Emotional Rescue- Why Depression Is a Common Condition in Women

When Jane Laskey, a clinical social worker in outpatient services at Holyoke Medical Center in Holyoke, told her father that she was getting therapy from a clinical psychologist, his response was, “that makes me glum.”

Laskey laughed as she recalled that story, and again when she explained her father’s reaction when she told him she wanted to pursue a career doing clinical social work. “He just didn’t understand it, and still doesn’t,” she said, adding that this attitude likely stems from the fact that he’s a man and from an older generation that has a hard time understanding vulnerability or seeking help when it comes to mental-health issues.

But even today, at 96, he tries to make light of her career choice, she said, by asking if she “made some people happy today.”

“People who don’t talk on that level with other people or don’t know anybody in therapy just don’t understand it,” Laskey told HCN. “But people who have been through it or have friends who have … they get it.”

And more importantly, they should ‘get it,’ because according to the National Institute of Mental Health (NIMH), about 15 million people experience depression each year in the U.S., and the majority of them are women.

A trauma specialist with more than 35 years of experience, Laskey works with men and women with all degrees of trauma in their past, most of whom are facing various degrees of typical or atypical depression. As described by the American Psychiatric Assoc., those with typical, or melancholic, depression, exhibit an inability to find pleasure or positive mood change with positive things. Their depression is subjectively different from grief, and might manifest as severe weight loss or loss of appetite, psychomotor changes, excessive guilt, early-morning awakening, and feeling worse in the morning. Melancholic depression can lead to, or be a part of, major depressive disorder or a bipolar disorder. Conversely, atypical depression features significant weight gain or an increased appetite, excessive sleeping, and significant social or occupational impairment, and is characterized by improved mood with positive events. Atypical depression is two to three times more common in women than in men.

Laskey said there are dynamic differences in how women and men both exhibit and deal with depression. Not only are women more prone to depression than men — probably due to the fluctuation of hormones throughout a woman’s life that can play a large part in any instance of depression — but more women are seeking help. And for many of those who don’t, it’s probably due to the stigma attached to admitting any mental-health condition, and how girls are raised compared to boys (more on this later).

“Women will ask for help,” said Laskey, who has three times as many female patients as she does male, “and statistically, they are seen as more depressed because they’re more willing to come in for help, but there certainly is still some stigma out there.”

For this issue’s focus on women’s health, HCN spoke with area mental-health specialists about why women have higher instances of depression, and also about changing attitudes concerning the stigma of this ailment, and treatments that are available to help individuals lead a full, healthy life.

Apparently, it all goes back to prehistoric times.

Laskey told HCN that there are three reasons why women specifically tend to suffer from depression. The first is the social assignment that women have had in the family unit throughout history.

“If you go back to caveman times, men were the hunter-gatherers, and women are back in the cave, taking care of the children, and those tendencies have carried forth into the present day,” she explained.  “So women tend to be more connected to people, more reactive to nuances in relationships, and when things happen, they are more emotional and feel rejected or not validated.”

Conversely, she said, men tend to be more outwardly focused and more superficial in their relationships. Meanwhile, they do not count as much on relationships for good feelings, but more on accomplishing things, even if that means not actually playing, but watching their favorite sports team accomplish a win.

Second, because of this nurturing history, women are allowed to outwardly show feelings, whereas men feel they are not, Laskey went on, adding that women, by and large, tend to care much more about all their relationships.

“Many will not allow themselves to be angry at other people, but blame themselves, and they get down on themselves and get depressed,” she noted, while citing the old axiom, ‘men get angry; women get depressed.’

In his book Male Menopause, author Jed Diamond, who has a Ph.D. in international health, surveyed the most current medical data and interviewed men and women regarding their struggles to live a healthy and happy second half of life. In addition to analyzing the issue of chemical and physiological changes that occur in men, his examples of how each sex responds to life events, large or small, is simplistic, yet very revealing.

Diamond found that, when depressed, women tend to blame themselves, while men tend to blame others. Women will feel sad, apathetic, and worthless; men will feel angry and irritable. To deal with depression, women will use food and ‘love’ to self-medicate,” finding it easier to talk to close friends about self-doubt and despair, while men may use sports, alcohol, and sex to self-medicate, and perceive self-doubt as weak.

“It shows how women handle their feelings, what connection means to them, and what feelings they allow or don’t allow,” said Laskey.

But what causes depression?

According to Dr. Andrea Vidal, who practices inpatient adult psychiatry with Susan Plante, a nurse practitioner and clinical psychiatry specialist at Providence Behavioral Health Hospital, the causes are rather complex.

With 34 years of combined experience in acute mental-health care, Vidal and Plante care for women and men who are facing acute mental-health challenges and have been admitted for intense treatment because they’ve become a suicide risk, a danger to others, or simply cannot care for themselves. Patient depression is prevalent in their work, in addition to more acute issues such as bipolar disorder, schizophrenia, and drug or alcohol addiction.

