Four major health problems in women

Townsend Letter for Doctors and Patients,  Dec, 2004  by Tori Hudson

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Depression in Women

Unipolar major depression is the most common psychiatric condition seen by primary care physicians, and most epidemiologic studies have shown that it is more prevalent in women than in men. Depressive disorders affect approximately 20 million American adults each year. They will affect one in eight individuals over the course of a lifetime, and are twice as common in women as in men. Depressive disorders can begin at any age, but they most commonly begin in the 20s and 30s. In this country, depression is diagnosed in two women for every man, on average. (Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994; 151: 979-986.) (Weissman MM, Olfson M. Depression in women: implications for healthcare research. Science. 1995; 269: 799-801.) (Weissman MM, Bland R, Joyce PR, Newman S, Wells JE, Wittchen H-U. Sex differences in rates of depression: cross-national perspectives. J Affect Disord. 1993; 29: 77-84.)

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The sexual difference in rates of depressive disorders is not apparent in childhood but is evident by the age of 12 and is well established by the age of 15. The reason for this gender difference is not so clear. Some attribute the differences to women in our society having higher rates of victimization, role conflicts, internalization of stress, and a greater tendency toward low self-esteem. Others counter that it has its basis in neurobiologic and endocrinologic differences. Both schools of thought are probably at work, and we know that there are periods of hormonal change that tend to coincide with particularly vulnerable times for the occurrence of depressive disorders such as adolescence, premenstrual, pregnancy, postpartum, miscarriage, perimenopause and postmenopause.

1. Psychotherapy

Both interpersonal therapy and cognitive/behavioral therapy are effective against depression, although women with severe depression may not respond as well as men to cognitive-behavioral therapy.

2. Lifestyle changes

Cigarette smoking can be a significant factor in depression. Smokers have more symptoms of anxiety and depression than nonsmokers. Major depressive disorders are more common among smokers than nonsmokers. Conversely, for some susceptible women, nicotine functions as an antidepressant and nicotine withdrawal can produce depressive symptoms. Several studies have explored the connection between caffeine intake and depression. (Gilliand K and Bullick W. Caffeine: A potential drug of abuse. Adv Alcohol Subst Abuse 3:53-73, 1984.) People prone to depressive moods or anxiety states tend to be especially sensitive to caffeine.

Many studies have clearly indicated that exercise has significant antidepressive effects. There have been at least 100 studies where an exercise program has been used to treat depression. In an analysis of the 64 studies done prior to 1980, exercise was shown to relieve depression and improve self-esteem and work habits. (Folkins CH, Sime WE. Physical fitness training and mental health. Am Psychologist 36: 375-88, 1981.)

Subsequent studies since 1980 have further demonstrated, with even greater scientific confirmation, that regular exercise is an important antidepressant. Some of these studies concluded that exercise can be as effective as pharmaceutical antidepressants and psychotherapy. (Martinsen EW. The role of aerobic exercise in the treatment of depression. Stress Med 3:93-100, 1987.)

3. Folic acid

In studies of depressed patients, one third of them have been shown to be deficient in folic acid.

(Crellin R, Bottiglieri T and Reynolds EH. Folates and psychiatric disorders. Clinical potential. Drugs 45: 623-36, 1993.)

Depression is also the most common symptom of a folic acid deficiency: 800 mcg per day of folic acid should be adequate to prevent deficiencies although much higher doses may be needed for a treatment dose.

4. S-Adenosylmethionine (SAM)

S-Adenosylmethionine (SAM) is formed in the body by combining the amino acid methionine with adenosyl-triphosphate (ATP). SAM is required for the manufacture of many neurotransmitters, including serotonin. It improves binding of neurotransmitters to receptor sites, which then will cause an increase in serotonin, resulting in significant improvement in depression, providing perhaps the most effective natural antidepressant to date. (Janicak P, et al. Parenteral S-adenosylmethionine in depression: A literature review and preliminary report. Psychopharmacology Bulletin 1989;25:238-241.)

5. St. John's wort (Hypericum perforatum)

St. John's wort (Hypericum perforatum) is the most talked about herbal antidepressant to date: 25 controlled studies have investigated the antidepressive effectiveness of hypericum extracts for mild to moderate depression. A total of 1592 cases have been included in those 25 trials. (Harrer G and Schulz V. Clinical investigation of the antidepressant effectiveness of Hypericum. J Geriatr Psychiatry Neurol 7 (Suppl 1): S6-8, 1994.)