|
The following information has been kindly supplied by
David Dove,
The Paloma Centre, Banbury. 01295 277686
info@thepalomacentre.com
www.thepalomacentre.com
Gender differences in the experience of Depression & its treatment.
“Depression” is a much misunderstood condition and one which in
modern times has become devalued through the common application of
this term to a wide range of conditions, not all of which are true
depressive states. It has become almost a medical fashion-label to
be attached to a wide variety of conditions which has consequently
led those people with genuine depressive states to be misunderstood
and devalued. Additionally, Depression is often seen as a “female”
condition and made the butt of jokes about PMT, for example, which,
again, tend to devalue the real impact that a genuine depressive
state has on the sufferers.
Depression is common to all genders; it is thought that about 15
percent of people will have a significant occurrence of a depressive
state at some point in their lives and it is considered to be the
fourth most common cause of disability worldwide. The number of
people with depression is hard to estimate for many reasons e.g.
because many do not seek help or are not formally diagnosed. Some
perspective at this point may be useful. Many, if not most of the
4,000 suicides committed each year in England are linked, directly
or indirectly, to depression. On average, 15% of people with
recurrent depression (repeated attacks) have an increased risk of
suicide. Depression can appear at any age and occurs in every
"Western" country. There is some debate about whether it is common
in or to every culture across the world, although it now seems
likely that depression is a universal human condition.
To gain an understanding of the inaccurate perception of Depression
being a “female problem” we firstly need to understand broadly what
is meant by "Depression", its symptoms and general occurrence; we
can then look at causes of Depression that are common to all
genders, explore in what ways the occurrence in men may be
under-reported before examining in some detail various causes that
are almost entirely specific to women and in themselves go a long
way to explain why this inaccurate perception should have gained
such credibility in the public perception.
A generalised description of depression might be "A mood disorder
that causes a person to feel sad or hopeless for an extended period
of time. More than just a bout of "the blues" or temporary feelings
of grief or low energy". Depression can have a significant impact on
the enjoyment of life, work and health, and the people the sufferer
cares about.
Before considering the difference between the levels of reported
depression between men and women it will be helpful to gain a basic
understanding of what we mean by the term "Depression" and some of
the ways that it occurs and the possible reasons. Depression affects
people in many different ways and can cause a wide variety of
physical, psychological and social symptoms.
Broadly speaking, Depression may be categorised in the following
three ways:
A. By how serious it is:
● mild, in which there is some impact on daily life
● moderate, in which there is significant impact on
daily life
● severe, in which activities of daily life are nearly
impossible.
B. By physical symptoms: If you have Depression you
will probably have one or maybe more physical ('somatic') symptoms
e.g. poor appetite, disturbed sleep patterns.
C. By psychotic symptoms: If you have severe
depression you may also have psychotic symptoms, such as
hallucinations
or delusions. These symptoms don't affect everyone with depression.
Some specific types of depression such as post-natal and menopausal
will be commented on later but in general terms there are some
common causes to the majority of depressive states experienced by
all genders.
Factors involved in causing depression, may include:
● A history of depression in the family: It is
believed that depression can be passed genetically from generation
to
generation, although the exact way this occurs is not known.
● Grief from the death or loss of a loved one.
● Personal disputes, like conflict with a family
member.
● Physical, sexual, or emotional abuse.
● Major events that occur in everyone's lives,
such as moving, graduating, changing jobs, getting married
or divorced,
retiring, etc.
● Serious illness: depressed feelings are a
common reaction to many medical illnesses.
● Certain medications.
● Substance abuse: close to 30% of people with
substance abuse problems also experience major depressive states.
● Other personal problems: these may come in the
forms of social isolation due to other mental illnesses, or being
cast
out of a family or social circle. For some people, upsetting or
stressful life events such as bereavement, divorce,
illness, redundancy and job or money worries can be the cause. This
is often known as 'reactive' depression - the
depression is a reaction to the event. It's also called exogenous
depression ('originating outside the body'). In other
cases, depression doesn't have an obvious cause. This is sometimes
called endogenous (originating within the body).
Because depression can have many causes, it's sometimes split into
three broad groups; psychological, physical and social.
● Psychological — a stressful or upsetting life
event causes a persistent low mood, low self-esteem and feelings of
hopelessness about the future.
● Physical or chemical - depression is caused by
changes in levels of chemicals in the brain. For example, your mood
can change as hormone levels go up and down. This is sometimes seen
in women and is associated with the
menstrual cycle, pregnancy, miscarriage, childbirth, and the
menopause, more later.
● Social understanding — doing fewer activities
or having fewer interests can both cause depression and happen
because of depression.
