COVER

Biology and mental health

Why do women suffer more depression and anxiety?

SARAH SCOTT January 12 1998
COVER

Biology and mental health

Why do women suffer more depression and anxiety?

SARAH SCOTT January 12 1998

Biology and mental health

Why do women suffer more depression and anxiety?

SARAH SCOTT

ANITA ELASH

Linda King was at the hairdresser, a year and a half after the birth of her first son, when the panic first hit. Her long red hair was tied up in rollers, all set for the hair dryer, when a dreadful, frightening feeling came over her, and she knew she had to get out of there, fast. “Get the rollers out of my hair!” she told the puzzled hairdresser. “I can’t stay.” That was 18 years ago, and for months afterward she could not go near a beauty salon without feeling the same claustrophobic sickness. Then the panic attacks struck in airplanes, in restaurants, at sitdown family dinners. She could not sleep and exploded angrily when her son dawdled before preschool. With her stomach tied up in knots, she often felt nauseated and dropped 12 lb. It took years for King to discover the cause of her problem—and the answers came from a self-help group.

At first, neither King nor her GP could isolate the cause of her depression. “Here I was with a child, a great husband and a lovely home,” she says.

“Pretty much the Canadian dream. But I thought I was going crazy. I had visions of people coming to get me.” It was only after the birth of her third son that King finally understood that her anxiety, panic attacks and depressions were triggered by childbirth. When she joined Vancouver’s Pacific Post Partum Support Society, she learned that 10 to 15 per cent of new mothers suffer depression, often accompanied by anxiety disorders. “I realized I'm not a deviant, a crazy, horrible person,” says King, now 42 and a counsellor at the society.

Postpartum depression is, of course, a uniquely female affliction, but it is just one facet of a major mental health problem for women. Although the overall rate of mental illness is the same for men and women, the statistics show women to be twice as likely to get depressed and anxious as men. One-quarter of women will experience clinical depression during their lifetime, double the rate for men. Men, on the other hand, are more likely to abuse drugs, including alcohol. While women share with men some of the classic symptoms of clinical depression—crying, low self-esteem, sleeplessness, eating disorders and even suicidal tendencies—depressed women have some symptoms of their own. They are more likely to be anxious and tired, says Toronto psychiatrist Dr. Barbara Dorian. Withdrawal and phobias are more common among women, as are stomach ailments. In fact, women make up nearly 90 per cent of North Americans who seek help for irritable bowel syndrome (IBS), characterized by abdominal pain, bloating and chronic diarrhea. And half of those women suffer from depression or anxiety, although it is not known whether depression causes IBS or the other way round—or if they happen together— says psychologist Brenda Toner, director of the women’s mental health program in the University of Toronto’s psychiatry department.

Theories about the prevalence of depression and anxiety among women have been influenced by changing attitudes towards women. In the 1940s and 1950s, the medical profession believed in the “raging hormone” explanation, says Dorian. Women were thought to be the weaker sex, biologically inferior to men and at the mercy of their hormones. In the 1960s, feminists discredited that theory, instead blaming women’s mental health problems on a patriarchal society. But now, as new research underlines the role of chemical imbalance in depression for both sexes, leading mental health researchers believe that depression in women is caused by a mix of biology, social conditioning and psychological problems.

There is little doubt that biology plays a powerful role, at least for some women. Studies have established that young boys are depressed slightly more often than young girls, but that picture changes dramatically at puberty, when girls are twice as likely as boys to get depressed and anxious. Only after menopause does the prevalence of depression in women decline to the rate for men. Estrogen and progesterone—hormones produced by the ovaries—are two key suspects. Those hormones, which increase dramatically at puberty, act on neurotransmitters in the brain, including serotonin, which is commonly associated with depression. Depletion of serotonin may precipitate depression. But there are no easy answers, says psychiatrist Donna Stewart, who heads the Toronto Hospital’s Women’s Health Program. If an increase in estrogen can trigger depression, why is it that some postmenopausal women’s moods improve with estrogen supplements? And why do sudden changes in hormone levels affect some women and not others? “The jury is out about what all of this means,” says Stewart.

Many feminists insist that social forces are far more important than hormones in promoting women’s depression. At adolescence, just as the ovaries are producing quantities of estrogen and progesterone, powerful cultural forces undermine girls’ self-esteem. In Reviving Ophelia, a best-selling book on adolescent girls, psychologist Mary Pipher tells how girls discard their authentic selves in a frustrating effort to become what society wants them to be—objects of beauty dedicated to caring for others, not themselves.

As women, they face different social pressures, says Toner, citing poverty, abuse and discrimination among conditions that contribute to many cases of depression. Juggling the kids and a job— as the majority of Canadian mothers of young children now dotakes its toll. Every day is a rush that leaves no time for “the solitude, reflection and quiet connections which refuel and sustain people,” says Dorian. Fatigue, rated the number 1 personal health concern of otherwise healthy Canadian women in 1996, can trigger depression. “It’s a woman’s way of saying things have got to change,” says Kathryn McCannell, associate professor of social work at the University of British Columbia. ‘Your body is on strike.”

But when depression shuts down young mothers, their children may suffer, too, warns Dr. Shaila Misri, a Vancouver psychiatrist, professor and co-director of reproductive psychiatry at B.C. Women’s Hospital. British and American researchers have found that toddlers’ thinking and emotions are disturbed by depression in their mothers, says Misri. A mother’s mood disorders can even affect her infant’s playing, sleeping and appetite. “The crucial early mother-infant relationship,” she says, “determines how a person will react with the rest of the world.” Misri advises patients to take Prozac while pregnant or nursing, even though tiny amounts of the antidepressant drug go to the fetus or infant, with unknown long-term effects.

Yet King says a postpartum depression does not have to ruin a mother’s relationship with her children. Talking about her illness has helped her build a solid and loving relationship with her three sons, she says. “I feel like it has worked itself out,” she adds. But it took effort. King still cries at the memory of what her eldest son, Chris, told her, at age 10, when she was suffering after the birth of her third son: “It’s because you didn’t like us that it happened.” Then, and for years later, King assured her children that her illness was not their fault. She now believes it sprang from a mix of hormones, unreasonable demands she placed on herself as a mother, her reluctance to provide care for herself, and the memory of bitter quarrels between her parents when she was young.

While support groups help women like King, a new generation of feminist mental health professionals is developing special ways to treat women with depression and anxiety. On the drug front, Dorian is looking at ways to fine-tune classical antidepressants to make them more effective for women. ‘Women’s brains,” she explains, “are wired slightly differently.” Women, for instance, respond more slowly to antidepressant drugs and may be helped by certain hormones and drugs that do not work on men.

Parents can play a role, too, by promoting healthy self-esteem in their daughters. ‘You can listen to the girls’ voices and respect what they have to say,” says McCannell. While she believes that only political and social change can resolve the problem, she says parents can help by encouraging their daughters to play sports and to decode TV ads that play on women’s insecurities. And mothers can be role models by taking care of themselves rather than playing the martyr. That is one lesson Linda King learned in the years it took her to come to terms with her depression. The nurturing, she says, “has to come from somewhere, rather than an empty well.”