Are you just sad … or depressed?

Depression doesn't look the same in all women.
March 1st, 2017
A sad woman looks out the window on a winter day.
Photo: Getty Images.

Everyone feels emotional pain at times. We lose a job, have relationship difficulties, or a loved one dies. It’s normal to feel grief, sadness and loss in these situations.

But when those feelings last too long or become debilitating, it’s time to ask for help, said Dr. Adria Pearson-Mauro, a clinical psychologist and Assistant Professor in the Departments of Family Medicine and Psychiatry at the University of Colorado School of Medicine. Her clinical practice at the University of Colorado Depression Center includes adults with a wide range of psychiatric diagnoses.

She also practices part time at the Women’s Health Integrated Services Clinic (WISH) as part of a grant for the development of integrated behavioral healthcare.

In addition to her clinical work, Dr. Pearson-Mauro provides training and supervision to psychiatry residents and teaches courses in the doctoral program in clinical health psychology at CU Denver.

Needless to say, she sees a lot of patients, often women, suffering from various mood disorders, including major depressive disorder, commonly referred to as depression.

Is it depression?

Major depressive disorder includes a set of symptoms that may vary, depending on the age, gender and how they present themselves in the patient.

“It doesn’t look the same for all women,” she said. “So it’s important to assess it carefully. It may not be what you would normally assume they are – like somebody staying in bed all day – but can include headaches, stomach aches or fatigue.”

This is a photo of Dr. Adria Pearson-Mauro, a clinical psychologist and professor in the Departments of Family Medicine and Psychiatry at the University of Colorado School of Medicine, who says depression doesn't look the same for all women.
Dr. Adria Pearson-Mauro, a clinical psychologist and professor in the Departments of Family Medicine and Psychiatry at the University of Colorado School of Medicine, says depression doesn’t look the same for all women.

When the symptoms are physical, a diagnosis of depression is sometimes missed because “some adults, especially older adults, feel like they can’t express those feelings, so they manifest as physical symptoms. There’s still a stigma attached to anything like mental illness. But if a patient is not sleeping well or sleeping too much, has chronic headaches or unexplained chronic pain, you need to check all those things out.”

In addition, a medical professional should also ask: “Could they be depressed?”

Dr. Pearson-Mauro said the first thing she asks is this: “Do you feel that way most days for two weeks? If the answer is yes, then the patient may have major depressive disorder.”

Then she asks: “Have you ever had this before?” If so, the topic deserves additional exploration.

Mood disorder in all its forms

If somebody presents with depression symptoms, she also wants to assess for hypomania or mania. When a patient presents with depression, it is important to assess the patient for a history of bipolar disorder.

“The common myth about mania and hypomania is that people feel great, but that’s not always true,” she added. “They can quickly become irritable or agitated, and won’t listen to feedback from those around them. They may have trouble sleeping and can even become hypersexual.

“They might stay in that state long enough to get reactions from a spouse or partner or coworkers. It can create relationship problems,” she said.

If a patient has a bipolar 2 disorder, she can have a period of hypomania followed by a depressive state, or vice versa. If she has what is called bipolar 1, she can experience full-blown mania (sometimes requiring hospitalization) or even psychosis – hallucinations or delusions of one sort or another. Individuals with bipolar disorders may stop sleeping for days at a time, and do impulsive things. They may talk very fast in a pressured manner.

Bipolar disorder usually initially manifests itself at a young age – from pre-teen to young women – and that window can extend to the early 30s. However, some people may have symptoms but not get diagnosed until later in life.

Depression can occur at any time in a woman’s life, Dr. Pearson-Mauro said.

It may take the form of dysthymia – manifested as a “low mood, not a major depressive disorder,” that lasts pretty consistently for at least two years.

“They’ll notice that they have changed over time, that they can function but not at full capacity.”

Some patients complain that they get depressed only in the fall. Seasonal affective disorder is related to major depression but only happens in autumn, when the daylight shortens.

“Some patients tell me, ‘I feel fine, except in the fall,’ indicating a possible seasonal affective component to depression. Those patients often respond to light therapy, which some clinics can provide.”

