Understanding Symptoms of Depression in Women

For Houston college student Lauren Lacson, depression is a cloud that’s followed her since she was 12 years old. “It was an ongoing thing in my childhood,” she remembers. “But I was never validated by my parents, so I would feel these emotions and they would be pushed aside.” 

When she was 18, she was finally diagnosed with clinical depression, a mood disorder that affects an estimated 21 million adults in the United States each year.¹ Lauren joined the 10.5% of adult American females who had a major depressive episode in 2020.²

Think you might also have depression? Read on to discover the most common symptoms of depression in women, along with the causes of this chronic illness, types of depression and options for treatment.

Signs and symptoms of depression in women

Though Lauren experienced feelings of loneliness and hopelessness throughout high school, it wasn’t until she entered college that she realized something was seriously wrong. “When I think back to that time, everything is so foggy,” she says. “That’s something depression does. It’s like a little cloud on your mind. There was a time when I didn’t get out of bed for three days, dishes were everywhere. I couldn’t pick anything up off the ground without crying.” By December 2020, she had plans to end her life. 

That was Lauren’s experience, but depression affects everyone differently and, to complicate things, there are different types of depression, too. 

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) is the guide used by healthcare practitioners to diagnose depression and other mental health disorders. It lists specific criteria that must be met for a diagnosis. Experiencing some of the signs of depression some of the time is not necessarily enough to qualify. However, mood disorders exist on a spectrum, and you don’t have to be experiencing quote-unquote depression to seek help or talk to your healthcare provider.

Here are some examples of psychological and physical symptoms for major depressive disorder, where you must experience at least five of the symptoms for at least a two-week period (and they must last through most of the day nearly every day). One of the symptoms must be depressed mood or loss of pleasure:³⁴

1. Depressed mood (feeling sad, empty, hopeless or tearful)
2. Loss of interest or pleasure in all or most activities
3. Weight loss or weight gain or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Slowing down of thought and physical movement
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating and making decisions
9. Recurring thoughts of death and/or suicide with or without a specific plan for committing suicide

If you’re experiencing some or all of these symptoms — particularly weight gain, changes in appetite or decreased energy — it may be worth taking imaware’s at-home Women’s Health and Wellness Test to assess your heart health, thyroid function, inflammation levels and diabetes risk, since symptoms of depression can both overlap with other conditions and exacerbate other conditions.

Depressed mood and loss of pleasure

Depression is different from sadness.⁵ Everyone experiences sadness because we all go through difficult life events like divorce, death of a loved one or job loss. Depression may feel similar to sadness, except it often won’t have an obvious trigger and will typically last for weeks or months. It also has a big impact on how you see yourself and the world. It may include low mood, loss of interest or pleasure in activities that you might normally enjoy (e.g. hobbies, travel, sex or socializing), feelings of hopelessness and even feelings of guilt.

You may feel unable to escape negative thoughts, such as:

• I will feel this bad forever
• I have a good life so I shouldn’t feel this way
• I’m lazy and weak
• I’m a burden and my friends and family would be better off without me

Weight loss or weight gain

The connection between depression and weight is complex. By its nature, depression affects sleep patterns and eating habits:

• You may be sleeping more and moving less
• You may also be eating more (for comfort) or eating less (because you have a lack of interest)
• You may be skipping meals or choosing unhealthy foods that are easy to snack on or order in because you have no energy to prepare food

Depression may also affect how your brain understands rewards and experiences sensations like hunger and thirst.⁶

Sleeping too much (or too little)

Insomnia affects around 75% of depressed individuals, while hypersomnia (sleeping too much) appears in about 40% of young depressed adults and 10% of older adults — with a higher incidence in women.⁷ If you have insomnia, it can also increase your risk of depression.⁸ Whether you sleep too much or too little, it can significantly impact your quality of life and ability to function day to day. 

General fatigue and lack of motivation

People who are depressed often have a lack of energy to complete daily tasks. One way to understand this concept is the “spoon theory,” which was first used by Christine Miserandino to explain living with a chronic illness.⁹ The basic idea is that everyone has finite units of energy — a.k.a. spoons — at their disposal. Brushing your teeth might take one spoon. Working all day might take 300. Someone with depression will have fewer spoons to use each day, which means they have to pick and choose where they put their energy. Letting simple tasks like showering and tidying up go on the back burner is a common symptom of depression.¹⁰

Thoughts of death

Another depression symptom is obsessively thinking about death and/or suicide. Though not all depressed people will develop a plan to attempt suicide, Lauren did. “I wanted to tell people so badly but I always felt like a burden,” she says. “Even when I was admitted into the hospital [after my attempt], I was crying and kept apologizing, saying ‘I’m so sorry you have to deal with me.’”

Lauren was overwhelmed by her mental illness and feelings of sadness — and she didn’t know what was causing them. Her depressed brain was lying to her, telling her that she was a burden and she would be better off dead.

Causes of depression in women

Depression is incredibly complex and the cause(s) can be hard to pinpoint. Brain chemistry, differences in the physiology of the brain, hormones (particularly for women with depression) and genetics may all be at play.¹¹ 

There are also several risk factors:¹²

• Having family members with mental illness
• Traumatic or stressful life events (physical or sexual abuse, death or loss of a loved one or financial problems)
• Being LGBTQ+ in an unsupportive environment
• Certain personality traits (introversion, neuroticism or low conscientiousness¹³)
• Serious illnesses such as cancer, stroke, chronic pain or heart disease
• Abuse of alcohol and/or recreational drugs
• Certain medications

Lauren still doesn’t know the exact cause of her depression, but she believes certain personality traits (like her people-pleasing nature) and a lack of emotional validation from her parents when she was growing up may have played a role. Like Lauren, depressed people don’t always have a clear reason for how they feel, and that’s okay — it doesn’t make the condition any less real. All cases of depression are worthy of help. 

