Improving depression treatment for women


Childhood trauma haunts women: Improving depression treatment for women goal of study

She saw women battling depression come to the inpatient mood disorder unit in the psychology department of the University of Toronto and was struck by how many of them weren't responding to their antidepressants. She noted the high numbers of women with trauma in their pasts and wondered if there was some relationship between the two that was being overlooked.

Now an associate professor in the University of Alberta Faculty of Nursing, Kathy Hegadoren is probing the effects of childhood trauma on the stress hormones of women with major depression. She's out to prove what women intuitively know already: they can be deeply affected by the collective experiences of their lives.

Her goal is to improve depression treatment.

Women are twice as likely as men to be depressed. They are most vulnerable to depression postpartum -- after the birth of a baby -- and perimenopausal, around the time they stop menstruating. Their common reaction to stress is depression.

The explanation goes beyond the biological differences in men and women and the effects of female sex hormones estrogen and progesterone, Hegadoren says, though the highest periods of vulnerability suggest some link.

Psychological literature says it has something to do with women feeling more vulnerable than men, who think of themselves as masters of their own destiny -- they control their lives from the inside. For women, the control is more external.

"Their relationships with friends, family, children and with their partners are very important," Hegadoren says. When you are that dependent on the social network in your life, you can be very affected when things get shaken up.

Originally, the effect of trauma on women's depression focused only on physical or sexual abuse, but that's not the only kind of stress that can lead to women feeling chronically blue. The relationship between parent and child, separation and perceived loss, distance and coldness as they were raised, can all have an impact. "Sometimes it can be just sheer quantity, a cluster of things like the death of a parent and financial worries and problems with a spouse or partner," Hegadoren says.

Social, psychological and biological factors or a combination of all three can affect depression in women, so it's little wonder that a pill used to improve mood would fail to make them feel better.

Dr. Pat Simpson, a psychiatrist at the Sturgeon Community Hospital in St. Albert, Alta. is excited by what she calls Hegadoren's groundbreaking research.

"For the longest time, people thought anxiety disorders were secondary to depression rather than primary," Simpson says. "We were not recognizing that anxiety disorders, like post-traumatic stress disorder, often exist from childhood and pre-exist long before people often get a depression, predisposing them to depression.

"By showing biological evidence for the condition, that it's something they can't control, my hope is, it would put anxiety on par with diabetes, multiple sclerosis and heart disease which would decrease the stigma related to it," Simpson says.

Many of the 24 women already recruited for Hegadoren's study have struggled with depression for years, getting little help from their antidepressants, Hegadoren says, suggesting their real problem is not being treated.

"It's not enough to ask women what their symptoms are - disturbed sleep, low motivation, stomach and headaches - you have to look at whether their depression symptoms are part of a larger post- traumatic syndrome, and if so, the treatment is different.

"We have to understand how to sub-group women better so we can predict better who needs different kinds of treatment and not have to wait until one treatment fails before we say OK, we'll try something else."

By coming to understand why they're depressed and getting the treatment most effective to help them - some may need only drug therapy, others may require talk therapy or psychotherapy - women should be able to better manage their depression, much like diabetics manage their condition, Hegadoren says.

These women will never not be depressed, but they can become healthy women with depression.