Peripartum (before delivery) or postpartum (after delivery) specifying criteria for depression are important to assess. This type of depression which onsets just before or after childbirth is crucial to talk openly about with both expectant and new mothers to provide education and services if needed. As with any other manifestation of depression, it can be mild or severe.

“Some women with postpartum depression may even have some level of psychosis. They may have thoughts of killing their baby or intrusive thoughts like ‘What if I dropped my baby?’ or ‘What if I shook my baby?’

“Women are very scared to talk about this because they think we will take the baby away from them, but not talking about it only makes it worse.”

There are treatment options

Psychological treatment for mood disorders includes psychotherapy and medication, often in conjunction. Psychotherapy prominently now includes more modern approaches to evidence-based cognitive behavioral therapy. Cognitive behavioral therapy refers to a very broad umbrella of psychotherapy treatment approaches, many of which are based in research evidence. The newest of these cognitive behavioral therapies, developed in the past 25 years, is acceptance and commitment therapy – ACT.

ACT is a current evidence-based treatment for depression as well as some other psychological disorders.

“Instead of aiming at complete symptom reduction, ACT emphasizes pushing people towards meaningful work and activities even in the presence of the difficult thoughts, feelings and physical sensations that accompany depression.”

In using ACT as well as other cognitive behavioral therapies, Dr. Pearson-Mauro helps patients develop a strategic plan for coping with their problem. The focus is on “How can I do that in a way that is meaningful – like maybe it means a lot to me to paint or draw but I haven’t done it in years because I don’t think I do it very well,” she said.

People coping with depression often abandon those things they enjoy just because they spend so much time managing the disorder.

“Psychiatry plays an important role in dealing with these disorders.” Dr. Pearson-Mauro said. “That, and medication, can make all the difference in the world.”

For mild depression, psychotherapy alone often can handle the situation, she said, “but with more moderate to severe depression or bipolar disorder, it is usually recommended that patients take medication.”

She warns patients to not stop taking meds without consulting a physician. “You can have symptoms from uncomfortable to dangerous. You can stop if you choose, but you need to do it under the guidance of a psychiatrist,” she said.

Other techniques for managing these disorders include tracking moods, perhaps with a journal, or even using apps on smartphones.

Suicide

The most extreme result of mood disorders is, of course, suicide.

She noted that Colorado has a very high suicide rate – one of the highest in the nation – so she always asks about suicidal thoughts.

“Just because somebody has the thoughts, we don’t put them in the hospital. There may be urges, but without a plan and means, it doesn’t always go any further.”

Suicide often happens when a patient is coming out of a depressive state because they finally have the energy to act on their thoughts. A decision to die can provide relief to a patient who might claim they are “fine now.”

Suicide is one of the leading causes of death in teens “because they do experience depression, but have less experience dealing with it, or have poor impulse control. They don’t have the foresight to see something as temporary.”

It’s important for parents to start conversations early about “the difference between a bad day and depression.”

“Talk to your kids about suicide,” she said. “Studies show that 85 percent of the population has thought about suicide at one time or another,” but as a clinical psychologist, she said: “It’s scarier when they’re not talking about it. If they’re talking about it, they are realizing their humanity, that they have a life, and that they have some control over it.”

Society’s stigma about mental illness is slowly changing, but it’s still there, she said, especially among older adults.

“It’s hard for them to come see somebody like me. But women are more likely to come than men. Women attempt suicide more often than men, but men succeed more often.

“There’s less of a cultural stigma with women talking about their feelings, particularly in that age group.

“From my perspective, I tell them that human pain is universal. At some time in their lives, everybody experiences it. Some people try to avoid it, drink alcohol or overwork or over-exercise, but over time … they are not finding the solution.”

Sometimes depression just goes away on its own – but not always.

“Sometimes we get stuck. We need help.”

Contact the UCHealth Depression Center at 303-724-3300.

About the author

Linda DuVal is a freelance writer based in Colorado Springs who writes articles for UCHealth.