Depression Can Differ in Men and Women

The National Institute of Mental Health conducts research to determine gender differences in various mental illnesses. To educate the public on this topic, it recently cosponsored a Smithsonian Resident Associates seminar entitled "Depression in Women and Men: What's the Difference?" Phyllis Greenberger, president of the Society for Women's Health Research, and Dr. Steven Hyman, director of NIMH, presided over the meeting, which explored gender differences in depression from a variety of perspectives.

Depression in both women and men is a debilitating disorder that disrupts relationships and daily lives and affects nearly 10 percent of the population. Despite the fact that depression is very common, only about 10 percent 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.

Dr. Ellen Leibenluft, chief of the unit on affective disorders in NIMH's Pediatrics and Developmental Neuropsychiatry Branch, spoke about the diagnosis of depression and gender differences. Her review of data has shown that when considering gender differences in the reported prevalence of depression, a common belief is that the difference could be the result of response bias, denial of symptoms or differential forgetting. Her conclusion is that depressed men are not more likely to deny symptoms than depressed women, but that men are more likely to minimize or forget past episodes. These results, however, cannot account for the gender differences in the prevalence of depression, she emphasized.

Men and women report similarities in degree of impairment, length of episodes, chronicity of the illness, time to first recurrence, or number of recurrences, but women are much more likely to report seven or eight symptoms of depression. And pure depression — in which the person has no other psychiatric illness — is more common in women. In cases when depression is secondary, following another illness, in women it often follows anxiety disorders, while in men it often follows substance abuse disorders or conduct disorder. Women are more likely to develop substance abuse disorder after they become depressed. Women also tend to develop brain and liver damage relatively early in the course of alcoholism. Leibenluft suggested that this damage might relate to body size or rate of metabolism.

Few men or women who have suicidal thoughts get treatment. More women attempt suicide, but more men complete suicide attempts, partly because they tend to use more lethal methods such as guns rather than medication overdoses.

Dr. Kimberly Ann Yonkers, associate professor in the department of psychiatry at Yale School of Medicine, focused on the treatment of depression. "About 70 percent of people treated for depression will respond initially to treatment," she said. "That does not necessarily mean they become totally well or stay well. We need to come up with more pervasive and enduring treatments."