Explainer: what is depression?

Many people know what it’s like to feel sad or down from time to time. We can experience negative emotions due to many things – a bad day at work, a relationship break-up, a sad film, or just getting out of bed on the “wrong side”. Sometimes we even say that we’re feeling a bit “depressed”. But what…

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Depression is more than the experience of sadness or stress. Sander van der Wel

Many people know what it’s like to feel sad or down from time to time. We can experience negative emotions due to many things – a bad day at work, a relationship break-up, a sad film, or just getting out of bed on the “wrong side”. Sometimes we even say that we’re feeling a bit “depressed”. But what does that mean, and how can we tell when it’s more than just a feeling?

Depression is more than the experience of sadness or stress. A depressive episode is defined as a period of two weeks or longer where the individual experiences persistent feelings of sadness or loss of pleasure, coupled with a range of other physical and psychological symptoms including fatigue, changes in sleep or appetite, feelings of guilt or worthlessness, difficulty concentrating or thoughts of death.

To be diagnosed with major depressive disorder, individuals must experience at least one depressive episode that disrupts their work, social or home life.

Depression is common in the community, with 12% of Australians experiencing major depressive disorder in their lifetime. More than 650,000 Australians have this experience in any 12-month period.

Because it’s highly prevalent and can be significantly disabling, the World Health Organization reports that depression is the third highest cause of disease burden worldwide, with a greater burden on the community than heart disease. There are also high levels of overlap between depression and other common mental disorders, including anxiety and substance use disorders.

Unfortunately, only 35% of people with symptoms of mental health problems seek help. This may be because of difficulties identifying depression in the community due to a lack of knowledge or accessing care, and stigmatising attitudes towards depression.

Depression prevention programs that provide accessible treatments, increase knowledge and change negative attitudes are an important way to increase access to treatment and reduce the burden of depression.

Causes and risk factors

There’s generally no single reason why an individual becomes depressed. There’s a constellation of risk factors, including physiological, genetic, psychological, social and demographic influences.

Biological risk factors include having a family history of depression, suffering a long-term physical illness or injury, experiencing chronic pain, using illicit drugs or certain prescription medications, chronic sleep problems, or having a baby. Having experienced depression in the past is a risk factor for a further depressive episode.

Psychological risk factors for depression include having low self-esteem, or having a tendency to be self-critical. Demographic and social influences include being female (women are almost twice as likely to suffer from depression than men), stressful life events (such as relationship conflict or caring for someone with an illness), experiencing a difficult or abusive childhood, or being unemployed.

People differ greatly in the amount or type of risk factors they’re exposed to or experience. And having several risk factors alone is not enough to trigger depression.

A combination of risk factors and the experience of stressful or adverse life events may prompt the onset of depression. The greater the number of risk factors that a person experiences, the more vulnerable they are to developing depression when stressful life events occur.

In contrast, those exposed to fewer risk factors are somewhat buffered, and may only develop depression when exposed to extreme levels of environmental stress.

Treatment and prevention

There are a number of effective treatments for depression. The most effective and widely used are cognitive-behavioural therapy and antidepressant medications.

Cognitive-behavioural therapy is a talking therapy that primarily aims to reduce negative thinking patterns, while antidepressant medications target brain chemicals thought to be implicated in depression.

There’s also evidence that low-intensity cognitive-behavioural therapy combined with education about depression can prevent individuals from developing depression. To widen the reach of such prevention programs, internet therapy programs have been developed and shown to be effective in preventing depression. Australian researchers are at the forefront of developing e-mental health platforms to reduce the prevalence of depression and other mental disorders.

There is some evidence that lifestyle changes can also help to prevent depression in some people. Engaging in healthy behaviours, such as getting adequate sleep, avoiding substance use, taking vitamins or fish oil supplements, engaging in physical activity and healthy diet, have all been shown to have associations with reduced depression symptoms. But research continues to examine whether making changes in these areas can lead directly to the prevention of depression.

