Treating Depression in Women
April 27, 2023
Psychiatrist Sharon Batista, MD, has spent her career treating depression in women. She utilizes evidence-based approaches for helping women overcome depression, anxiety, workplace stress, and loneliness. In this expert interview, she discusses her approach to developing treatment plans, misconceptions about depression in women, and her advice for caregivers.
In your experience, does depression present differently in women than in men?
While men may also exhibit a down mood and loss of interest in things they once loved, I see these symptoms in women quite a bit. They also present with feelings of guilt, outwardly visible signs of sadness, overeating or not wanting to eat at all, and somatic symptoms such as fatigue, body aches, and cramps. There are types of depression that are unique to women. These include perinatal depression, perimenopausal depression, and premenstrual dysphoric disorder (PMDD). PMDD can be very disabling and is a risk factor for postpartum depression, another form of depression unique to women.
What are some common misconceptions about depression in women?
One big misconception is that genetics do not play a big role in determining which women are at risk for depression. There is so much new data coming out about heritability of mental illness. Some data suggests that up to 50% of mood disorders have a genetic component. This can have a meaningful impact on screening and preventative care for women.
Another major misconception that I observe on a regular basis both in our culture and among medical practitioners is that mental health-related medications are not safe during pregnancy and breastfeeding. Some medical professionals seem to believe that the risk that of depression in pregnancy or postpartum is negligible. This implies that there are not consequences to a developing fetus from a mother’s untreated mental illness. That is simply untrue. Our patients, who are truly the experts of their own experience, are getting varied and unscientifically-based advice from medical providers in whom they have placed their trust.
The last topic that comes to mind is menopause. Menopause is getting a little more attention in the media and our pop culture, which is really encouraging. I have treated a lot of women who are menopausal or perimenopausal and they find that their medical providers don’t have a lot of education on what they are going through. Menopause is not just a time when women stop having menstrual periods. There is data to indicate that women are more vulnerable to depression, with one study at Mass General Hospital indicating that between 20-40% of women experience depression during menopause. There is also some data showing that this can be influenced by other factors like vasomotor symptoms, being Black, having financial difficulties, history of childhood adversity, recent adverse life events, and low social supports.
What, if anything, is different about how you approach creating a treatment plan for a women?
I like to think of treatment as having phases of short-term vs long-term. The short term is focused on stabilizing and bringing the depression into what we call remission, meaning low to no symptoms. With long term treatment, we are focused on preventing a recurrence of symptoms.
We have to take into account risk factors for any patient when we are creating a treatment plan. We haven’t fully solved the puzzle of why some people get depression and others do not. It’s clear, however, that family history is a strong predictor of risk even in women who don’t have a history of mental health conditions. I would encourage primary care doctors, family doctors, and ob/gyns to include screening for personal and family mental health history as a part of their risk assessment because if they are able to identify women at risk then they can also help them to approach their mental health preventatively.
Working moms are often carrying a double burden. How can the loved ones around them better support their mental health?
Every family’s situation is different so this is not a one size fits all answer here. The good news is that there’s a lot that family members and partners can do to support a mother. Here are four suggestions.
- Check in with the moms in your life. Ask how things are going. If mom needs a helping hand or a break from watching the kids, volunteer your time. Sometimes just being able to take a shower uninterrupted can boost an overwhelmed mom.
- Be nonjudgmental and open-minded when she describes what she’s experiencing. If you are also a working mother, you can compare notes about the challenges you face, normalizing the struggle. There are so many things women have in common but we can feel ashamed to admit we don’t have it all together. Society sends us messages that can cause a woman to feel inadequate.
- If appropriate, be involved with visits to the primary care doctor or pediatrician to ask questions, advocate, and help out.
- Encourage getting professional help if needed. Reinforce the message that seeking help is not a sign of weakness.
Sharon Batista, MD, is a psychiatrist and Consultation-Liaison specialist. Dr. Batista completed her residency in psychiatry at the Mount Sinai Hospital and a fellowship in psychosomatic medicine at New York University. She is an active member of several associations including the American Medical Women’s Association and the American Psychiatric Association for which she is a Distinguished Fellow.
- Find more resources about the gender gap and depression in women.
- Read about Dr. Sharon Batista.
- Watch Ziona’s story of living with depression.