Quite often, depression can be triggered by more than one of these
factors, and they can influence and affect each other in complicated
ways. Other frequent causes of depression include drinking excess
alcohol and using street drugs such as cannabis and cocaine.
A valid question to ask, given the difference in reported
occurrence, would be, is depression in women different than in men,
or is it exhibited or reported differently? Because of the
difference in numbers of cases depression was once considered to be
a "woman's disease," linked to hormones and premenstrual syndrome.
The lingering stereotype of depression being a female condition may
still prevent some men from recognizing its symptoms and seeking
appropriate treatment. This may contribute to the disparity in
reported numbers, see later.
In reality, depression affects both sexes, disrupting relationships
and interfering with work and daily activities. The symptoms of
depression are similar for both men and women, but they tend to be
expressed differently. The most common symptoms of depression
include low self-esteem, suicidal thoughts, loss of interest in
usually pleasurable activities, fatigue, changes in appetite, sleep
disturbances, apathy and sexual problems, including reduced sex
drive.
Male orientated Depression
● There are several reasons why the symptoms of
depression in men are not commonly recognized:
● Men tend to deny having problems because they
are supposed to "be strong."
● Western culture suggests that expressing
emotion is largely a feminine trait. As a result, men who are
depressed
are more likely to talk about the physical symptoms of their
depression, such as feeling tired, rather than those
related to emotions.
● Depression can affect sexual desire and
performance. Men often are unwilling to admit to problems with their
sexuality
mistakenly feeling that the problems are related to their manhood,
when in fact they are caused by a medical problem
such as depression.
● The observable symptoms of male depression are
not as well understood as those in women. Men are less likely to
show "typical" signs of depression, such as crying, sadness, loss
of interest in previously enjoyable activities, or
verbally expressing thoughts of suicide. Instead, men are more
likely to keep their feelings hidden, but may become
more irritable and aggressive.
For these reasons, many men, as well as
doctors and other healthcare professionals, fail to recognize the
problem as depression. Some mental healthcare professionals
suggest that if the symptoms of depression were expanded to include
anger, blame, violence and abuse of alcohol, more men might be
diagnosed with depression and treated more appropriately.
Depression in men can have devastating consequences. The Centers
for Disease Control and Prevention report that men in the U.S. are
about four times more likely than women to commit suicide. An
amazing 75-80% of all people who commit suicide in the U.S. are men.
Though more women attempt suicide, more men are successful at
actually ending their lives. This may be due to the fact that men
tend to use more lethal methods of committing suicide, for example
using a gun rather than taking an overdose. Depression in men can
often be traced to cultural expectations. Western male stereotypes
still demand that men are supposed to be successful, that they
should restrain their emotions and that they must remain in control.
These cultural expectations can mask some of the true symptoms of
depression, forcing men to express aggression and anger instead and
thereby be referred for "anger management" or Counselling rather
than treated for the underlying depression.
In addition, men generally seem to have greater difficulty in
dealing with the "stigma" of depression. They tend to deal with
their symptoms with a macho attitude or by drinking alcohol. This
attitude still pervades society generally but particularly within
many male-dominated institutions, such as the military and
athletics, where men are taught that "toughness" means putting up
with physical pain and admitting to emotional distress is taboo.
Rather than seek help, which means admitting to what they perceive
as a (female) weakness, men are more likely to deal with their
depression by drinking heavily or committing suicide thereby totally
avoiding possible reportage.
Differences in the experience of Depression.
Some of the other ways in which depression may be experienced
differently by men and women are:
● Depression in women may occur earlier, last
longer, be more likely to recur, be more likely to be associated
with
stressful life events, and be more sensitive to seasonal changes.
● Women are more likely to experience guilty
feelings and attempt suicide, although they are successful less
often
than men.
● Depression in women is more likely to be
associated with anxiety disorders, especially panic and phobic
symptoms,
and eating disorders.
● Depressed women are less likely to abuse
alcohol and other drugs.
From this it can be seen that men may be experiencing or dealing
with depression differently or, because of social stereotyping, be
reported and/or diagnosed differently thereby significantly altering
the statistics.
It is interesting to compare the male attitude, and resultant lower
reportage, with a survey of female attitudes towards depression
conducted by Mental Health America on public attitudes and beliefs
about clinical depression:
● More than one-half of women believe it is
"normal" for a woman to be depressed during menopause and that
treatment
is not necessary.
● Approximately 10%- 15% of all new mothers get
post natal depression which most frequently occurs within the first
year after the birth of a child.
● More than one-half of women believe depression
is a "normal part of ageing."
● More than one-half believe it is normal for a
mother to feel depressed for at least two weeks after giving birth.
● More than one-half of women cited denial as a
barrier to treatment while 41 % of women surveyed cited
embarrassment or shame as barriers to treatment.
