Depression in both
women and men is a debilitating disorder that disrupts relationships and daily
lives and affects nearly 10 % of the population. Despite the fact that
depression is very common, only about 10 % of cases receive clinical attention.
Once a person has a single episode of depression, the chances of recurrence are
high. The disease is twice as common in women as in men, although both sexes
suffer its debilitating effects. The almost same ratio is sustained across many
cultures, nations, and ethnicities. This is true whether depression is indexed as
a diagnosed mental disorder or as sub-clinical symptoms.
According to the
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text
Revision (DSM-IV-TR), depression is two to three times more common in women
than men. The prevalence of depression in women has varied from 5 to 9 percent
as opposed to 2 to 3 percent of men.
Based on the
statistical data, diagnosable depressive disorders are extraordinarily common
in women, who have lifetime prevalence for major depressive disorder of 21.3%,
compared with 12.7% in men.
Most explanations
for the gender difference in depression have focused on individual variables, and
studies have attempted to show that one variable is better than another in
explaining the difference. In three decades of research, however, no single variable has been found been responsible for the gender difference in depression.
In recent years,
investigators have moved toward more integrated models, taking a transactional,
developmental approach. Transactional models are appropriate because it is
clear that depression impairs social and occupational functioning, and thus can
have a major impact on an individual’s environment. Developmental models are
appropriate because age groups differ markedly in the gender difference in
depression. Girls are no more likely than boys to evidence depression in
childhood, but by about age 13, girls’ rates of depression begin to increase sharply,
whereas boys’ rates of depression remain low, and may even decrease. By late
adolescence, girls are twice as likely as boys to be depressed, and this gender
ratio remains more or less the same throughout adulthood. The absolute rates of
depression in women and men vary substantially across the life span, however.
Gender Differences in Depression
Men tend to act out
their mood disorder while women typically turn it inward. Depression symptoms
in men and women can be radically different, leading to lack of understanding
and correct diagnosis. Based on the latest research findings here are some of
the prime differences between male and female depression (of course not
everyone will have the same symptoms, and almost certainly not all of them,
this is just a rough guide):
1. Symptoms in men
* Blames others
* Anger, irritability, ego inflation
* Feels suspicious, guarded
* Creates conflict
* Restlessness and agitation
* Compulsiveness
* Sleeps too little
* Becomes controlling
* Fear of failure
* Becomes over status-conscious
* Self-medicates through alcohol
* Over use of internet/TV/email
1. Symptoms in men
* Blames others
* Anger, irritability, ego inflation
* Feels suspicious, guarded
* Creates conflict
* Restlessness and agitation
* Compulsiveness
* Sleeps too little
* Becomes controlling
* Fear of failure
* Becomes over status-conscious
* Self-medicates through alcohol
* Over use of internet/TV/email
2. Symptoms in women
* Tendency to self-blame
* Feels sad, apathetic, worthless
* Feels anxious, frightened
* Avoids conflict
* Slows down, nervousness
* Procrastination
* Sleeps too much
* Difficulty maintaining boundaries
* Guilt
* Problems with success
* Assumes low status
* Self-medicates through food
* Withdrawal
Following down the
path of differentiation between depression appearance between men and women,
scientists have determined that the following patterns are statistically valid:
- Eating disorders are more likely in
women and there's more often a co-morbid depression.
- Among women, depression disorders are
much more likely to be accompanied by co-morbid anxiety disorders.
- During a bout of depression, women are
much more likely than men to experience atypical symptoms including
hyperinsomnia and an increase in appetite.
- Bipolar disorder is equally prevalent
among women and men; however, the course of the disorder may be quite
different. Compared with men, women are more likely to have rapid cycling
episodes, experience more depressions and more dysphoria manias and to
develop lithium-induced hypothyroid disorder.
- Women are more likely than men to have
anxiety disorders and have a greater incidence of panic disorder with
agoraphobia.
- The prevalence of obsessive-compulsive
disorders among men and women is almost equal, but women tend to have an
earlier onset and more obsessions related to food and weight than men.
- Schizophrenia affects women more
favorably than men. Women have a later onset, fewer symptoms and a better
response to treatment.
