The WHO classifies depression as the leading cause of disease burden in women of childbearing age, worldwide.
"While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males. In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries."
I focus on women's mental health because the evidence shows that women are disproportionately affected and disabled by symptoms of depression. Biologically, we can identify hormonal changes that may account for some of these vulnerabilities. For example, during the postpartum period, the quick drop in progesterone following delivery is associated with the onset of postpartum depression. Or in the week prior to your period each month, worsening in mood or irritability is often associated with an abnormal response to a quick rise and fall of progesterone and allopregnanolone. Evidence of these hormonally-based triggers seem to be bolstered as researchers and scientists work to create medications that target the hormonal changes-- such as brexanolone (Zulresso) and zuranolone. However, hormonal changes are just one component of the experience of mental health as a woman.
In my practice, I work with all who identify as women. In the United States, there are countless policies and social pressures that affect women's mental health beyond hormonal differences. To name just a few--
- The U.S. is one of 6 countries without any national paid leave policy
- The U.S. has the highest maternal mortality rate of any wealthy nation in the world
- Every year, people in the U.S. die of pregnancy-related causes at more than double the rate among nations with similar levels of income 
- Where women made up 43 percent of the work force, they accounted for 56 percent of Covid-related job losses 
- Racial and gender wage gaps remain profound 
- A common experience I see affecting a woman's mental health is the mental load or "invisible labor"-- the unseen responsibilities and planning that often falls to the woman in a family unit.
I work with women throughout all stages of life to help identify when there might be hormonal changes affecting mood and anxiety and also help identify when there are other psychological and social structures at play. While we cannot change the world and its policies overnight, what we can do is acknowledge the challenges that are imposed on many women and despite these challenges, rise up and thrive.
Stahl SM. In: Stahl’s Essential Psychopharmacology. 2013;284-323; Wise DD, et al. CNS Spectr. 2008;13:647-662.
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