● In general, over one-half of the women said
they think they "know" more about depression than men do.
From this it will be seen that the more "open" attitude towards
recognising, accepting and dealing with depression among the female
population will influence the statistical reporting of the
complaint.
Female Specific Depression.
In addition to the general experience of depression and the
difference in the ways that male oriented depression is reported
there are significant areas that are unique to women. Rates of
depression appear to be similar in girls and boys before
adolescence. However, with the onset of puberty, a female's risk of
developing depression increases dramatically, to twice that of
males. It is believed that women may be more prone to depression
because of changes in hormone levels that occur throughout a woman's
life such as during puberty, pregnancy and menopause, as well as
after giving birth, having a hysterectomy, or experiencing a
miscarriage. In addition, the hormone fluctuations that occur with
each month's menstrual cycle increase the risk for premenstrual
syndrome, or PMS. In addition, for women trying to balance a home, a
family and a career, unique stresses are experienced that may lead
on to wider health and social problems.
As would be expected, there are also various aspects of everyday
life that have been identified as tending to increase the likelihood
of depression in women occurring and some of these are:
● Loss of a parent before age 10.
● Physical or sexual abuse as a child.
● History of mood disorders in early reproductive
years.
● Family history of mood disorders.
● Use of certain oral contraceptives.
● Use of certain infertility treatments.
● Ongoing psychological and social stress (e.g.,
loss of job, relationship stress, separation or divorce).
● Loss of social support system or the threat of
such a loss
Up to 75% of menstruating women experience premenstrual syndrome
(PMS), a disorder characterized by emotional and physical symptoms
that fluctuate in intensity from one menstrual cycle to the next.
Women in their 20's or 30's are those most affected. About 3-5% of
menstruating women experience premenstrual dysphoric disorder, or
PMDD, a severe form of PMS, marked by highly emotional and physical
symptoms that usually become more severe 7 to 10 days before the
onset of menstruation. It is now recognised and accepted that these
fluctuations in hormone levels are important causes of discomfort
and behavioural change in women. While the precise link between PMS,
PMDD and depression is still unknown, chemical changes in the brain
and fluctuating hormone levels are both thought to be contributing
factors.
Of course, the most obvious "unique" experience for women is that
of childbirth and, not unnaturally, this brings with it a whole
range of complex emotional issues to deal with, particularly for the
first birth experience, which if not recognised and dealt with can
give rise to depressive states. In one way, pregnancy is often
viewed as a period of well-being that protects women against
depressive or emotional disorders given the level of care and
attention given to her at this time. But depression appears to occur
almost as commonly in pregnant women as it does in those who are not
pregnant.
The factors which appear to increase the risk of depression during
pregnancy are:
● Having a history of depression or PMDD.
● Age at time of pregnancy, the younger the
woman, the higher the risk.
● Living alone.
● Having limited social support from family and
friends.
● Marital conflict.
● Uncertainty about the pregnancy.
The stresses of pregnancy can cause depression or a recurrence or
worsening of depression symptoms and depression during pregnancy can
increase the risk for having depression after delivery (post natal
depression, see below). The potential impact of depression on a
pregnancy is particularly important as it can interfere with a
woman's ability to care for herself during pregnancy. She may be
less able to follow medical recommendations, and sleep and eat
properly. Depression can also cause a woman to use substances such
as tobacco, alcohol, and/or illegal drugs, which could harm the baby
and the depressive state may make bonding with the baby difficult.
Having a baby is a life-changing experience. Pregnancy and the
first year after the birth are periods that many parents find quite
stressful. The birth of a baby is an emotional experience and, for
many new mothers, feeling tearful and depressed is also common.
However, sometimes longer periods of depression, known as post-natal
depression (PND), can occur during the first few weeks and months of
the baby's life.
PND can have a variety of physical and emotional symptoms, and many
mothers are unaware that they have the condition. It is therefore
important for partners, family, friends and healthcare professionals
to recognise the signs of PND as early as possible so that the
appropriate treatment can be given. Following childbirth, there are
three generally recognised forms of this type of depression:
● So called 'Baby blues' is a common type of
depression, and it is the least severe. It does not usually last
very long,
starting from around the third day after birth and lasting until
around the tenth day. During this time, the mother may
feel tearful and irritable, but no longer-term affect occurs.
● Postnatal depression affects about I in 10
mothers in the UK, and usually develops in the first 4-6 weeks after
childbirth. However, in some cases it may take several months to
develop. The mother may feel depressed for most
of the time, and the feelings remain for an extensive period of
time, months.
● Postnatal psychosis is a rare, but severe, form
of depression. It develops in about I in 1,000 mothers. Symptoms can
include irrational behaviour, confusion, and suicidal
thoughts. Women with postnatal psychosis often need specialist
psychiatric treatment.
