Depression in women

M. M. Weissman and M. Olfson, Depression in women implications for health care research, Science, 269, 799 (1995). 

A series of studies demonstrates a synergistic effect between drug therapies and psychodynamic talk therapies. The effectiveness of each form of therapy used independently is less than their combined use in the case of major depression. See A. Solomon, The Noonday Demon An Atlas of Depression (New York Scribner s, 2001) E. Good, Chronic Depression Study Backs the Pairing of Therapy and Drugs, New York Times (May 18, 2000) L. Altshuler et al., Treatment of Depression in Women A Summary of the Expert Consensus Guidelines, of Psychiatric Practice 7 (May 2001) 185-208. Kleinman, Rethinking Psychiatry p. ii. 

Despite overwhelming data supporting the efficacy of ECT treatment for major depression, marked variation in the extent and pattern of its usage continues. Use of ECT declined in the 1970s but then appeared to stabilize or increase in the 1980s (J. W. Thompson et al. 1994]. ECT is used far more commonly in private hospitals than in public institutions and is more commonly administered to older patients and to women. Its more common administration to women may be the result of higher rates of depression in women (J. W. Thompson et al. 1994]. Olfson et al. [1998] similarly reported that ECT is used more often in white persons, those with higher incomes, and the elderly. 

Kendler KS, Kessler RC, Neale MG, et al The prediction of major depression in women toward an integrated etiologic model. Am J Psychiatry 150 1139-1148, 1993... 

Klaiber EL, Broverman DM, Vogel W, et al Estrogen therapy for persistant depression in women. Arch Gen Psychiatry 36 550-554, 1979 Klawans HL, Weiner WJ, Nausieda PA The effect of lithium on an animal model of tardive dyskinesia. Prog Neuropsychopharmacol 1 53-60, 1976 Klein DP Delineation of two drug-responsive anxiety syndromes. Psychopharmaco-logia 5 397-408, 1964... 

Weissman MM Epidemiology of major depression in women. Paper presented at the annual meeting of the American Psychiatric Association, New York, May 4, 1996 Weissman MM, Leckman JF, Merikangas KR, et al Depression and anxiety disorders in parents and children results from the Yale Family Study. Arch Gen Psychiatry 41 845-852, 1984... 

Respiratory drive and rhythm are depressed by barbiturates. Coughing, sneezing, hiccupping, and laryngospasm may occur during anesthesia with barbiturates. Sedative ot hypnotic doses of barbiturates teduce heatt tate and blood pressure to levels found in normal sleep. Anesthetic doses produce more pronounced effects. Barbiturates cross the placenta when used in labor, they can cause respiratoty depression in neonates. Anesthetic doses dectease force and frequency of uterine contractions among pregnant women. 

The usually accepted prevalences for generalized anxiety disorder (GAD) are around 1.6% for current, 3.1% for 1 year and 5.1% lifetime (Roy-Byrne, 1996). The condition is twice as common in women as in men (Pigott, 1999). A small minority (10%) have GAD alone, and about the same proportion suffer from mixed anxiety and depression. Morbidity is high. About a half of those with uncomplicated GAD seek professional help, but two-thirds of those with comorbid GAD do so. Up to a half take medication at some point. The condition may coexist with other anxiety disorders such as phobias, with affective disorders, or with medical conditions such as unexplained chest pain and irritable bowel syndrome. 

Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J. et al. (2003). Treating depression in predominantly low-income young minority women. JAMA, 290, 57-65. 

ERYTHROCYTES. Erythrocytes are biconcave diskshaped, blood cells (with pits or depressions in the center on both sides), the primary function of which is to transport hemoglobin, the oxygen-carrying protein. The biconcave shape of the erythrocyte provides a large surface volume ratio and thereby facilitates exchange of oxygen. The average diameter of erythrocytes is 7.5 pm, and thickness at the rim is 2.6 pm and in the center about 0.8 pm. The normal concentration of erythrocytes in blood is approximately 3.9-5.5 million cells per pL in women and 4.1-6 million cells per pL in men. The total life span of erythrocytes in blood is 120 days. 

In the past several decades there has been increased incidence of depression, which motivated Gerald Klerman to describe this era as the age of melancholia [5], The lifetime prevalence of depression in the U.S. is higher in women (21.3%) than in men (12.7%). Although the rates of major depression vary across the world, data from fifty countries support the notion that this disease is the fourth leading cause of disability worldwide (second in developed countries) [3]. Longitudinal studies verify that the typical course of the disease is recurrent, with periods of recovery and periods of depression symptoms however, approximately 17% of patients have a chronic unremitting disease [6], Depression is the major cause of suicidal behavior and the rate of suicidal attempts has been estimated to be around 56% in depressed patients [7]. 

Migraine headaches without aura in women <35 years old Depression... 

A variety of kinds of evidence have linked emotional behavior to hormones. Two conditions, the menstrual cycle and menopause, have been the focus of a great deal of research on human behavior. In addition, gender differences in the prevalence of mental illnesses have been used as indirect evidence for possible hormonal effects on emotional disorders. For example, depression is more common in women than in men. In contrast, a pubertal onset of schizophrenia is more common in males than females (Hafner, et al., 1993), although the lifetime occurrence of schizophrenia is approximately equal in men and women (Seeman, 1996). Effects of hormones on emotional lability in men are described above in the context of aggression. 

For reasons that are not entirely clear, insomnia is also more common in women than men. There are particular times when a woman is especially vulnerable to insomnia, including pregnancy, the transition into menopause, and the premenstrual phase of the menstrual cycle. This, of course, suggests that it is changes in the female reproductive system that somehow alter sleep. Depression and anxiety are also more common in women at these times, and insomnia is a common symptom of these psychiatric illnesses. 

Uterine fibroids Preexisting uterine leiomyomata (uterine fibroids) may increase in size. However, there is no evidence of this with low-dose hormonal contraceptives. Depression The incidence of depression in OC users ranges from less than 5% to 30%. Pyridoxine deficiency may be a factor in the depression. Women who become significantly depressed when using hormonal contraceptives should stop the... 

Emotional disorders Consider removing the capsules in women who become significantly depressed since the symptom may be drug-related. Carefully observe women with a history of depression and consider removal if depression recurs to a serious degree. 

Labor and delivery - May produce fetal bradycardia, respiratory depression, apnea, cyanosis, and hypotonia in the neonate. Maternal administration of naloxone during labor has normalized these effects in some cases. Use with caution in women delivering premature infants. 

Zubenko GS, Hughes HB, Stiffler JS, Brechbiel A, Zubenko WN, Maher BS, Marazita ML (2003) Sequence variations in CREBl cosegregate with depressive disorders in women. Mol Psychiatry 8 611-618... 

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