Women are two to three times more likely than men to be diagnosed with depression. But this simple fact is complicated by many factors. Is there a bias in the diagnostic criteria? Do men manifest depression differently than women? And if it’s true that women are more likely to experience depression, is this because their bodies are different? Or is it the way society treats them? Do they have more to be depressed about than men do?
Let’s address some of these questions.
Is it possible that women who are unhappy with their “traditional” lot in life are labeled sick merely because they don’t meet male-defined standards of normality? This thesis has been considered by feminist thinkers since the 70s. It’s an idea that will not go away, and probably contains a grain of truth. Like it or not, psychiatry represents conventional values; it is an important means of social control and subject to abuse. If women are made to feel that there is something inherently inferior about being women, they are more likely to feel depressed. One study showed that in 2004 a third of women’s doctor visits resulted in a prescription for an antidepressant. How many of these women felt cared for, and how many felt (like some of my patients have told me) that they were being told to shut up and go away?
Still, it's very hard to read the epidemiologic studies and conclude anything else than there is more than bias at work here; that women are indeed more vulnerable to depression. I can think of several possible reasons: One is that perhaps women have more to be depressed about than men do. Anyone who feels she has to please other people is at risk for depression. The more sources of gratification one has in one's life, and the more predictable and controllable those resources, the less risk for depression. If a woman is taught to define her worth in terms of keeping her husband or the men in her life happy, she is too dependent on arbitrary and capricious sources of gratification. If she’s taught to believe that male approval is more important than self-satisfaction, she’s not going to put her own needs first.
Another factor leading to more female depression, at least in America, has to do with the way women are made to feel about their bodies. The thin, emaciated look glamorized by popular culture is simply impossible for most women to achieve. As boys grow into puberty, their bodies become more like that of the idealized man—broader shoulders, better muscle definition—but girls' bodies go in the opposite direction, becoming softer and more curvaceous. Fashion’s ideal is a prepubescent girl; so it’s no wonder that when girls find their bodies taking them away from the ideal, they become dissatisfied with their bodies and themselves. Girls and boys are about equally likely to become depressed before puberty; after puberty, many more girls become depressed.
Another possibility why women are more likely to be depressed is that their moods are, to a greater extent than men, influenced by hormonal changes. Many women with depression report an expectable waxing and waning of symptoms that coincides with their menstrual cycle. Women whose depression worsens during the premenstrual period have lower levels of serotonin during that time than they do post-menstrually, and lower levels than women without PMS. Besides the direct effects of hormones on moods, women may be more prone to feelings of powerlessness because their moods change due to forces they can’t control.
Still another factor is women’s experience of abuse and victimization. There is good reason to believe that sexual abuse of female children is much more frequent than anyone would like to admit; a study conducted by the American Psychological Association's Task Force on Women and Depression found that 37 percent of women had had a significant experience of physical or sexual abuse by the time they reached 21. A great many of my female patients were abused as children or teens, and I see the lingering effects of trauma like this in adulthood. Anxiety, difficulty trusting, difficulty sleeping, fears associated with sex, a sense of helplessness—these are enough to set anyone up for depression.
Finally, as one of my happily widowed clients put it, one good reason why more women are depressed is that they have to live with men.
So there is plenty of reason to believe that women are, indeed, more depressed than men, and it's easy to understand why this should be the case. But let me, the male writer, say a word about men and depression. Men are five times more likely than women to commit suicide. They are much more likely to become antisocial personalities, end up in jail, and/or to fall victim to substance abuse, than are women. They die, on average, 5 and a half years younger than women. Poverty and discrimination seems to lead to depression in women, but to antisocial activity and drug abuse in men. This certainly fits with common perception, but why should it be so?
Far too often, men get the idea that they are not supposed to feel, that they must at all times hide their feelings behind a supposedly tough outer shell. The number of men I know who have conversations with other men about anything meaningful is pitifully small. Instead of permitting ourselves to feel the emotional symptoms of depression, we defend against them by acting out (dangerous, self-destructive, or antisocial behavior), by somatization (rushing to the ER with chest pains that turn out to be an anxiety attack), or by trying to treat them with alcohol. Many men feel they are faking it, making it up as they go along, always one misstep away from disaster. They try to reassure themselves by swaggering around the house, but they wonder if women aren't really laughing behind their backs. From where I sit, women's depression may be a healthier alternative than any of these; men might actually be a whole lot better off if they could permit themselves to feel depressed.
(from Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. Second edition © 2010, Little, Brown & Co.)