Women, Hormones & Depression
Depression in men and women is thought to be different. One of these differences is the assumption that some imbalance of female hormones can play a significant role in the onset of depression in women. This, it is often argued, helps to explain the reason why more women than men appear to suffer from depression. But is it really as simple as this?
Two conditions commonly associated with hormones and depression are Premenstrual Dysphoric Disorder and the so-called ‘baby blues' (postpartum depression). Premenstrual disorders and postpartum depression do seem to point to hormonal imbalance, but research findings are actually less conclusive than might be expected in relation to the role of female hormones to depression.
A diagnosis of Premenstrual Dysphoric Disorder (PDD) follows after five or more of the following symptoms of major depression during most menstrual cycles:
- Feeling of sadness or hopelessness, possible suicidal thoughts
- Feelings of tension or anxiety
- Panic attacks
- Mood swings marked by periods of being tearful
- Persistent irritability or anger that affects other people
- Disinterest in daily activities and relationships
- Trouble concentrating
- Fatigue or low energy
- Food cravings or binge eating
- Sleep disturbances
- Feeling out of control
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain *
Symptoms typically worsen a week prior to menstruation and then improve afterwards. PDD, or Premenstrual Syndrome (PMS), is a controversial topic. The focus of the controversy is whether or not the condition even exists, whether it is a hormonal condition, some facet of personality or maybe a response to stress. To date, it appears that social, cultural, biological, and psychological factors all appear to be involved and this may be due to the complex lives that many women lead. It is not uncommon for women to feel that they must try to please everyone but in themselves they feel they are nobody. This reflects a poor self-image and is likely to be a significant factor in the onset of depression.
The baby-blues (postpartum depression) affects women in different ways. Feelings of sadness, low mood and crying are quite common after the birth of a baby. This mood will often pass after a few days and is considered quite normal. The cause of the low mood is generally attributed to the hormonal upheaval that follows birth, namely the low estrogen and progesterone.
By contrast, major depression following childbirth can affect up to 15 percent of women. This is clearly an issue of concern but as Hammen (2005) points out, it is still only a minority of women that are affected and is not therefore an inevitable consequence of hormonal changes following childbirth. Hammen goes on to state that roughly 1 in every 1000 women will experience a psychotic form of depression. This is mostly associated with women who have a history of bipolar disorder. Psychotic postpartum depression is characterised by delusions (false beliefs). In my own experience, for example, I came across a patient who firmly believed she could only continue to breath if fresh flowers were pressed against her mouth and nose.
In these two examples, it seems clear that hormones do play a role in the onset of depression, but because of the intimate relationship between physical, emotional and environmental factors, questions remain over the very specific role of hormones in relation to depression.
Hammen, C. (2005) Depression. Psychology Press.
* Robertson, Audra (2006,11,08). Premenstrual dysphoric disorder. Retrieved September 10, 2007, from MedlinePlus Web site: Premenstrual dysphoric disorder