How depression affects women differently

Depression in women ages 14 to 25 is diagnosed more than twice as often as in young men.¹⁴ This disparity decreases with age, but a depression diagnosis is still about 1.7 times more likely in women.¹⁵ One reason may be that men are more likely to have untreated depression because they’re less likely to seek help.¹⁶ 

But that’s not the whole picture. Women also have more life stages where hormones fluctuate and their bodies change. Plus, as a whole, women experience more risk factors in their life circumstances such as financial instability, sexual abuse and stress associated with the caregiving of children and elderly relatives.¹⁷ 

Hormones and depression

The reproductive hormone fluctuations that occur during a woman’s menstrual cycle, during and after pregnancy and during perimenopause can all impact mood — and can even cause depression.¹⁸ Typically, other factors like those listed above (including life experiences and inherited traits) also play a role.

Depression may also be a symptom of hypothyroidism (when thyroid hormone levels are too low) or hyperthyroidism (when thyroid hormones are too high).¹⁹ 

Types of depression in women

When most people imagine depression, they think of major depression (a.k.a. major depressive disorder or MDD). It can affect any gender and was the diagnosis that Lauren received. 

These types of depression can also affect anyone:²⁰ 

• Persistent depressive disorder (a.k.a. dysthymia)
• Seasonal affective disorder (SAD)
• Depression with psychosis
• Bipolar disorder

There are also forms of depression that only affect people with ovaries:

• Perinatal depression
• Premenstrual dysphoric disorder (PMDD)

Major depressive disorder (MDD)

Also known as clinical depression or major depression, major depressive disorder is a severe form of depression that lasts for at least two weeks and interferes with daily life.²¹

Persistent depressive disorder (PDD)

Also called dysthymia, persistent depressive disorder often has less severe symptoms than major depressive disorder, but it lasts for two years or longer.²²

Seasonal affective disorder (SAD)

Someone with seasonal depression will typically experience depression symptoms during late fall and winter and will feel better through the spring and summer.²³

Depression with psychosis

Very severe forms of depression can trigger psychosis, which is a break from reality. It will usually be accompanied by delusions (false beliefs) or hallucinations (hearing, seeing or touching things that aren’t there).²⁴ 

Bipolar disorder (I or II)

Bipolar disorder is characterized by alternating high and low moods. With bipolar I, you must have had at least one episode of mania that’s preceded or followed by hypomania (a less severe form of mania) or a major depressive episode. A bipolar II diagnosis requires at least one hypomanic episode and one major depressive episode, but no mania.²⁵

Perinatal depression

Perinatal depression is a serious form of depression that can occur during pregnancy (prenatal depression) or up to a year after delivering a baby (postpartum depression).²⁶ It’s not just mild worry or exhaustion that new mothers experience (known as the “baby blues”).

Premenstrual dysphoric disorder (PMDD)

Like premenstrual syndrome (PMS), premenstrual dysphoric disorder occurs in the seven to 10 days before your period starts and may continue for the first few days of your period.²⁷ The difference is that it causes extreme shifts in mood that can disrupt daily life, from sadness and hopelessness to irritability or anger.

Treatment options and management

Treatment of depression typically comes down to three things — medication, talk therapy and lifestyle changes²⁸²⁹ — often used in tandem. Brain stimulation therapy, such as electroconvulsive therapy, may also be an option if nothing else proves effective.³⁰

Medication

Doctors tend to start by prescribing a selective serotonin reuptake inhibitor (SSRI),³¹ which increases serotonin in the brain, but there are also several other types of antidepressant drugs, mood stabilizers and anti-anxiety medications that are available to treat symptoms of depression. 

Side effects of these medications range from mild to severe and will vary depending on the type of med and the individual. Research into alternative therapies (think hormone therapy,³² psychedelics³³ and ketamine therapy³⁴) is ongoing for people who don’t respond to antidepressants.

Talk therapy

If you have depression, you may benefit from regular conversations with a psychologist, psychotherapist or counsellor who can help you challenge distorted thoughts and develop better coping mechanisms. Some standard types of therapy for people with depression are cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and interpersonal therapy.³⁵

Self care

When possible, a healthy diet,³⁶ regular exercise³⁷ and getting quality sleep may help manage depression symptoms.

For Lauren, treatment looks like taking the SSRI Zoloft, which was prescribed by her psychiatrist, and attending appointments with a psychotherapist. “We’ve been working through my intrusive negative thoughts,” Lauren says, noting that she tries to challenge negative beliefs and pinpoint where they come from. “If I really can’t snap out of it, we’ve been working on a lot of grounding techniques. I touch my fingers together and I’ll breathe in for four, hold it for four and let it out for four.” She also credits journaling and adopting a rescue dog with helping her manage depression.

If you think you may have depression, seek out a health-care professional who can put you on the right track for depression treatment that works for you.

Summary

Depression is a complex illness that affects people from all walks of life and there is no definitive cure.³⁸ But that doesn’t mean that it’s not possible to recover and live a fulfilling life. 

“I get really sentimental whenever I have happy moments,” says Lauren, reflecting one year after her suicide attempt. “When I had my twentieth birthday, my boyfriend and I went to the Virgin Islands. On the plane ride home, I thought, ‘I could not have been alive for this. It’s so beautiful.’ There have been so many things that I’m so glad I experienced and it makes me feel like I’m here for a purpose.”