||Vijai P. Sharma, Ph.D
Some women regularly and "periodically," experience depressed feelings, irritability, discomfort, and motor tension. Everybody knows about PMS, thanks to the media, but, not everybody applies the diagnosis accurately. Subjective impressions can be misleading. You have to use a daily chart for at least three months of your periods and moods to be confident of your observation. If a woman regularly and repeatedly experiences depressed feelings which begin with ovulation and get worse until menstruation starts, she has "PMS." Mental health experts diagnose it as, "Pre-Memstrual Dysphoric (depressed mood) Disorder," the PMDD. Cyclical rise and fall of estrogen and other hormones are suspected to be the culprits here.
Depression in the post-pregnancy period is another piece of this reproductive cycle- depression link. Studies suggest that women who had experienced depression, particularly untreated depression, during the pre-pregnancy period, are more likely to experience post-partum depression than those who don't have any history of depression. Furthermore, a woman who had one or more episodes of untreated depression, if she faces stressful family circumstances during pregnancy, has even a greater risk of experiencing post-partum depression. The good news is that for most women, post-partum depression is transient and doesn't have any adverse consequences. However, a few women may experience severe depression or, even psychotic depression, even though they might not have had depression or a psychotic illness before.
Miscarriages, still child-birth, and infant death are also associated with depression. A woman's grief is profound at such times, but rarely recognized or acknowledged by our society. In the recent years, our awareness of a mother's "silent sorrow" has expanded. Today, expression of grief for an unborn or stillborn baby doesn't have to be totally silent and private, it can now be publicly acknowledged, at least in some quarters of our society.
When a mother comes to a clinic with depressive or anxiety episodes, Health care professionals, hopefully, are more alert to identify silent grief related to a pregnancy loss. However, what may still go unnoticed is the "anniversary grief reaction" of the loss of pregnancy. I have seen several women who had been hospitalized year after year in the same month and the significance of it, as related to pregnancy-loss, was never discerned by the staff or the patient. Those professionals who did identify a pattern in such admissions speculated about the presence of the "Seasonal Affective Disorder."
A mother's depression during the reproductive cycle has a direct implication for her child. Evidence suggests that depression in mothers may have a negative effect on children's behavior and their psychological, social, and intellectual development. This makes it even more imperative on women and their families to recognize depression early, and seek treatment not just for their sake, but also for the sake of their families.
Contrary to the popular myth, menopause does not increase the chances of depression. Even women who get depressed during menopause, their depressive thoughts or symptoms are not any different from the depressed women at other ages. Change- of- life, rather than menopause, appears to be the most relevant issue for these women. The transition from one phase of life to another seems to contribute to the increase in stress, depressive thoughts, and depressive symptoms. Again, women who tend to get depressed with the change of life are those who have had prior episodes of depression. In fact, children who experience depression between the age of six to thirteen, have seventy-two percent chance of getting depressed as an adult.
A woman also bears greater emotional burden than does a man, as in the case of childlessness. Infertility or the decision not to have children can bring about extreme anxiety and sadness. Many women report depression, and sometime their very first episode of depression, after hysterectomy (surgical removal of uterus).
Racial-cultural factors are also important in
estimating the risk of depression in women.
Prevalent rate of depression among African American women
and Hispanic women is double that of their male
counterparts. Depressive disorders, such as major
depression or chronic depression, are diagnosed less
frequently in African American women than in Caucasian
women. Depression is diagnosed slightly more
frequently in Hispanic women than in Caucasian
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1996, Mind Publications