Depression

1
Depression Anxiety in Women

• Dr. Nadia Szkrumelak, M.D., F.R.C.P

2
Depression anxiety

• Women more prone to depression and anxiety than
  men
• Cause of depression in women are different
• Pattern of symptoms often different

Depression is

• A serious condition
• Has multiple impacts
• Treatable

3
Depression in women

• 1/8 women will develop depression at some point
  in their lifetime
• Nearly twice as likely than men (21)
• Most common in women between the ages of 40-59
• Multiple impacts work, relationships, social
  life worth
• Causes reproductive hormones, social
  pressure, female response to stress

4
Anxiety disorders in women

• Women have higher prevalence rates than men
• Overlap between depression and anxiety
• Often under-recognized and under-treated

5
Anxiety disorders in women

• Panic disorder (21)
• Social phobia (21)
• Agoraphobia (31)
• PTSD (10-14 of women to 5-6 of men)
• Generalized anxiety disorder (6.6 of women
  3.6 men)

6
Types of depression

• Major Depression
• Postpartum Depression
• Manic depression or bipolar disorder
• Dysthymic Disorder
• Adjustment Disorders
• Psychotic depression
• Seasonal Affective Disorder (SAD)

7
(No Transcript)
8
Signs and symptoms

• Feelings of sadness, emptiness or unhappiness
• Angry outburts, irritability or frustration
• Loss of interest or pleasure in normal
  activities
• Suicidal thoughts
• Sleep disturbances
• Appetite and weight changes
• Difficulty concentrating
• Lack of energy

9
Signs and symptoms

• Feelings of guilt or worthlessness
• Fixating on past failures
• Slowed thinking, speaking or body movements
• Unexplained physical problems

10
Depression and gender
Women tend to

• Feel sad, apathetic, and worthless
• Blame themselves
• Feel anxious and scared
• Avoid conflicts at all costs
• Find it easy to talk about self-doubt and
  despair
• Use food, friends, and love to self-medicate
• Feel slowed down and nervous

11
Depression and gender
Men tend to

• Feel angry and irritable
• Blame others
• Create conflicts
• Feel restless and agitated
• Use alcohol, TV, sports, and sex to
  self-medicate
• Find it weak to admit self-doubt and despair
• Need to feel in control at all costs

12
Causes of depression in women
Across racial, ethnic, and economic divides

• Biological and hormonal causes
• Psychological causes
• Social causes

13
Biological and hormonal causes

• Women produce more stress hormones than men
• Progesterone prevents the stress hormone system
  from turning itself off
• Estrogen interacts with serotonin which
  regulates mood, sleep and appetite

14
Biological and hormonal causes

• Premenstrual problems (PMS/PMDD)
• Pregnancy and infertility
• Postpartum depression (baby blues to severe
  depression to psychotic depression)
• Perimenopause and menopause
• Health problems (chronic illness, injury,
  disabilities)

15
Psychological causes

• Focusing on and rehashing negative feelings
• Includes crying, ruminating, and talking to
  others
• Overwhelming stress at work, school or home
• Body image issues
• Adolescents and girls body dissatisfaction

16
Social Causes

• Marital or relationship problems
• Balancing career and home life
• Family responsibilities (children, spouse,
  ageing parents)
• Work stress (discrimination, losing, or changing
  jobs)
• Persistent money problems
• Death of a loved one
• Any other stressful life event

17
Treating depression in women

• Is your depression connected to your menstrual
  period and is a possible side effect of PMS?
• Are you pregnant and have complications and
  concerns?
• Are you struggling with baby blues after
  giving birth?
• Are you approaching menopause and dealing with
  hormonal and emotional fluctuations?

18
PMS PMDD

• Bloating
• Moodiness
• Fatigue
• Uncomfortable by not disabling

• 1/10 women
• Severe depression
• Irritability/mood swings
• Food craving or binge eating
• Physical symptoms

19
Self-Help for PMS PMDD

• Exercise
• Diet modifications
• Lower intake of caffeine, alcohol, salt, and
  fatty food
• Nutritional supplements (vitamine B6, calcium,
  magnesium, vitamin E, and tryptophan)
• Herbal remedies (primrose oil, chaste tree
  berry, maca)
• Stress reduction

20
4 fast mood boosters

• Exercise a brisk 30 minute walk makes a
  difference!
• Meditate yoga lowers heart rate, blood
  pressure, espiratory rate, and oxygen
  consumption
• Socialize
• Find purpose

21
Biological Treatment

• Antidepressants dont cure rather reduce
  symptoms
• Different types of anti-depressants affect
  different neurotransmitters in slightly
  different ways
• Choice of medication based on your particular
  symptoms

22
Types of anti-depressants

• SSRIs
• Selective serotonin reuptake inhibitors
• Zoloft, Paxil, Celexa
• SNRIs
• Serotonin and norepinephine reuptake inhibitors
• Effexor XR, Pristiq, Cymbalta

23
Types of anti-depressants

• Atypical
• Wellbutrin
• Few sexual side effects, may lower appetite, may
  help with quitting smoking
• -

• Tricyclic
• Elavil, Aventy, Tofranil
• -

• MAOs
• Monoamine oxidase inhibitors
• Nardil, Parnate
• -

24
Making anti-depressants work for you

• Be patient
• See if side effects improve
• If it doesnt work, try something else
• Take it consistently and at the correct dose
• Dont stop taking it before talking to your
  doctor first
• Add psychotherapy

25
(No Transcript)
26
Other treatments

• Repetitive Transcranial Magnetic Stimulation
  (rTMS)
• Electroconvulsive therapy (ECT)
• SAD lamp

27
Psychological Treatments

• Cognitive Behaviour Therapy (CBT) for milder
  depression
• Combination for moderate to severe depression

28
9 best ways to provide support

• Be there (just listen, hold hands)
• Try a small gesture (a card, a text, cook a
  meal)
• Dont judge or criticize
• Avoid the tough love approach
• Dont minimize their pain
• Avoid offering advice
• Avoid making comparisons
• Learn as much as you can about depression
• Be patient

29
(No Transcript)
30
(No Transcript)
31
Depression Anxiety in Women
Q A

• Dr. Nadia Szkrumelak, M.D., F.R.C.P