Prone to depression?

While good mental health is essential, women experience depression, anxiety, and post-traumatic stress at higher rates than men, writes Dr Prathima Reddy

Mental pain is less dramatic than physical pain, but it is more common and also hard to bear, wrote C S Lewis in The Problem of Pain where the famed British author accurately described the double burden of depression and other mental health disorders.

What is depression?

According to the WHO, depression is a common mental disorder, characterised by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. It can impact how you feel, think and behave and lead to several emotional and physical problems, including sometimes a feeling that “life is not worth living”.

What is the incidence of depression in women in India?

Indians are said to have some of the highest rates of depression in the world. The prevalence rate of depression in India in the general population ranges from 1.8% to 39.6%. As per the National Mental Health Survey of India (2015-16), one in 20 people over 18 years of age have at least once in their lifetime suffered from depression amounting to a total of over 45 million persons with depression in 2015. Depression is said to be 2-3 times more common in women than in men.

Why are women more prone to depression?

Many factors in women may contribute to depression, such as developmental, reproductive, hormonal, genetic and other biological differences (e.g. premenstrual syndrome, childbirth, infertility, and menopause). Social factors may also lead to higher rates of clinical depression among women, including stress at work, family responsibilities, the roles and expectations of women, and increased rates of sexual abuse and poverty.

What are the symptoms of depression?

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

Persistent sad, anxious, or “empty” mood, including bouts of crying.

Feeling hopeless, helpless, worthless or useless.

Irritability.

Loss of interest or pleasure in hobbies and activities.

Decreased energy or fatigue.

Moving or talking more slowly.

Feeling restless or having trouble sitting still.

Difficulty concentrating, remembering, or making decisions.

Difficulty sleeping, early-morning awakening, or oversleeping.

Feeling easily annoyed, bothered, or angered.

Appetite and/or weight changes.

Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.

Thoughts of death or suicide, or suicide attempts. Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many.

When are women more prone to depression?

There are particular stages in a girl’s/woman’s life that make her more prone to depression. They are:

Puberty: Hormonal changes in this period may increase the risk of depression. However, temporary mood changes, not amounting to depression, are common in this period.

Premenstrual period: For most women, Premenstrual Syndrome or PMS entails abdominal bloating, irritability, anxiety, breast tenderness etc. A small number of women have severe and disabling symptoms including suicidal thoughts, that disrupt their lives. This is known as Premenstrual Dysphoric Disorder and is thought to be due to an imbalance between estrogen and progesterone hormones.

Pregnancy and post-delivery: Depression affects about 11% of women during this period. There is an enormous change in the level of hormones during this period and contributes to mood changes and depression. The post-delivery period is particularly stressful due to sleeplessness, feeding issues, loss of feminity etc.

Perimenopause & Menopause: Again, a fluctuation in the hormones are thought to cause depression. Apart from this, loneliness (empty nest syndrome), effects of menopause on sex (eg., decreased libido, dry vagina), increasing weight etc., can also contribute to depression. However, it is encouraging to note that more women are now seeking help to combat this condition.

(The author is a senior obstetrician & gynaecologist.)