The Gender Gap in Depression

11/03/2015 13:36 GMT | Updated 10/05/2015 10:59 BST

Epidemiological studies have consistently shown that women are about twice as likely to become depressed at some point in their lives as men. This comparative risk was replicated in a morbidity survey carried out in Britain in the nineteen-nineties. The WHO tells us that depression is the main source of "disease burden" (the overall impact of ill health) for women worldwide.

A lay person may find it difficult to understand depression as an illness, as the concept of depression seems to overlap so much with common unhappiness. But depression, in either gender, is a very real illness, associated with real suffering and amenable to real treatments.

Unfortunately, some standard treatments for depression are simply not very good. Studies have found that more than half of those who are given an antidepressant by their GPs do not recover fully. The majority of these treatment-resistant individuals are women, simply because most depression sufferers are women. Three-quarters of the participants in a recent influential study on treatment-resistant depression conducted in a specialist centre in South London were women, a fact so unsurprising for the authors of the study that they did not feel the need to comment on it.

Depression is a very real clinical problem, but treatment-resistant depression is not a clinically neutral concept, as those who don't respond to standard treatments (mainly women, remember) are often labelled as having personality issues. A personality disorder is always mentioned in the psychiatric literature as a main cause of resistance to treatment. So she has a good chance of not improving and later being told it's her fault.

We need to ask ourselves whether there is, perhaps, a degree of social complacency about female depression. If sadness is the result of our lost battles with a hostile world, some may take the condescending view that women are less resilient than men and therefore more likely to be depressed, and to stay depressed after treatment. The reality however is that women face very challenging social demands, and yet their "social value" is disproportionately affected by their physical appearance and by their ability to project the image of a good mother, even at the highest strata of society, as sociologists have repeatedly shown us.

Women are, as we say in psychiatry, more "affective" than men. This means that their mood is more responsive and more vulnerable to events happening around them. But this doesn't mean women are weaker. Let's consider again the issue of perceived weakness and resilience. One could argue that becoming depressed - the "affective" reaction- is a way of acknowledging the sadness of adversity. In contrast, some men confronting adversity or loss don't acknowledge feeling sad, becoming enraged instead. Anger is their depression. So women tend to "flex" painfully with the winds of adversity, whereas some men, rigid with futile defiance, simply snap. Because of this, many more women get depressed, but more men kill themselves. From this point of view, flexing with the pain of depression, rather than snapping, is in fact a type of strength.

Women's emotions are "almost always less under control of the will than in men, being usually more volatile and displaying a greater tendency to childishness", asserted Mr GJ Romanes, Fellow of the Royal Society in a lecture he gave at the Royal Institution in 1887. One wonders to what extent we may still carry these prejudices with us when we attribute female depression to their perceived psychological fragility.

The National Institute of Mental Health informs us in their website that hormones are often to blame for women's melancholy. The Mayo Clinic website also mentions hormones as a major contributor to their depression and mentions premenstrual syndrome as an example of the psychological havoc that these hormone imbalances can play in a woman's mind. Reproductive systems and menstrual cycles always seem to be somehow implicated in a woman's depression. Classical textbooks would say that they challenge the "economy" of their physiologies. It all seems very mechanistic. The reasons behind the female statistical excess in the depression statistics are probably very complex and not reducible to mere hormone imbalances.

When researchers looked at the gender gap in depression across the world they found that the difference was less marked in traditional societies. We cannot be sure of the reason, but it is possible that women may feel more valued in those communities. They could feel more valued here too, but only if they were supported in their very complex roles by employers and policy makers.

Depression is an illness, not an inherent female trait. When an antidepressant tablet doesn't help, which happens in over half of all cases, the depression doesn't automatically mutate into an unfortunate expression of female weakness, or a mere result of their reproductive physiology, or a personality defect. It is still depression, but one that will require a better treatment.