorbidities to depression are anxiety disorders, eating disorders, sleep disorders, personality disorders and substance abuse.

In closing, the most important thing for women with depression is to see your doctor for a thorough evaluation and diagnosis, which is then followed by treatment.

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