Depression, they said, can add to or result from a combination of family history of mood disorders, past trauma, losses in relationships or jobs, medications, and drug or alcohol addiction, just to name a few, and it’s the brain’s neurotransmitters that are affected in these instances.

According to the Journal of Neurophysiology, neurotransmitters are the brain chemicals that communicate information throughout the brain and body, relaying information to tell the organs to work. When out of balance, they can also affect mood and cause adverse symptoms.

Laskey added that the hormones estrogen and testosterone affect female and male brain chemicals differently as their levels rise and fall over a lifetime, leaving each susceptible to depression at different times. A woman’s past premenstrual syndrome and postpartum depression, for instance, can be a predisposition for depression during menopause, said Laskey, adding quickly that not every woman who goes through menopause gets depressed, just like every woman who gives birth doesn’t suffer postpartum depression.

Once there is a diagnosis of depression, the most common course of treatment is medication and/or psychotherapy.

Antidepressants, especially serotonin and norepinephrine, primarily work on the brain’s neurotransmitters, Plante explained. Other antidepressants work on the neurotransmitter dopamine.

Elaborating, Plante and Vidal told HCN that some of the newest and most popular antidepressants are what’s known as selective serotonin reuptake inhibitors, or SSRIs. Most have generic versions, but the brands have become well-known due to the millions in advertising spent on them, and include Prozac, Zoloft, Lexapro, Paxil, and Celexa. Serotonin and norepinephrine reuptake inhibitors, known as SNRIs, are similar to SSRIs, and include Effexor and Cymbalta. In a class by itself is Wellbutrin, a popular antidepressant that works on dopamine.

Plante added that tricyclics and monoamine oxidase inhibitors (MAOIs) are “old-school” antidepressants, and while they are still used in some instances, SSRIs and SNRIs tend to have fewer side effects. Finding the right drug for a patient is an exercise based on many variables, but part of treatment education for patient and family alike, Plante added, is understanding that it’s a trial process, and it can take weeks or months to find the right medications and doses.

This process can involve three steps: increase, augment, and switch. To find the right balance of depression medication, the practitioner starts with the initial agent (medication) and increases it to the maximum dose; if a partial positive response with the patient’s mood is noted, then another drug is augmented. If there is no response, the patient is switched to another drug, and the process is repeated until the patient is showing a response that indicates the treatment is working.

“And we can tell,” said Vidal. “They are sleeping better, have more energy, they’re eating more, they’re up earlier. They may still be feeling depressed, but there are changes that we notice.”

Laskey said some people do get better without any medication at all. Based on the type and cause of depression, sometimes just changing the circumstances is enough, because the build-up of various stresses can change the brain’s chemicals causing depression. “So just making a change in your job or your relationship or whatever is causing it can pull you out of that depression in some cases.”

“And I think stress and hormones do affect depression, she said. “But there are a lot of factors that affect depression, like the biochemical makeup, — which could be genetic, but not always — the parenting you had, and then there’s the big factor of trauma.”

For those who are suffering from deep depression and other behavioral issues as a result of past trauma, Laskey is one of thousands of mental-health practitioners in the nation using a two-decades-old therapeutic method called eye movement desensitization and reprocessing (EMDR), which, she said, has revolutionized trauma treatment.

EMDR is an information-processing therapy that uses an eight-phase protocol to process distressing memories, while receiving one of several types of bilateral sensory input, including side-to-side eye movements, reducing the lingering effects of past trauma and allowing clients to develop more adaptive coping mechanisms. The EMDR therapy, Laskey said, is similar to how the healthy brain processes stressful issues of the day by dreaming overnight, which also involves rapid eye movements.

“So if something upsetting happens in the day, and you sleep on it, the next day you don’t feel so bad; dreaming is our way of working through things,” she explained.

An example of a positive outcome for one of Laskey’s patients was a woman who worked all the time in her job and cared for everyone around her. When she retired, depression set in.

“She came to therapy because it was supposed to be ‘her time’ and she didn’t even know what she liked, who she was, or what she wanted to do with her time,” she explained.

Revisiting childhood, she was able to see how her strict parents always made her work, why she became such a workaholic herself, and why her self-esteem was based on doing things for other people rather than for herself, Laskey told HCN, adding that, as she helped the woman process through all these issues over two periods totaling just over 18 months, she started to get out more and do more for herself, her depression lifted, and she blossomed.

Whether or  not it’s due to the Baby Boomers, who comprise not only a huge demographic, but are more open-minded than their parents and grandparents, Laskey and the 80 or so EMDR therapists throughout the Pioneer Valley have waiting lists for those who are seeking therapy.

“I think it’s more accepted now,” Laskey stated. “Today, when someone hears that someone else is in therapy, they say, ‘good for you.’”

And it would make sense that diagnosis of depression will probably grow, Plante added, because access to care and the screening tools used by practitioners are greater now than in the past.

For the patients, as well as the practitioners, attitudes about depression and therapy are shifting, and the reward is a healthy psyche.

“It takes a lot of energy and hard work, but it’s so rewarding to see people treating themselves better,” Laskey said with a broad smile. “To see people truly feeling differently is very rewarding.”