- Naturally, women more often
showed visible signs of emotion, such as crying, while men tended to be
more rigid and show less emotion.
- Men suffer from significantly more frequent and intense anger attacks (episodes of intense, inappropriate anger)
Reporting
Differences
While it is clear
that the women biologically are more prone to the depressive disease, some
researchers admit that the statistical difference might be exaggerated. When
asked about symptoms of depression, women are more likely to admit to such
features than men, a difference usually put down to women being more open and
men being more likely to use denial. Similarly, women are more prepared to seek
help than men for their depression. Thus, examining sex differences in those
who receive treatment is not an appropriate way for determining whether there
is a true sex difference.
Another artificial
influence is that many measures of depression include items that reflect
depression responses and expressions that are more likely to be experienced by
women, such as crying, as well as appetite and weight changes. These can
artificially inflate scores in women and, if there is a cut-off to decide if an
individual is depressed or not, women will then be more likely to be assigned
as having “depression”.
Another influence
that has been demonstrated in several studies is that, over time, women are
more likely to remember episodes not previously nominated when asked (and to
remember more symptoms), while men are more likely over time to “forget”
previously reported episodes. This bias has been described as a “mood
amplification” phenomenon.
Causes of
Gender Differences
Although there is
still much to be learned about the gender differences of depression, the
scientific community has a fairly extensive knowledge of its general causes,
both biological and environmental. However, it is still unknown how these
causes relate, and what causes are the inherent initiators.
Generally, there are three major factors that can cause depression in individuals, and usually, it is a combination of these factors that ultimately leads one to depression. The three factors are genetics, neurobiology, and environment. It is disputed which one contributes the greatest towards causation, but there is a relative consensus on the fact that all three contribute to depression.
The evidence of genetic causation lies mostly in the fact that depression frequently runs in families. People with blood relatives that have had depression are more likely to become depressed themselves. However, the exact gene or genes responsible for depression have not been found. Various regions of certain chromosomes have been targeted as locations of possible depression genes, but scientists are having difficulty pinpointing the exact gene(s). Some believe that this is due to the fact that multiple genes contribute a small portion to depression. There probably isn't one depression gene, or even few genes devoted to depression. However, studies support that depression can be genetically caused. Therefore, it is most likely that there are some genes that trigger certain biological situations, which in turn can cause depression.
Biologically, there
are both neural and hormonal areas linked to depression. The neural areas
involve monoamine neurotransmitters such as serotonin and norepinephrine.
Serotonin is found throughout nature, but when acting as a neurotransmitter in
the human brain, it plays a large role in mood and feelings of happiness.
Depression can occur when there is a lack of serotonin in the brain. This is
most likely due to the fact that the release of serotonin causes feelings of
happiness. If serotonin is not released, then one does not feel as happy.
Depression can also result when there is a lack of norepinephrine in the brain.
Norepinephrine functions as a response to short-term stress. Most likely, a lack
of it causes depression, because it helps one deal with short term stress. If
there is a lack of norepinephrine then one cannot properly deal with stress,
and high stress levels have been known to cause depression.
Neurotransmitters are not the only neurobiological areas active in depression, hormones, most specifically corticotropine, affect depression. Corticotropine plays a large role in flight aspect of the flight or fight model. It causes the release of other biochemicals that are released during the flight aspect of the model. These biochemicals cause repressed appetite for food and sex. People with depression often have large amounts of corticotropine, which is also stress responsive by causing feeling of stress.
It is difficult to tell whether these biological causes of depression are initiators or only pathways from other genetic or environmental factors that initiate depression. What is known is that depression always occurs through neurobiological responses, and can be cured chemically. Therefore, it can be assumed that it is the final step from initiator to depression. It is most likely that genetics or environmental factors cause these neurobiological factors in one way or another.
