APA Expert Opinion
An APA expert answers common questions about women's mental health issues

Nada L. Stotland, M.D., M.P.H., is Vice President of the American Psychiatric Association and Professor of Psychiatry, Obstetrics and Gynecology at Rush Medical College

How do I know if I am depressed?

Depression is a common, serious, but very treatable medical disorder. Nearly twice as many women as men are affected by a depressive disorder each year.

Depression is not the same as having a bad day. The symptoms of depression include feelings of sadness or irritability, changes in sleep and appetite, feelings of hopelessness and helplessness, loss of pleasure, energy, and concentration, and withdrawal from friends and family. People with depression often have thoughts of death or suicide; in severe cases, they may commit suicide. A diagnosis of depression requires that the individual have at least five of these symptoms, for most of the day, every day, for at least two weeks.

If you think you may be depressed, you need to get an accurate diagnosis from a mental health professional, and, if depression is diagnosed, you should also get a comprehensive, individualized treatment plan. Unfortunately, many depressed people do not recognize their symptoms as signs of an illness. Untreated depression causes great suffering, affects friends and family, and makes it difficult to carry out work and family responsibilities. Treatment with psychotherapy and/or medications relieves symptoms in most people. Treatment should be supervised by a physician and should continue at least as long as an untreated episode of depression would last, which is up to one year; stopping treatment before that time often brings symptoms back. Medication can take up to six or eight weeks to work; dosages may have to be adjusted, and you should be monitored carefully during that time. Side effects of medications, such as upset stomach, jitteriness, or tiredness, generally subside within a few days.

Could I have postpartum depression?

As many as 90% of new mothers have a brief episode of heightened emotions within a few days of birth. This is called ‘baby blues,’ and it generally goes away within days without treatment. Postpartum depression on the other hand, is clinical depression occurring within six to twelve months after childbirth. It is experienced by as many as 10% of new mothers, regardless of socioeconomic factors.

The symptoms of postpartum depression include:
• Sadness or irritability
• Feelings of hopelessness and helplessness
• Disturbances in appetite and sleep
• Confusion
• Loss of energy
• Inability to enjoy things
• Lack of interest in the baby
• Fear of harming the baby or oneself

Since a new baby does interrupt sleep and normal schedules, many new mothers are tired and distracted; inability to sleep when the baby is sleeping is a good indicator of postpartum depression. The symptoms, and their severity, vary from woman to woman. Because new motherhood is supposed to be a happy time, women experiencing these symptoms often feel isolated, guilty and ashamed. Women who have postpartum depression love their children but may be convinced that they're not able to be good mothers. Women with a family history of a mood disorder are at an increased risk of postpartum depression.

Postpartum depression deprives the mother and baby of emotional interactions that are vital to the baby’s development. It is important for spouses, family members and friends to watch for symptoms, to urge the new mother to seek medical attention, and to support her during treatment, which is much like the treatment for depression at any other time of life. Friends and relatives should reinforce the mother’s self-confidence with the baby rather than taking over the baby’s care.

Can I keep taking my antidepressant while I am pregnant or trying to get pregnant?

There have recently been a number of reports of complications for the babies of mothers who take antidepressants during pregnancy. If you have been diagnosed with depression, or another illness, it's important to work with your physician before stopping any medication. In general, symptoms don't take a break and neither should effective treatment. Women who discontinue medication during pregnancy are very likely to suffer a return of the symptoms of depression. Untreated depression can have negative effects on the pregnancy as well. Therefore treatment decisions have to be made by you and your physician on an individual basis, depending on the severity and frequency of depressive episodes you have experienced and the ease or difficulty you have had in finding the most effective treatment. One possibility is to reduce medication gradually, under medical supervision, and substitute psychotherapy for the duration of the pregnancy.

Does menopause cause depression?

For many years, physicians believed that menopause caused depression; that is a much more controversial belief now. Some women seem to be very sensitive to hormonal changes. If you have had severe premenstrual syndrome (PMS) or postpartum depression, depression at menopause could be hormonal, and taking hormones might help. Otherwise, depression at menopause can be treated like depression at any other time in life. If you think you are depressed, it’s important to be evaluated by a psychiatrist or other physician. You may feel tired because hot flashes are disrupting your sleep, or have a general medical condition requiring treatment. It’s important to review your life circumstances; often the depressed feelings people blame on menopause are really caused by disrupted relationships, problems with children or grandchildren, or frustrations at work.

I feel nervous all the time. Do I need treatment?

Anxiety disorders are the most common of emotional disorders, affecting 19 million Americans; women twice as often as men. Anxiety disorders differ from normal feelings of nervousness. If you feel anxious nearly all the time, and realize that your worries are out of proportion to your life situation, you may have generalized anxiety disorder (GAD). If you have episodes of severe anxiety, your heart is pounding, you are perspiring, you feel you can’t breathe, and you are convinced you are in danger of dying, you may have panic disorder. Untreated anxiety disorders can push people into avoiding situations that trigger or worsen their symptoms. People with anxiety disorders are likely to also suffer from depression, and may abuse alcohol and other drugs in an effort to gain relief from their symptoms. Job performance, school work, and personal relationships are affected.

The first step towards getting relief from anxiety symptoms is a thorough medical evaluation. Some general medical conditions, such as an overactive thyroid, can mimic anxiety symptoms. If an anxiety disorder is diagnosed, there are several effective forms of therapy, including psychotherapy and medication. Signs of effective treatment can take several weeks; patients should have close medical supervision during that time.

Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have real, treatable illnesses. Other people fear their family, friends or coworkers might criticize them if they get help. It is important not to discount your feelings and to consult a psychiatrist or other mental health professional for a thorough examination.

To locate a psychiatrist in your area, visit www.psych.org and click on "District Branches & State Associations" to contact your local APA District Branch. You may also visit www.MentalHealthScreening.org to locate a depression screening site near you.

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