Future research

There are a number of promising research areas that are currently being explored. Researchers are investigating ways to make cognitive-behavioural therapy more effective through better understanding of the processes involved in recovery. And technology has improved the availability of online, mobile and computer-based treatments, so that people at risk of depression in under-served areas such as rural locations or developing countries can access evidence-based services.

Population-based research is leading to a better understanding of risk factors for depression and improvement in its early detection. Research on the biological and genetic bases of depression is resulting in continual refinement of physical and pharmacological treatments.

A more nuanced understanding of the treatment options that work best for specific individuals has great promise for allowing an individually tailored approach to treating and preventing depression.

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner or in Australia, contact Lifeline 13 11 14 for support, beyondblue 1300 22 4636 or SANE Australia for information.

This is the first article in our short series on depression. Click on the links below to read the other articles:

Part two – Treating depression ethically requires more than drugs

Part three – Predicting the risk of depressive disorder – promises and pitfalls

Part four – The science of interpreting common symbols in dreams

Part five – Genetic testing for depression creates an ethical minefield

Part six – Are antidepressants over-prescribed in Australia?

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34 Comments sorted by

  1. Jim KABLE

    teacher

    I think I am a pretty buoyant character - but I know I have had several periods of depression - which I came to identify as "reverse culture shock" - returning to Australia after lengthy periods abroad - trying to readjust to the familiar (which was, in effect, no longer familiar). Each time I understand on a cerebral level what was happening - and I felt myself simply hanging in there until at last the skies cleared to a brilliant blue.

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  2. Stephen John Ralph

    carer

    I realise that in any given decade or century there are factors within societies that engenders disillusionment or despair.

    Notwithstanding we can really only relate to our own time and place.

    I think the current set of local and world situations is fuelling depression. Top of the list is the environment and the seemingly inevitable slide into a cataclysm. After that the rest of the list is up for grabs.

    But for my money a random list would include lack of political leadership or ethics across local government and upwards, poverty and hardship in juxtaposition with a seemingly wealthy and materialistic society, urban sprawls and their related problems,
    a lack of sense of community and family - people living in isolation within a sprawling city or town, the constant fear of dying of cancer, heart attack, car accident - all ceaselessly promoted in ads on t.v., etc etc etc

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  3. Colin Kline

    logged in via Facebook

    This article is useful to those first meeting the illness of depression.

    It is much less useful to those who are carers of patients who suffer medication resistant depression, and needless to say, no use to the patient thus suffering.

    Here are the enormous problems that were not mentioned in the article.

    1. Psychiatry likes to puff itself up with the label "Science." But it is no science !

    Where, in the Psychs, are the objective data sampling methodologies that exist in the true Sciences…

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    1. Nick Stafford

      writer

      In reply to Colin Kline

      Hi there people

      this is an interesting article. But I do not feel it gets to the heart of things. I experienced regular major episodes of depression from the age of 17 to 47, this year.

      I have seen between 10 and 20 psychologists/counsellors/psychiatrists/therapists over these years and while I learned interesting things from each of them I can now see that they never actually helped me overcome depression at all.

      I can now see that our mental health system is not designed to actually help…

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    2. Colin Kline

      logged in via Facebook

      In reply to Nick Stafford

      -
      Hi Nick,

      Congratulations for having the courage to be so open.

      You assert :
      "It was not me who had a mental illness. It was my parents, too damaged by their own childhoods who had the problem."

      Well of course, I am unable to comment upon the factual basis of that claim.

      But may I contribute a socio-philosophical comment ?

      I contend that one CANNOT factually - or morally - blame one's parents/partners/friends/etc for all one's internalised problems, for none of them can have such…

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    3. Nick Stafford

      writer

      In reply to Colin Kline

      Hi Colin

      thanks for your reply. I understand what you are saying. I do not blame my parents at all. These emotional patterns are past through the generations. What I have only just waken up to is that when a person does not face their own childhood trauma and becomes a parent they pass it on to their children. I knew it intellectually, but I can see it in my heart. My mother and family simply refuse to acknowledge any of this and insist I take total blame for my depression (and drug addiction…

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    4. john mills

      john mills is a Friend of The Conversation.

