www.psychiatrictimes.com/display/article/10168/50256 -
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Published on: 10/1/1996
Last Visited: 6/16/2008
Kimberly A. Yonkers, M.D., assistant professor of psychiatry and director of the Reproductive Mood Disorder Program at the University of Texas Southwestern Medical Center, said major depression goes undiagnosed in 50% of cases and, even when detected, undertreatment occurs in two-thirds of patients.
She called major depression the 'most common medical illness a doctor will see,' with 20% of women having at least one episode.
'Depressive disorders occur twice as often in women as in men,' she said, adding that the ratio is found globally across cultures. 'Underlying psychosocial risk factors and biological differences may affect vulnerability to depression at different points of a woman's life. '
Yonkers, who is also an assistant professor of obstetrics and gynecology, noted the association of depression with reproductive function, pointing out that it's around the age of puberty that rates for men and women begin to diverge, beginning to converge again after the age of menopause.
Regarding psychosocial contributions to depressive vulnerability in preadolescent girls, Yonkers discussed gender stereotypes and socialization that encourage girls to be helpless, dependent and concerned with appearance rather than competent, powerful and confident.
'Given what's in your toolbox to support yourself, the toolbox given to little girls is not as good as what's given to little boys,' she said.
Yonkers also noted that while clinical criteria for diagnosing the illness are the same for men as for women, depressed women are more likely than depressed men to experience guilt, decreased sexual interest, increased appetite, panic with phobia and hypersomnia.
She then discussed the differences between major depressive disorder (MDD), premenstrual dysphoric disorder (PMDD), premenstrual syndrome (PMS) and postpartum depression.
'PMDD is a newer clinical entity,' she said, explaining that unlike PMS, which affects about 70% of menstruating women and doesn't necessarily affect mood, PMDD occurs in about 3% of women, with at least one symptom being a mood symptom.And whereas functional impairment is not necessarily a feature in PMS, PMDD symptoms do cause functional impairment at work or with interpersonal relationships, she said.
In fact, PMDD, which has an age of onset in the late 20s and probably worsens with increasing age, will cause 1,400 to 2,800 symptomatic days over the course of an afflicted woman's lifetime. 'This is four to eight years if you run it consecutively,' Yonkers said. 'So this is really nontrivial and needs to be treated.'
Regarding the relationship between PMDD and MDD, Yonkers said that about 30% of women with PMDD have a previous history of MDD, and women with PMDD are at greater risk for developing a future episode of MDD.
Yonkers next discussed depression during and after pregnancy, stating that mood disorders may predate or occur during pregnancy.
'About 10% of pregnant women will have a mood disorder during pregnancy,' she said. 'Risk factors include financial difficulties, troubled relationship with partner, prior psychiatric illness and a concurrent general medical illness.'
Postpartum disorders include 'maternity blues,' which is common and requires no treatment; postpartum depression, which includes MDD without psychosis and minor depression; and the very serious emergency of postpartum psychosis, which includes MDD with psychosis, mania and brief reactive psychoses.
Yonkers said that contrary to myth, most women do not become depressed during older age.However, depressive symptoms are more likely during the four-year period before or after the last menstrual period, and women with previous episodes of depression or surgical menopause may be at risk for recurrence during the perimenopause, she said.
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