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Health: Fighting the fog of depression in women

in Living

By Tiffany King, for Wausau Pilot & Review

MMG-NP-King 102016
Tiffany King, DNP, FNP-C, APNP is a board-certified family nurse practitioner at Ascension Medical Group at Westwood. Photo courtesy of Ascension Medical Group

Depression can have profound consequences on women, not only mentally but physically as well. It can make even bright days seem dim, drain joy from life, and can create confusion and a lack of direction.

Everyone feels sad or down occasionally–when things go wrong at work, when we have an argument with a loved one, or when financial worries loom. We lick our wounds, regroup and dive back into the fray. Depression is a more profound reaction to biological and external factors that weigh us down.

For women, the lifetime risk of depression is 20 percent compared with 10 percent for men. The reasons for the imbalance are believed to lie in biology, sociology and economics.

Depression is not common in young children but appears more often at puberty when young women are affected more often than boys. Other risk factors for women coincide with pregnancy and childbirth, as well as menopause and all times of major hormonal transitions.

Sociological factors include stress caused by a history of sexual abuse, living in a toxic relationship, the burden of single parenthood and economic insecurity. While none of these factors causes depression directly, they can act as triggers. And all affect women disproportionately.

Depression is diagnosed when a person has a combination of at least four psychological and physical symptoms in addition to depressed mood for two weeks or more. Psychological symptoms include feelings of hopelessness and helplessness, loss of interest in pleasurable activities, feeling that life is meaningless and suicidal thoughts.

Physical symptoms include sleep problems, either being unable to sleep or sleeping too much; changes in eating patterns leading to either weight loss or weight gain; difficulty concentrating; lack of energy; and being unable to carry out normal daily activities.

In addition to hormone fluctuations and social and economic stress, risk factors for depression include a family history of depression, serious illness and loss of a loved one or a relationship.

These situations all lie in our life’s trajectory and it’s not possible to live without encountering some of them. What’s important is knowing what’s normal for you and reaching out for help when feelings of sadness and despair overwhelm you for more than two weeks.

Two primary treatment approaches are medication and psychological therapy. Either can be used alone or together.

Medication is effective for many patients, although it’s important to recognize that antidepressants normally take two weeks or more to have a noticeable effect.

SSRIs (selective serotonin reuptake inhibitors) include sertraline (Zoloft), fluoxetine (Prozac), ptalopram (Celexa), escitalopram (Lexapro) and paroxetine (Paxil.). They are not without side effects, however.

Commonly reported side effects of Prozac, for example, include diarrhea, anxiety, insomnia, nervousness, dizziness, headaches and sexual problems.

SSRIs work by blocking the reabsorption of the neurotransmitter serotonin. SNRIs (selective norepinephrine reuptake inhibitors) block the reabsorption of norepinephrine as well as serotonin. This group includes duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq.)

Older drugs to treat depression include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Although safe and effective for many, antidepressants carry a black box warning indicating that some patients face an increased risk of suicidal thoughts and suicide attempts, particularly during the early weeks of treatment and for those with anxiety when they begin taking them. For this reason patients should be carefully monitored during the early weeks of therapy.

Psychological therapy offers a number of different approaches.

Psychotherapy can help a woman deal with areas of conflict in her life and work with her in developing interpersonal skills.

Cognitive behavioral therapy works with the patient on examining negative thought patterns and assists in developing coping strategies to deal with stress.

Couples therapy can be effective in helping couples work through issues with a third party and develop more positive interpersonal communication.

Depression can envelop any of us either for biological reasons or when other life forces weigh us down. Like most other illnesses, it can be treated. Reaching out for help is the first step to move you out of the fog.


About the author: Tiffany King, DNP, FNP-C, APNP is a board-certified family nurse practitioner at Ascension Medical Group at Westwood.

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