Clinical features of depression in women compared with men

Objective: to study the clinical features of depression in women compared with men. Patients and methods. 120 women aged 18-65 years with recurrent depressive disorder (RDD; ICI-10 F33) (a study group) and 67 men of the same age with RDD (a control group) were clinically examined using a specially designed schedule and the Montgomery-Asberg Depression Scale. Results. The clinical picture and the course of RDD have gender differences. The earlier onset of the disease in women with a large number of depressive attacks and lower quality remissions is due to the relationship and mutual influence of menstrual and reproductive function and depression. Such typical symptoms of endogenous depression, as slow thinking, anhedony, decreased sleep duration and early morning awakenings, as well as diurnal swings of mood with its deterioration in the morning, were characteristic for most women and men. The pattern of depression in women is more commonly characterized by anxiety; ideas of self-accusation; suicidal thoughts; avoidance of contacts with others; weakness; fatigue; decreased or increased appetite; sleep onset insomnia; lack of sleep feeling. That in men is more often marked by symptoms, such as melancholy; motor retardation; decreased motivation; somatic symptoms of depression (tachycardia, constipation); comorbid panic attacks; and concomitant diseases of the cardiovascular, respiratory and genitourinary systems. Men more frequently abuse alcohol and other psychoactive substances. Conclusion. The revealed features of depression in women and men will be able to more accurately diagnose and to prescribe adequate therapy.

1. Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011 Sep;21(9):655-79. doi: 10.1016/j.euroneuro.2011.07.018.

2. Silverstein B, Edwards T, Gamma A, et al. The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Soc Psychiatry Psychiatr Epidemiol. 2013 Feb;48(2):257–63. Epub 2012 Jul https://doi.org/10.1007/s00127-012-0540-7

3. Тювина НА. Депрессии у женщин. Москва: Издательство «Сервье»; 2006. 32 с. [Tyuvina NA. Depressii u zhenshchin [Depression in women]. Moscow: Izdatel'stvo «Serv'e»; 2006. 32 p.]

4. Тювина НА, Балабанова ВВ, Воронина ЕО. Гендерные особенности депрессивных расстройств у женщин. Неврология, нейропсихиатрия, психосоматика. 2015;7(2):75-9. [Tyuvina NA, Balabanova VV, Voronina EO. Gender features of depressive disorders in women. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2015;7(2):75–9. (in Russ.)]. doi: 10.14412/2074-2711-2015-2-75-79

5. Blanco C, Vesga-Lopez O, Stewart J, et al. Epidemiology of major depression with atypical features: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2012 Feb; 73(2):224-32. doi: 10.4088/JCP.10m06227. Epub 2011 Sep 6.

6. Marcus S, Kerber K, Rush A, et al. Sex differences in depression symptoms in treatmentseeking adults: confirmatory analyses from the Sequenced Treatment Alternatives to Relieve Depression study. Compr Psychiatry. 2008 May-Jun;49(3):238-46. doi: 10.1016/j.comppsych. 2007.06.012. Epub 2008 Mar 4.

7. Тювина НА, Балабанова ВВ, Воронина ЕО. Гендерные особенности терапии депрессии у женщин. Психиатрия и психофармакотерапия. 2017;19(5):25-31. [Tyuvina NA, Balabanova VV, Voronina EO. Gender features of depression therapy in women. Psikhiatriya i psikhofarmakoterapiya. 2017;19(5):25-31. (in Russ.)].

8. Romans S, Clarkson R, Einstein G, et al. Mood and the menstrual cycle: a review of prospective data studies. Gend Med. 2012 Oct;9(5): 361-84. doi: 10.1016/j.genm.2012.07.003.

9. Сметник ВП, Кулаков ВИ. Руководство по климактерию. Москва: МИА; 2001. 685 с. [Smetnik VP, Kulakov VI. Rukovodstvo po klimakteriyu [Guide to menopause]. Moscow: MIA; 2001. 685 p.]

10. Сметник ВП, Ткаченко НМ, Глезер ГА, Москаленко НП. Климактерический синдром. Москва: Медицина; 1988. 288 с. [Smetnik VP, Tkachenko NM, Glezer GA, Moskalenko NP. Klimaktericheskii sindrom [Climacteric syndrome]. Moscow: Meditsina; 1988. 288 p.]

11. Юренева СВ, Каменецкая ТЯ. Депрессивные расстройства у женщин в пери- и постменопаузе. Гинекология. 2007;9(2):5-12. [ Yureneva SV, Kamenetskaya TYa. Depressive disorders in peri- and postmenopausal women. Ginekologiya. 2007;9(2):5-12. (In Russ.)].

12. Bennett HA, Einarson A, Taddio A, et al. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004 Apr;103(4): 698-709.

13. Bromberger JT, Kravitz HM, Chang YF, et al. Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychol Med. 2011 Sep;41(9):1879-88. doi: 10.1017/S003329 171100016X. Epub 2011 Feb 9.

14. Bromberger JT, Matthews KA, Schott LL, et al. Depressive symptoms during the menopausal transition: the Study of Women’s Health Across the Nation (SWAN). J Affect Disord. 2007 Nov;103(1-3):267-72. Epub 2007 Feb 28.

15. Lee PJ, Liaw JJ, Chen CM. Concept Analysis of Postpartum Depression Hu Li Za Zhi. 2015 Jun;62(3):66-71. doi: 10.6224/JN.62.3.66.

16. Тювина НА, Балабанова ВВ, Воронина ЕО. Депрессии у женщин, манифестирующие в период климактерия. Журнал неврологии и психиатрии им. С.С.Корсакова. 2017;117(3): 22-7. [Tyuvina NA, Balabanova VV, Voronina EO. Depression in women, manifested in the period of menopause. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. 2017;117(3):22-7. (In Russ.)].

17. Жиляева ТВ. Предменструальные расстройства настроения: этиология, патогенез, диагностика и лечение (обзор литературы). Проблемы репродукции. 2015;21(4): 76-85. [Zhilyaeva TV. Premenstrual mood disorders: etiology, pathogenesis, diagnosis and treatment (literature review). Problemy reproduktsii. 2015;21(4):76-85. (In Russ.)].

18. Epperson C, Steiner M, Hartlage S, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry. 2012 May;169(5):465-75.

19. Ross L, Steiner M. A biopsychosocial approach to premenstrual dysphoric disorder. Psychiatr Clin North Am. 2003 Sep;26(3):529-46.

20. Seeman MV. Psychopathology in women and men: focus on female hormones. Am J Psychiatry. 1997 Dec;154(12):1641-7.

21. Halbreich U, Kahn LS. Atypical depression, somatic depression and anxious depression in women: are they gender-preferred phenotypes? J Affect Disord. 2007 Sep;102(1–3):245–58. Epub 2006 Nov 7.

22. Silverstein B, Edwards T, Gamma A, et al. The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Soc Psychiatry Psychiatr Epidemiol. 2013 Feb;48(2):257-63. Epub 2012 Jul 3.

23. Lai CH. Major depressive disorder: gender differences in symptoms, life quality, and sexual function. J Clin Psychopharmacol. 2011 Feb;31(1): 39–44.

24. Levitan RD, Lesage A, Parikh SV, et al. Reversed neurovegetative symptoms of depression: a community study of Ontario. Am J Psychiatry.1997Jul;154(7):934–40.

25. Moskvina V, Farmer A, Jones IR, et al. Sex differences in symptom patterns of recurrent major depression in siblings. Depress Anxiety. 2008;25(6):527-34.