Beat the blues: Janet Slack explores depression's stronghold on the gender and offers up advice on turning that mood around.

Depression may be the most significant mental health issue for women. Statistics show that clinical depression strikes one out of every four women in her lifetime, and that even more women struggle with a depressed mood from time to time. The rate of depression in women is twice that in men, and, perhaps the most frightening statistic of all: depression in women is misdiagnosed thirty to fifty percent of the time. Additionally, women tend to have longer episodes of depression and may be more likely to experience depression as a recurrent condition.

We all have the blues occasionally and suffer through a depressed mood that can last several days at a time. Clinical depression occurs when a person has several symptoms all day, nearly every day for at least two weeks. Symptoms may include loss of interest in things that used to be enjoyable, changes in appetite or sleep, loss of energy, feelings of worthlessness or guilt, difficulty, concentrating or remembering, problems making decisions, and feeling slowed down, irritable or suicidal. Women display symptoms of depression that may look different than those for men; symptoms may be less typical and may include anxiety and even eating disorders.

SOME RISK FACTORS FOR DEPRESSION IN WOMEN

Genetics--Depression can be an inherited disorder, although researchers do not yet know the specific gene responsible. Evidence shows that the genetic risk of depression for females is almost fifteen percent higher than the risk for males.

Stressors--More than eighty percent of initial cases of depression follow a severe negative life event that is stressful and may be traumatic. Three times as many women as men respond to these types of events by experiencing depression.

Hormones--Boys and girls have the same rate of depression until about the age of eleven or twelve. Girls' changing hormone levels have an impact on their risk of depression, and this increased risk continues throughout their reproductive years. Male and female risks of depression equalize again in the mid-fifties.

Relationships--Women tend to invest a great deal of energy into relationships and also experience personal stress from stressful events in the lives of others. Tendencies to neglect the serf to take care of or to please others are characteristic of many women. These qualities may increase women's vulnerability to depression.

LIFE CYCLE ISSUES

A woman's life cycle presents many instances that may lead to or complicate feelings of depression. Let's follow a typical woman through her life to look at these times of increased risk.

Joy, our typical female, experiences her first increased risk as she begins menstruation. Changing hormone levels combined with the social and identity stresses of adolescence can initiate depression. If Joy begins to smoke, her risk is even more elevated.

Joy moves into adulthood and becomes pregnant at 25. Pregnancy and the postpartum period are another risky time. Women are at most risk of postpartum depression (PPD) in the first months after the birth of their first child. PPD affects up to fifteen percent of all new mothers and can have a range of severity. Less severe cases should resolve on their own within days to a week. It is thought that the cause of PPD may be the vast changes in hormonal levels that occur within 24 hours of giving birth. Depressive symptoms can affect the mother's ability to function and to bond with her child, so women who are impaired by symptoms should seek treatment immediately.

In her thirties, Joy has problems with depressed moods every month before she menstruates. Five percent of menstruating women are diagnosed with premenstrual dysphoric disorder, characterized by severe symptoms and life impairment. Two thirds of women with depression say their symptoms are worse premenstrually. Some medical authorities state that approximately half of women with PMS have an underlying problem with depression or anxiety.

Although many believe that depression is a symptom of menopause, research does not support this. Our typical woman, Joy, is really at greater risk of depression during perimenopause, the interval before menopause begins. This may be related to the gradual decline in estrogen or progesterone levels during this phase of life. Doctors have seen many cases where hormone replacement therapy helps create positive moods.

At 58, Joy has a heart attack and faces an increased risk of depression. Forty-five percent of women will experience significant depressive symptoms after a heart attack. Depression can slow the recovery of the heart and is thought to lower six-month survival rates.

PREVENTION AND SELF CARE

There are a variety of techniques that are effective for the prevention of depression.

First, a healthy lifestyle with adequate rest, exercise and nutrition is vital. These are the building blocks of a healthy, functioning brain, the chemical controller of all our moods, including depression. Work to improve these areas first. In terms of nutrition, Omega-3 fatty acids, found in many foods like fish and nuts or in supplement form, have been shown to be helpful for women experiencing postpartum depression and mild cases of clinical depression.

Exercise is a well-known remedy for depression, and as little as ten to fifteen minutes at a time can prove helpful. Exercise will increase levels of the positive mood neurotransmitters and feel-good endorphins. It will also decrease levels of the stress hormone cortisol and improve sleep.

Social support can also be vital; it is best to be in nourishing relationships, with equal amounts of give and take. Learn now to ask for help and support so you will be able to do so if you become depressed. Have empathy for others, but learn to keep a healthy detachment with your feelings.

Also, learn to be aware of yourself and your own stream of thoughts. Journaling is a technique that can lead to greater self awareness and understanding. Monitor your thoughts for overly negative or repetitive subject matter. Try to use a signal for yourself to stop those thoughts by consciously focusing on something else.

Meditation has also helped many women to be less stressed and more self-aware. It can help you keep problems in proper proportion. Mindfulness meditation teaches you to pay attention in a non-judgmental way to the present moment. When this is combined with cognitive therapy, there is a decreased likelihood of recurrence of depression.

If you do become depressed, follow the tips above to help yourself improve. Antidepressant medications can be very helpful, but are not effective in up to thirty percent of depressed individuals. Working with a trained therapist can also help, and many have found St. John's wort to be a natural and useful alternative to prescription medications. (See the pullout box on p. 13 for more information on St. John's wort and other supplement treatments.)

Try to be gentle with yourself if you are depressed; this is a medical illness, not a lack of motivation on your part. Set priorities to help manage your life until you feel better. Break necessary tasks into very small steps, then notice and applaud yourself for any progress. Focus on physical tasks you can accomplish and postpone analysis or decision making until you feel better. Most importantly, ask for help from family, friends or caring professionals. And remember, depression is one chronic illness that is treatable.

TREATMENT WITH SUPPLEMENTS

ST. JOHN'S WORT

It is likely that St. John's wort acts in the nervous system as an SSRI, or selective serotonin reuptake inhibitor, like other antidepressant medications. In fact, it has long been used in Europe to treat mild cases of depression and other mood disorders. The recommended dosage is 300 mg of an extract, standardized to 0.3 hypericin, taken three times a day. While the natural treatment may not present the same potential for side effects of prescription medications, there are medications it should not be taken in conjunction with; so, do your research or consult your physician before beginning a regimen.

SAM-E

Short for S-adenosylmethionine, SAM-e is a substance that occurs naturally in our bodies and can be taken in supplement form. Uses include the treatment of osteoarthritis as well as depression. Recommended dosage is 400-1,600 mg of the enteric-coated tablets or capsules, or the butanedisulfonate form. It is thought that it works faster than St. John's wort, but it is more expensive and may produce mild side effects.

B VITAMINS

These vitamins, particularly B6 and folic acid, can be helpful when taken on their own for cases of mild depression, and they can also help the efficacy of prescription antidepressant medications.

Sources: www.drweil.com, www.webmd.com

Janet Slack is a licensed professional counselor with an office in Hendersonville, NC where she specializes in depression, anxiety, couples counseling, trauma and substance abuse. Janet also owns Life Adventure Coaching and can be reached at 828-691-4655 or on the Internet at www.gmwthandchange.com or www.lifeadventurecoaching.com.