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"The higher prevalence of depression among women than men appears to result from a much higher prevalence of a type of depression associated with somatic symptoms (appetite and sleep disturbances and fatigue accompanied with pain and anxiety)," states Brett Silverstein, PhD.1
Vivien Burt, MD, PhD,2 Professor of Clinical Psychiatry at the UCLA School of Medicine, Los Angeles, California, concurs. She has studied gender issues in the treatment of depression with physical symptoms. "Depression is the second leading cause of medical disability for women, but the tenth leading cause for men," she said. "Depression is more prevalent in every adult age group for women than men. And, women are also considerably more likely than men to have physical symptoms for both depression and anxiety disorders."
While "pure" depressions without any other physical symptoms or comorbid anxiety disorders are equally common in women and men, anxious somatic depressions are considerably more common in women. The implication of this is that the difference in prevalence between genders is a function of the increased rate of "somatic depression."
Since there is considerable evidence of overlap of the physiology of pain and mood disorders, the question remains as to whether antidepressants treat both, and probably the reason that many patients do not achieve remission is because painful symptoms are not addressed as a component of the depression.
Dr. Burt studied both psychosocial variables, such as cultural disadvantages and increased child rearing burdens, and biological variables, such as reproductive related transitions including puberty, premenstrual days, peri- and postpartum, and perimenopause that contribute to depression in women. She found that perimenopausal women are more susceptible to depression because they are particularly prone to physical symptomatology.
A lifetime history of depression and current depression are associated with earlier perimenopause. For some perimenopausal depressed women, the transition into menopause can improve mood, and the shorter the perimenopausal transition, the less likely there will be depression. Recommendations for perimenopausal depression involve psychotherapy and antidepressants.
There have been three positive studies about the use of estrogen in perimenopausal depression, and these responses take place in the perimenopausal period but not in postmenopausal women. A recent study of hormone replacement therapy found that the sum of risks was greater than the sum of benefits for postmenopausal women (perimenopausal women were not represented).
Estrogen therapy may be an option for depressed perimenopausal women. In the treatment of perimenopausal depression and hot flashes, there have been positive studies for venlafaxine, paroxetine, and fluoxetine, and antidepressants should be considered to treat both conditions.
Dr. Burt says that remission, not just response, should be the goal of treatment, that physical symptoms are common presentations in depressed patients, particularly women, and the comprehensive treatment of all symptoms may make the difference.
References
- Silverstein, Brett, PhD., Gender Differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry. 159:6, June 2002.
- Burt VK. Gender considerations in the treatment of physical symptoms of depression. Program and abstracts of the American Psychiatric Association 2004 Annual Meeting; May 1-6, 2004; New York, NY. Symposium 19D.
* Reprinted with permission from Medscape
http://www.medscape.com/viewarticle/480898 © 2004, Medscape.
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