Women and Depression: Is it Biochemistry?

Q.A new common wisdom took shape: Nurture, not nature, makes women more depressed than men. Women are diagnosed with the illness two to four times more frequently than men because of the way they are socialized as girls and treated throughout their lives. Feminist scholars documented, for example, that among all segments of society, married women suffered the greatest rates of depression.

A.At the University of California, San Diego, for example, researchers are testing whether hormone fluctuations during the menstrual cycle may contribute to depression by disrupting women's internal body clocks. Related research is exploring whether estrogen interacts with melatonin — a hormone released by the body in response to variations in daylight — in ways that trigger seasonal affective disorder, a form of depression thought to be two to three times more prevalent in women than men. Other investigators are pursuing evidence that estrogen indirectly sets the stage for depression, particularly after a stressful event, by intensifying and prolonging the body's "fight-or-flight" response to stress. Recent research shows that estrogen increases the body's production of cortisol, a stress hormone, and prolongs its activity. It's long been known that depressed people tend to have chronically elevated cortisol levels, and cortisol is thought to play a key role in depression. If estrogen exaggerates the stress response and amplifies cortisol production, the effect could go a long way toward explaining why more women than men develop depression. “As a feminist, I can see not wanting to talk about hormones (as a cause of depression), because hormones have always been used against us. But if we’re going to look at biochemistry, we’ve got to look at biochemistry, and our hormones are an integral part of our biochemistry,” says Martha Manning, a 46-year-old Virginia author and former psychology professor who became suicidal after suffering two miscarriages. These differences between men and women may help lead to gender-specific drug therapies. In a recent issue of the Journal of Clinical Psychiatry, Dr. Susan G. Kornstein of the Medical College of Virginia reports that depressed men seem to respond best to antidepressant drugs that affect both the norepinephrine and serotonin systems, such as an MAO inhibitor like Nardil or a tricyclic antidepressant like Sinequan, while women respond better to drugs that affect the serotonin system alone, such as Prozac, Paxil and Zoloft. Meanwhile, recent research at the National Institute of Mental Health suggests that women who take birth control pills may need higher doses of tricyclic antidepressants, and that antidepressants in general may take longer to work in women than in men. At the same time, geneticists are unearthing evidence that a predisposition to depression in both men and women can be inherited, passed down from parent to child through the generations.

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