Here’s what you should know—especially if you’re a woman or love one

October is Depression Awareness Month—a topic of particular relevance and importance to women, as women are twice as likely to experience depression as men. This could be due to biological, hormonal, and social factors that are unique to women.

While some mood changes and depressed feelings may be normal with hormonal changes, depression usually is not caused solely by these changes.

For example, during puberty and the onset of menstruation, hormonal changes can lead to physiological changes that may raise questions about sexuality, gender identity, body shame, and self-esteem. These changes can also accentuate conflict with parents or peers, and amplify fears about “fitting in” or missing out. Together, these may result in longer-lasting feelings of anxiety, sadness, or depression.

Similarly, a small percentage of women (10%-15%) experience depression after giving birth. Again, hormonal changes are probably only part of the picture. Post-partum depression may be the result of:

• Major hormonal fluctuations that influence mood
• The responsibility of caring for a newborn, including sleeplessness and around-the-clock feeding
• Poor social support
• The loss of a woman’s previous identity as an independent actor
• The need to develop a new identity as a primary caregiver
• Pregnancy and birth complications
• Breastfeeding problems
• Infant complications or special needs

In other words, the higher rate of depression in women isn’t the result of biology alone. Life circumstances and cultural stressors can also play a role. For example, women are more likely than men to:

• Live below the poverty line;
• Perform more of the housework (even if they also work outside the home);
• Be the victim of physical or sexual abuse (even if the abuse occurred in childhood, the aftereffects can cause depression in adulthood);
• Be at higher risk of chronic illness such as arthritis, asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes.

In addition, there is evidence that men are more likely to respond to these stressors in their own lives with anger or rage, while women are more likely to suppress their rage, causing it to take the form of depression. At any rate:

Depression is not just feelings of sadness, but a common and severe mood disorder. Depression symptoms can interfere with your ability to work, sleep, eat, or even get out of bed in the morning. In fact, that is one of its defining symptoms: loss of interest in activities you used to enjoy.

It’s crucial to understand that depression is not likely to be alleviated by friends encouraging you to “snap out of it,” or self-care remedies like a massage or bubble bath, soothing as these may be. Self-care is essential, but it may not be enough.

What WILL help?

Identifying and addressing the cause. If your depression is due to hormonal imbalances or chronic illness, taking hormone supplements and treating the underlying disease can help. If constant exhaustion from overworking is the cause, an honest conversation with your partner, your employer, housemates, and even your children may be necessary. If your depression is the lingering result of past trauma, you may benefit from psychotherapy with a compassionate counselor.

Psychotherapy can help you identify and address underlying issues and experiences contributing to your depression. Two kinds of therapy—cognitive-behavioral therapy and interpersonal therapy—are most often recommended for treating depression. Cognitive-behavioral therapy (CBT) helps you examine how negative thoughts and behaviors may contribute to your depression and explore positive changes in your thought processes that can improve how you feel. Interpersonal therapy can help you improve your relationships with family and friends, resolving issues that otherwise keep you feeling hopelessly “stuck.”

Prescription medication. There are a variety of antidepressants available to treat depression, but it may take some trial and error to find the one that works best for you. Researchers also are studying and developing new medications for depression, such as brexanolone for postpartum depression, esketamine for treatment-resistant depression (TRD) and major depressive disorder (MDD), and intravenous nicotinamide adenine dinucleotide (NAD), a natural, non-FDA approved treatment for depression and PTSD. Effective treatment often combines both psychotherapy and appropriate medication.

Diet and exercise are also part of an effective, long-term holistic approach to depression. A balanced diet of vegetables, fruits, whole grains, seeds and nuts, fish and lean meats can help stabilize blood sugar levels and is especially crucial when dealing with depression. For the same reason, it’s wise to limit sugary snacks, drinks, and desserts, as well as alcohol, which is a known depressant. Some people also need to limit caffeine, which, along with sugar, worsens their depression.

Exercise can also have a positive effect on your mood and energy level. It causes biochemical changes in the brain, including increased serotonin (the feel-good hormone), an effect similar to that produced by medication. In addition, exercise gives people a sense of self-mastery and empowerment, which are an antidote to depression. And exercise can be a good option for those who cannot take medication, such as pregnant or postpartum women, or children. Better still, studies show that those who exercise are less likely to have a relapse of their depression.

Other types of therapy—such as transcranial brain stimulation (TMS), family constellation therapy, EMDR (eye movement desensitization and reprocessing) therapy, and psychotropic drug therapy are other options that can help people with depression when the options described above aren’t enough. Ask your family physician for more information and a referral.

Developing a stress-reduction self-care practice. Whether it’s yoga, meditation, journaling, breath work, affirmative prayer, or any combination of methods that work for you, invest in your long-term well-being by devoting time to them each day.

Being patient. Depression therapies can take a while to work, so give them time to take effect. And if your first approach is not bringing relief after several weeks, talk to your doctor about alternatives. Depression can be treated and your quality of life depends on it.

Always remember: If you are in immediate distress or are thinking about harming yourself, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline  website.

You are worth it.