The environment definitely plays a role in depression. As stated, high stress levels can cause one to become depressed. Anxiety can as well. Life events, such as traumatic childhood experiences can lead to depression in adulthood. Romantic breakups also tend to cause depression is some individuals. One of the most prominent environmental factors is lack of achievement, direction, or freedom in one's life. Many people who do not achieve the success they hope; do not have a plan for themselves or know where they want to be; or, are stuck in situations where they cannot leave, become depressed. Ultimately, there are many environmental factors that can lead to depression. However, these situations do not cause depression in everyone. Therefore, these environmental factors may trigger depression, but there are other genetic or biological factors that must be involved.
A causal study of depression is a difficult one. The major factors leading to depression have been located and thoroughly studied, but the role in which each factor plays in causing depression is almost totally unknown. Therefore, currently, a philosophical approach to the way in which the brain, mind, and environment work is the only means to shed light on how a person becomes depressed.
First, it must be understood that the nervous system can perform the same function in many different ways. Therefore, because depression always occurs in some way neurobiologically, it can be interpreted that depression can be caused in many different ways. Furthermore, the neurobiological aspect of depression is the most essential, because no matter if it is initially caused biologically, environmentally, or genetically, depression changes the brain and can be treated with chemicals that directly affect the brain. All people who are depressed have biochemical changes.
In assessing the relationship between causes, it is best to start at the source of depression (neurobiology) and move out, towards the initial cause. In many situations of depression either genetics or environmental factors, or both initiate the depression, and cause neurobiological changes that leads eventually to clinical depression. However, the fact that the nervous system can manipulate behavior without inputs suggests that the nervous system can inflict depression by itself. Taking an assumption that all the smart mechanisms inside and outside the human body have a valid purpose, the brain might be able to manipulate itself to cause depression. Theoretically, it is quite possible that the brain needs to be depressed in order to perform certain tasks or enhance specific types of learning and application.
Not only could the
unconscious brain be responsible for initiating depression, but the I-function
could as well. A person could want something that causes depression. For
example, a person may want to be more creative, and in result becomes depressed
to do so. However, in this situation other environmental factors would be present.
Ultimately, since there is no solid evidence supporting one factor inherently causing depression over the other, as of now, it must be left at the theory that either of the three can inherently cause depression. However, because there is evidence to support that neurobiological factors are always involved, and also, there is evidence to support that brain equals behavior, there are four possible ways that depression can arise:
1. The nervous
system by itself can cause depression.
2. Genetic predispositions
can cause neurobiological changes that cause depression.
3. Environmental
factors can cause neurobiological changes that cause depression.
4. Any combination of the three.
Relaying on the
outline possible depression causes and mechanisms, we can come to the male and
female differences in depression. As stated, women become depressed twice as
often as men. This discrepancy is real, but because depression occurs in many
different ways, there are multiple explanations for this gender difference.
Some explain the difference through more practical reasoning. For example, women are much more prone to diagnosing themselves as depressed, or reaching out for help, as has been specified earlier. However, this explanation cannot account fully for the discrepancy, because it has been noted that females attempt suicide much more often than males. Also, men would rather not reach out for help and deal with their problems through substance abuse or activities, while women would dwell on their issues. Another theory is that men become depressed over different things than women, and the things that women get depressed over occur more frequently. However, this theory has been unsupported, and there is evidence that shows that men and women become depressed over the same issues; only women become depressed more often.
Others try to account for the discrepancies in incidence through environmental factors. The most prominent theorized cause is the social status of women. Women have less freedom than men do, and cannot always do as they please. This may cause an increased need for emotional support that if women do not get, causes to depression. Furthermore, women have higher chance of depression right after childbirth. This has been explained socially by the fact that after childbirth women realize that they cannot aspire to do anything else, but care for their children. This makes sense, since both women and men become depressed due to failing aspirations and career problems.
Finally, the last group of reasons for the discrepancy is biological. Studies have indicated that during a menstrual cycle, women have a greater release of hormones in their HPA axis, which is responsible for the release of corticotropine. Furthermore, women do not have the same ability to shut off the production of stress hormones as men, because women's sex hormone blocks their ability to do so. Therefore, women get stressed more easily, and this can leads to more depression. This could very well account for depression during and after pregnancy, because hormonal levels increase. Also, although it has not been confirmed, it has been suspected that there is a gene on the X chromosome that causes depression.
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