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Lesbians and Depression

Ellen Haller, MD
UCSF School of Medicine
The WomenCare Mental Health Clinic

What is depression?

Depression is not the same as The Blues. In depression, down times last longer and symptoms are both emotional and physical. One cant simply snap out of it and may often feel completely hopeless and have thoughts of suicide. Functioning is often impaired.

Many myths exist about depression, however, it is not:

  • a personal weakness

  • a condition that can be willed away

  • a persons own fault

  • a hopeless, untreatable illness

Following are the diagnostic criteria for Major Depression:

A. Five (or more) of the following symptoms have been present during the same two-week period on nearly every day and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure.

  1. Depressed mood most of the day

  2. Markedly decreased interest or pleasure in activities most of the day

  3. Decrease or increase in appetite

  4. Decrease or increase in sleep

  5. Restlessness or decreased activity

  6. Fatigue or loss of energy

  7. Feelings of worthlessness or excessive or inappropriate guilt

  8. Decreased concentration or indecisiveness

  9. Recurrent thoughts of death or suicide

B. Symptoms are not a mixed episode of Bipolar Disorder (also known as Manic Depression).

C. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

D. The symptoms are not due to a general medical condition or a substance (including prescribed, over the counter, or illicit drugs).

E. The symptoms are not better accounted for by bereavement (they last more than two months after the death of a loved one).

 

How Common is Major Depression?

Depression is a common illness with significant cost to individuals and to society. The total annual cost estimate (both direct and indirect costs) is $43.7 billion in the United States. The first episode of major depression usually occurs in the 20s or 30s age ranges, although it can occur at any age. After one episode of major depression, there is a 50% risk of a subsequent episode. This risk increases to 70% after two episodes, and after three or more episodes, the recurrence rate is 90%.

Overall, rates of depression in post-pubertal women are twice the rates in men. Its estimated that approximately 20% of all women will have at least one episode of major depression in their lifetimes.

Explanations for the gender difference are numerous. Social stressors such as womens increased vulnerability to domestic violence and rape, their typically lower wages compared with male counterparts, lower social status and the resultant financial difficulties can contribute to the development of depression.

Life cycle and developmental issues are crucial as well, such as the multiple roles juggled by women throughout their lives including mother, spouse and worker. Women who are mothers of preschool children have been shown to have the highest rates of stress. However, women with adolescents and those at mid-life whose children are out of the home also have the potential to develop psychiatric symptoms in response to their changing roles. Although the developmental tasks of young women, women of child-bearing age, those at mid-life and older women are different, all must cope with balancing their multiple roles.

 

How Common is Depression in Lesbians?

The definitive answer to this question remains unclear. In addition to the risk factors for depression in women listed above, lesbians and bisexual women may be more at risk for developing depression.

Living in a homophobic society, facing possible rejection from ones family, not having equal legal recognition of relationships, being closeted in some (or all) aspects of ones life, using substances abusively, and lacking equal health insurance benefits - all are risk factors for depression in lesbians and bisexual women.

The true prevalence of depression in this population is not clear. Some studies have found higher rates of depression in lesbians compared to heterosexual women, but others have not.

 

Components of Depression Treatment

Although a common symptom of depression is feeling hopeless that it will ever go away, depression is a treatable condition. Components of depression treatment include a thorough evaluation, education and self-help, individual or group talk therapy and sometimes the prescription of antidepressant medications. Treatment should begin with a thorough evaluation to rule out an underlying medical condition or the side effect of medications as the cause of the depression symptoms. For example, thyroid illness may initially present with depression.

Some behavioral steps one can take to help combat depression include setting realistic goals, breaking tasks into small pieces, spending time with others, being physically active, avoiding drugs and alcohol consumption, being patient about the rate of improvement and avoiding making major life decisions. Helpful books include Feeling Good by David Burns and Queer Blues: The Lesbian and Gay Guide to Overcoming Depression by Hall and Hardin.

Two specific types of psychotherapy have been proven effective in treating depression. These are (1) cognitive-behavioral (CBT) and (2) interpersonal (IPT) therapy.

CBT focuses on the cognitive triad of depression: a negative view of the self, the world, and the future. In the therapy, one learns about distorted thoughts that contribute to depression and about how to challenge the veracity of these thoughts, to develop alternatives and to increase flexibility. CBT is usually time-limited, i.e. 12 sessions total and can be done individually or in a group setting.

In interpersonal psychotherapy (IPT), one focuses on relationships, current issues and social functioning using an educational approach. IPT is usually time-limited (often 12-16 weekly individual sessions) and includes ongoing maintenance visits less frequently.

Medications including herbs, supplements and prescription antidepressants can be helpful in treating depression. Herbs and supplements are not regulated by FDA, and there is no guarantee that they are pure, safe, and effective. Very little is known regarding interactions with other similar products or with prescription or over-the-counter drugs, and their safety in pregnancy or with breastfeeding unknown.

Many people are hesitant to take prescription antidepressants because they fear becoming addicted or are frightened by the stigma or by the many media stories such as the reports of Prozacs potential to make people violent or suicidal (which has since been definitively disproved). Some individuals are hesitant to take these medications because they associate them with illicit drugs such as amphetamines or cocaine which artificially and temporarily elevate mood.

Prescription antidepressants are not addictive and do not cause a high. Several different classes are available, and all appear to be equally effective. Typically, response to an antidepressant may take four to six weeks, and once a response is achieved, it is recommended that the medication be continued for an additional nine to twelve months of feeling good. Stopping the medication sooner may result in a relapse back into the depression. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.

Where to get help

If you are unsure where to go for help, ask your family doctor, OB/GYN physician, or health clinic for assistance. You can also check the Yellow Pages under "mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals" or "physicians" for phone numbers and addresses. In times of crisis, the emergency room clinicians may be able to provide temporary help for an emotional problem and will be able to tell you where and how to get further help.

The Association of Gay and Lesbian Psychiatrists (www.aglp.org) and the Gay and Lesbian Medical Association (www.glma.org) can help with referrals. Your insurance company can also be a referral source; many managed care plans actually require that they be contacted by you if you are in need of a mental health referral before you schedule an appointment with a clinician.

Conclusions

Depression is a common problem with significant morbidity and mortality and may affect lesbians more frequently than heterosexual women. Depression is more than just feeling tired of blue. Multiple options exist for treatment of this condition, and the decision about what treatment to pursue depends on the severity of symptoms, past history, family history, and individual preference. A critical message to retain is that depression is treatable!

 

Additional Resources

Association of Gay and Lesbian Psychiatrists
http://www.aglp.org 

Gay and Lesbian Medical Association
http://www.glma.org 

U.S. Public Health Service Office of Womens Health
http://www.4woman.org/owh 

National Institute of Mental Health Depression Information (specifically for women)
http://www.nimh.nih.gov/publicat/depwomenknows.cfm 

Depression After Delivery (organization for women with post-partum depression)
http://www.depressionafterdelivery.com 

National Foundation for Depressive Illness
800-248-4344
http://www.depression.org 

National Depression and Manic Depressive Association
312-642-0049
http://www.ndmda.org
 

 

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