Major Depressive Disorder in Women Approximately twice as many women as men get diagnosed with MDD (major depressive disorder). Hormonal changes such as menstrual cycle changes, pregnancy, miscarriage, postpartum changes, pre-menopause, and menopause may contribute to the higher rate of MDD in women, but these differences between men and women are not the whole story. Women seem to be more vulnerable to depression following childbirth and it's very common for new mothers to show some symptoms of depression. It may be that the hormonal and physical changes associated with childbirth and the post-partum period and the stress associated with such an important life event are factors that can result in postpartum depression. However, MDD following the birth of a child is not normal. It is a serious problem that requires help right away. While hormonal factors may be important, it may be that MDD is more common in women because women are simply under more stress than men. Women often have responsibilities to work outside the home and do most of the work that needs to be done inside the home, including caring for children and aging parents, and maintaining relationships. In addition, women have the stress associated with being a single parent more often than men. Another reason why women may be more likely to become depressed compared to men is that women's sense of self seems to be largely derived from their relationships. In order to preserve their relationships (and hence self-esteem) women are more likely to initiate and maintain relationships in self-sacrificing ways making them particularly vulnerable to depression. Also, in times of conflict, women are more likely to ruminate or think "over and over again" about the conflict. Thinking too much about something negative often leads to increased feelings of depression. Finally, as compared to men, women may be more likely to admit to being depressed and doctors may be more likely to ask women about depression. Major Depressive Disorder in Men Although it may be that fewer men than women may have MDD, at any one time at least 2-3% of men are affected by it. MDD in men is just as serious a problem. In fact, although more women attempt suicide, the rate of completed suicide is four times higher in men. As compared to women, men are less likely to admit to having the symptoms of MDD, and doctors are less likely to ask men about depression. Depressed men are more likely to say that they feel irritable, angry, and discouraged, rather than describe themselves as hopeless and helpless or sad. This may be one of the reasons why depression is harder to recognize in men as compared to women. Even when men know that they're depressed, men may be less likely to ask for help. Men often attempt to deal with their depression by working all the time or by abusing alcohol or drugs. Sometimes it takes the encouragement and support of concerned family members and friends to convince men that depression as a real medical illness and that effective treatments are available. Major Depressive Disorder in the Elderly Many people think that it is normal for elderly people to be depressed. In fact, nothing could be further from the truth. Most older people enjoy happy, active and interesting lives. Unfortunately, when an elderly person gets depressed, people often dismiss the symptoms as a "normal" part of aging, as they assume that getting older in and of itself must be "depressing." Once again, this is simply not true. Untreated depression in the elderly is a serious problem that causes great suffering. One difficulty in identifying depression in the elderly is that many of the symptoms of depression (e.g., sleep difficulties, fatigue, appetite disturbance) can mimic certain medical conditions. Sometimes depression in the elderly is mistaken for Alzheimer's Disease or dementia. Hope this helps. Please feel free to ask questions! Danielle, Bilingual Health Educator

KiKi in Cali, In this instance I was referring more to negative thoughts and assumptions. Often, the negative thought patterns and core assumptions we hold of ourselves and our world lead us further down the negative spiral. If we can track those negative thoughts and figure out what the underlying issue is we can begin working on stopping that downward spiral as oppose to feeding into it. In regards to your question, I have recopied a past post of mine explaining what some of the causes of MDD are, happy reading! The exact causes of MDD are unknown, although biological, psychological, and social factors all likely play important roles in the illness: Genes In some families, MDD affects someone in every generation, suggesting a biological (genetic) component to the disorder. However, MDD also happens to people with no family history of depression. So, in some cases, a vulnerability to MDD may be inherited and in other cases not. Genes are probably not the whole story. Whether inherited or not, MDD, and especially chronic MDD has been associated with some fairly specific changes in brain chemistry and structures. Stress Stressful life events such as the death of a loved one, relationship problems, and marital problems, problems at work, financial problems, or unemployment can trigger a depressive episode. Sometimes even positive life changes such as marriage, new relationship, job promotion, or moving can trigger a depressive episode. The brain changes in MDD may be related to the brain's response to stress (or bad experiences) in early life. Later in life, this may cause the brain to react to one or more new negative events. Without any negative life events, people may avoid the risk for developing depression. Neurotransmiters Neurotransmitters are chemicals that convey or inhibit communication between nerve cells. Research has implicated a number of transmitter systems in MDD including serotonin, norepinephrine and dopamine. Brain Structures The use of modern brain imaging techniques has shown brain structure changes associated with MDD in a number of brain areas (including the limbic, orbital and prefrontal cortex, amygdala, ventral striatum, and hippocampus). Psychological Factors and Personality Some people with certain characteristics seem to be more likely to suffer from MDD. Some of these personality types include: people with low self-esteem, people who are pessimistic, those who self-criticize, perfectionists, and people who are easily overwhelmed by stress. These characteristics sometimes represent a psychological predisposition to depression. Sometimes they represent early symptoms of MDD. Other Factors Other events associated with MDD include childbirth, menopause and seasonal changes. Medical illnesses Stroke, heart attack, cancer, Parkinson's disease, infectious diseases such as influenza and hepatitis, and some hormonal disorders can cause depression. Depression complicates these medical illnesses because the depression makes people less able to look after themselves properly and work towards recovery and getting back to health. Medications Some medications such as antihypertensive medication, oral contraceptives and corticosteroids can cause depressive symptoms. Most often it's likely that some combinations of biological, psychological, social and environmental factors are involved in the onset of an initial episode of MDD. Once a person has had one episode of MDD, new stressful events can trigger future episodes. While most people can identify a "trigger" for a depressive episode, it is sometimes difficult or impossible to identify an event or stress. Sometimes depression seems to just happen out of nowhere and come "out of the blue."

