Each year, between 8 and 16% of women aged 18 to 50 suffer from depression. A figure “twice as high” as that of men, according to Lucie Joly, psychiatrist at the Saint-Antoine and Trousseau hospital and lecturer at Paris Sorbonne University and Hugo Bottemanne, psychiatrist at the Bicêtre hospital and lecturer at Paris Saclay University.
On the occasion of the release of their book this Wednesday Depression in women (Editions du Rocher), they explain to 20 Minutes why women are more affected by this disease than their male counterparts.
To begin with, you explain in your book that there is a “female depression” and “atypical” symptoms. What are these?
Lucie Joly: There is a feminine face of depression. Women will show more sadness, despair, feelings of uselessness, anxiety. Men, on the other hand, have more angry depression, with addictions, irritability, escape through overinvestment in work, sports or sex. In addition, women tend more often to present so-called atypical symptoms, including a greater appetite and sleep than usual, an acceleration of movements and thoughts, more painful sensations.
You also say that there are biological differences between men and women that may explain a higher figure in the latter. What are they?
LJ: Hormonal changes are one of the keys to understanding depression in women, although it is not the only one. The best example is premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMDD is a pathological condition that affects 5% of women with symptoms of severe depression in the days before their period. PMS is physiological and affects 20 to 50% of women, with symptoms of emotional hypersensitivity or fatigue before their period. The pregnancy and postpartum period are also important, with brain changes making them more susceptible to anxiety and depressive disorders. Symptoms of postpartum depression will affect one in five women and depression during pregnancy affects 10 to 15% of women. Finally, the last major period concerned is premenopause. Contrary to popular belief, it is not during menopause but during the two years preceding it that there is a greater risk of depression.
How do these hormonal changes affect depression?
Hugo Bottemanne: There is brain plasticity at all times, meaning that neurons are constantly changing their connection to each other to meet the needs of the body and to prepare to react to changes in the environment. Hormones influence this brain plasticity. They can modify the action profile of neurotransmitters, which are the chemical molecules that allow the transmission of information. In association with stress factors and inflammation, this can contribute to the emergence of psychiatric disorders in women.
And what about the link between the birth control pill and mood disorders?
HB: Old scientific literature had shown an effect of hormonal contraception, particularly estrogen-progestin, on emotions. But more recent literature shows that its effects are not so clear. Some studies even show that they are protective against mood disorders. What we know in any case is that the earlier you start contraception, around 12-13 years old, the more there will be hormonal variations that can be potentially harmful. Some studies have shown that resuming progestin contraception in the first months after giving birth could be associated with an increased risk of postpartum depression. To give a global message, I would say that we must adapt to the particular case of each woman and pay attention to the potential effects on mental health when prescribing contraception.
You explain that there are also socio-economic factors to take into account, such as precariousness or sexual and domestic violence. How do they impact depression?
LJ: When you experience precariousness and violence, you are more likely to suffer from depression. For example, 30% of women who are in precarious situations suffer from this pathology.
HB: I have worked for the last two years at the Maison des Femmes de la Pitié-Salpêtrière and in some victims of domestic violence, sometimes many years after the events, symptoms of depression can appear.
OR Contrary to popular belief, a study has shown that depression is not more common among victims of physical violence compared to psychological violence. It is possible that we know how to better manage physical violence from a social, legal and medical point of view, while psychological violence often remains hidden and unpunished.
However, are these figures biased by the fact that men consult fewer mental health professionals than women?
HB: Indeed, women consult more professionals and express their complaints more easily than men. They will talk more about their psychological suffering while men, for their part, will rather alleviate their suffering by consuming a psychoactive substance such as alcohol or committing transgressions. In addition, the angry depressions that men suffer more from do not fit into the cultural representation that we generally have of depression and therefore it is sometimes poorly or not diagnosed. This bias must play a role but it is not enough to explain a figure that is twice as high for women.
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What solutions could be considered to reduce the number of depressions among women?
L. J: We advocate a personalized approach to medicine. In cardiology, for example, we now take into account risk factors and female symptoms in myocardial infarction because we have noticed that women have a much longer treatment delay than men. We should do the same for depression. This is starting to work since, in postpartum depression, a treatment that acts on specific receptors has just been released in the United States. And we must also encourage clinical trials on women. We have long thought that hormonal variations would bias the results, but it is quite the opposite. By taking these variations into account, we ensure that they are better treated.