Although postnatal depression is more common in women, men can be
affected too. As the birth of a new baby can be a stressful time for
both parents, some fathers feel unable to cope, or feel that they
are not giving their partner all the support she needs. They can
also find it upsetting if the new baby is getting all of their
partner's attention, giving rise to resentment, feelings of loss and
depression. PND can put a strain on a relationship. This can cause
the break up of some relationships, which is why it is important to
recognise the symptoms of PND at an early stage and take steps to
get treatment for either or both partners.
Further types of depression that are unique to women are
perimenopausal and menopausal depression. The perimenopause is the
stage of a woman's reproductive life that begins 8 to 10 years
before menopause itself. During this time the ovaries gradually
begin to produce less oestrogen. Perimenopause lasts up until
menopause, the point when the ovaries stop releasing eggs. In the
last one to two years of perimenopause, the decrease in oestrogen
accelerates. At this stage, many women experience menopausal
symptoms.
The menopause is a period of time when a woman stops having her
monthly period and experiences symptoms related to the lack of
oestrogen production. By definition, a woman is in menopause after
her periods have stopped for one year. It is a normal part of ageing
and marks the end of a woman's reproductive years. Menopause
typically occurs in a woman's late 40's to early 50's. However,
women who have their ovaries surgically removed undergo a similar
condition known as "sudden" menopause.
The drop in oestrogen levels during perimenopause and menopause
triggers physical, as well as emotional changes -- such as
depression or anxiety and changes in memory. Like any other point in
a woman's life, there is a relationship between hormone levels and
physical and emotional symptoms. Some physical changes include
irregular or missed periods, heavier or lighter periods, and hot
flushes.
All of these "unique to women" conditions have a significant effect
on reported cases of depression, the more possible causes the
greater likelihood of reportage.
An additional depressive state that is biased towards women but for
less well known reasons is Seasonal Affective Disorder (SAD). SAD is
a type of depression or mood disorder with a seasonal pattern. The
most common form of SAD is also called winter depression or winter
blues, because symptoms are worst in the winter months. They tend to
start from around September, are worse when the days are shortest
(in December, January and February) and improve in the spring. There
is also a summer version of seasonal affective disorder, but this is
far less common and has different symptoms.
Around I in 50 people in the UK have SAD. It is more common in
women than in men and most commonly starts between the ages of 18
and 40. Up to I in 8 people in the UK experience milder symptoms of
winter 'blues' (sub-syndromal SAD). Studies around the world have
shown that SAD becomes more common the further you are away from the
equator.
Summary.
The apparent disparity in numbers suffering depression may be
explicable by several factors which contribute to the imbalance. For
example, while there are generalised causes of depression which are
common to all genders, there are also some significant causes that
are specific to the female gender and there are also social factors
which may distort the reportage of the condition.
I have been unable to determine to what extent the specific causes
skew the generalised results and so will restrict my comments to
those areas where they are more obvious. It is clear that the causes
unique to women are statistically significant both in terms of the
comparative size of the female population and the sheer number of
specifics.
For example:
Puberty, reproductive, hormonal, genetic and other biological
differences (e.g. premenstrual, post natal, infertility, loss of
child and menopause).
Social factors affecting only women also play a part as in the
example of the mother who is also a business woman trying to be a
mother, a wife, a home maker and an executive, all having
conflicting pulls on her time and emotions.
Social factors also affect the reporting by men of depressive
conditions in terms of their perceived roles and standing in the
community as the male archetypical "macho" male who doesn't cry and
suffer from "girly" things like depression. The male experience will
also affect the manner in which it is reported and may well be
disguised as alcohol related issues or anger management.
For these reasons alone it is not surprising that depression would
appear to affect female more than males, but statistics can and do
lie. The lesson from this is to always look for the "why" and not
accept presenting issues at face value, particularly as a therapist,
that which is presented at therapy.
Treatment will be specific to the individual and may be a blend of
elements taken from psychotherapy e.g. CBT to address the issues at
the Cognitive or logical level while supported by Hypnotherapy to
build confidence in dealing with the issues at the more subjective
level. Additionally, modern coaching techniques may be utilised to
take the client forward towards a constructive, planned, positive
future while also using techniques taken from modern Meridian Energy
Therapies such as EFT to deal with the negative emotional issues as
they arise.
Material has been extracted from many sources, not all directly
attributable, but significant research was conducted on the internet
and particularly important sources were:
NHS Web
The Cleveland Clinic Department of Psychiatry and Psychology.
The Centers for Disease Control and Prevention
The National Library for Health
Department of Health
NICE
|