Danielle, Would you mind expanding on your comment to Hazel? [i] "To get out of the pit, you have to understand and work on what got you there in the first place. What do you think this was for you? [/i] Is this to say depression is caused by environmental issues (the events in our lives) and is not due to a hereditary predisposition? I am truly interested and would like to know your thoughts. Kiki in So. Cal.

[quote] I sleep too much I avoid my friends and family a lot I am able to maintain some normalcy for my son ( I am a single mom of a 9 yr old boy)--its amazing what we Mom's can do when we have to [/quote] Hi Hazel ... I can identify with how you feel. Sleep and avoiding people are the two things I do with great success when I'm depressed. As for being a Mom ... well, I don't know how anyone manages that job, never mind being a single Mom and being depressed. Hats off to you!! The more you share here, the more you'll get to know the folks and this is a great bunch of people!

Thanks for the support and kind words... It truly helps to hear that others know what I am going through ... :) If all else fails, we should stop looking up and find a new way to tunnel out ..perhaps sideways?... I have always been fond of colouring outside the lines... lol P.S. The quote is from a famous poet named Dylan Thomas... Very insightful -- perhaps he suffered from Depression as well?

I wish I had a simple answer to that, but I'm still digging my way out of my pit too. But it took me a long time to dig myself this far down, it's going to take a while to climb back out. Being a Mom while trying to deal with depression is so tough. We want to be the best we can for our kids, but some days there's just nothing left to give. My daughters are 12 & 17 and I've tried to be honest with them (in an age-appropriate kind of way) that I might be a little out of sorts right now, but that's because I'm working on getting better. Because I love them and want to be the best mom I can. I am setting a good example for them by taking care of myself and being honest and teaching them that we can love ourselves even when we're not perfect. Kids often surprise me with how much they really understand. I agree, it is amazing what Moms can do when we have to. Remember though that there are some moms that don't do what they have to - you do because you are a GOOD mom. And thank you for your two cents on my question about taking time off from work. I have put the ball in motion for short term leave but I'm still waiting for the approval. You say you have to go back to work...is there no way your leave could be extended? Have you run out of benefits? Does your manager know that you're not ready? Maybe discuss that with him before you commit to going back. Some companies offer an adjustment period where you only work a few hours at first and gradually increase so that it's not so stressful. Could that be an option? If the therapy isn't working, maybe consider a new therapist. Your therapist has to be a good fit for you and there are good ones and not so good ones. Sometimes a new perspective from a different therapist can shed some light on your situation in new ways. I believe there's a poem that says "Rage, rage against the dying of the light / do not go gently into that good night"... I remind myself of that when it all just feels like too much... Take care :)

Hi Hazel, Tipper is right. People with depression feel so lost, isolated, desperate, useless. Two months ago it could have been me writing your words of avoiding family and friends, no spark, no enjoyment in my life, no enthusiasm. Some of these things are still true of me today, but now I am on session 5 and can see some kind of light. I really felt that I had been out shopping and left my brain somewhere and couldnt find it. Its hard going, bad days, worse nights, not so bad days, even the odd o.k.days. All i can say to you is post often, vent your feelings on here, there is such understanding, and work through those sessions as slowly as you need. It took the first 3 sessions before i noticed what it was all about, how it could work for me, but work it does. Hang in there. x

Hi Hazel Keep on plugging. You mean a lot to many more people, not the least is your son. If you meds are not allowing you to 'slip further' - that is a good thing, however, maybe you should speak to your doctor again and explain just that to him. How long since the change? You certainly do "make sence" - people with depression do feel 'lost'. You are an articulate person. It is good to do the sessions. Just remember, things can and do get better. Do some thing a little thing out of your comfort zone each day. It can be just a very little thing, but give yourself credit for it. We know how hard it can be. Take care

Hazel, To get out of the pit, you have to understand and work on what got you there in the first place. What do you think this was for you? Have you started using the tools of the program? Danielle, Bilingual Health Educator

Hi everyone, I have been reading the posts a lot and adding in my two cents where I think I can. I have now started doing the activity logs for Session one and hoping that I can succeed at this.... I have been off of work since October and not feeling any better... My meds have adjusted so I don't think i am slipping any deeper into that "well of darkness" but stopping the decline is one thing.. what about getting out of the well alltogether? I sleep too much I avoid my friends and family a lot I am able to maintain some normalcy for my son ( I am a single mom of a 9 yr old boy)--its amazing what we Mom's can do when we have to I don't have any spark in my life .. no enjoyment in anything.. even the stuff I used to like to do such as reading or watching movies/tv.. I can't concentrate on anything.... I have been off work for 2 months and the therapy I am in is not helping .... I am going to have to go back to work and the thought makes me physically ill.... What do I do? I feel like I am lost in a country I know I have been to before but I have forgotten the language... (hope this makes sense) HELP !