      artist

      In reply to Nick Stafford

      What a perfect post, your exactly right Nick, every problem or concern has a reason and an answer, answers heal, and once that sits comfortably in the heart or mind of that someone, or someone knows that, and starts to work at understanding and resolving the issues concerning them, with or without some help, which is called maturity,usually better with help, they start to free themselves/ their minds and their hearts up, i maintain there are two entities working, a thought and a feeling, hand in…

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    5. Chris Buchli

      Music Tutor

      In reply to Colin Kline

      Colin,

      I can't begin to tell you how offensive comments like "Bloody grow up" are when it comes to mental health issues. My first thought (as someone with GAD) is 'oh, what a bloody great idea, why didn't I think of that?'. Read that with as much sarcasm as you can muster. Preferably also with a condescending tone equal to your own.

      You seem to fail to recognise depression as an illness that requires treatment. There are certainly areas where people with depression will need to undergo some…

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    6. Tanya Clark

      logged in via email @hotmail.com

      In reply to Nick Stafford

      Nick, that's a moving and powerful read. I've been grappling with a way to express the same thoughts. Each time I've tried, some doctor wants to medicate me.

      You've obviously thought very deeply over a long period of time, and you're spot on saying "Depression occurs when a person is unable to speak the truth. It is just frustration turned inward. The fact that women, dominated by men, unable to express their truth, experience depression at much higher rates than men proves this to me."

      I…

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    7. Jim KABLE

      teacher

      In reply to Tanya Clark

      Tanya, Nick - I know what I am going to ask may seem bizarre but just yesterday with my wife went to see and was really moved by the new movie "Silver Linings Storybook" (Bradley COOPER, Jennifer LAWRENCE, Robert de NIRO, Jackie WEAVER). It seemed that the two lead characters are dealing with the avoidance of medication while speaking straight - in a world of euphemism and politeness. There was something so noble and admirable in that struggle to be self, true to self. And as portrayed in the film. Does it ring true to you, though, I wonder?

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    8. Nick Stafford

      writer

      In reply to Tanya Clark

      Hi Tanya

      thank you for your reply. You raise many interesting points.

      It is really frightening to wake up and face what is going on with our mental health system. And you describe the sickness well of how those of us who are badly hurt are expected to learn how to accept being abused and mistreated as part of life.

      The psychiatrists at a Melbounre hospital actually tried to bully me into taking Lithium, which is even more of an emotional labotomy than Epilim. I refused that and they insisted…

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    9. john mills

      john mills is a Friend of The Conversation.

      artist

      In reply to Colin Kline

      Hi Colin, I totally agree with Nick, If you've got bent parents, your going to pick up a lot of that/their bent, just the way it is, I dont know if its as much blame, as it is bad luck, but either way example is how we learn, so its not possible that parents cant or shouldn't be responsible for a lot of the thinking feeling behaving they learn from their parents, and in their life, the things they have and haven't learnt, and should have,and that they pass on to their offspring, then there's the…

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    10. Colin Kline

      logged in via Facebook

      In reply to john mills

      Hi John,

      I found it hard to summarise what you said above, into cogent points, or threads.

      But I did notice an absence. And that is, any mention of inheritance.

      Each child has no control over what they genetically inherit from their parents, grandparents ... all the back to the first self-reproducing molecules in the primeval swamp.

      No child, no parent, no grandparent ... can be "blamed" in any way for being tall, fat, ugly, handsome, what ever.

      Likewise, no child, no parent, no grandparent…

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    11. john mills

      john mills is a Friend of The Conversation.

      artist

      In reply to Colin Kline

      Hi Colin, The reason I didn't mention inheritance was because that's not what we were talking about, we were talking about how peoples behaviours and words influence others, like im trying to do with you now, and how I was saying that the people who set those behaviour examples, create behaviours and feelings in others, which is a fact, and for that I apportioned blame to the person setting that example, and Colin if that doesn't happen, someone needs to tell all the advertising companies. I dont…

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    12. Kim Darcy

      Analyst

      In reply to Nick Stafford

      Nick, I am really glad you've experienced this catharsis, even if it hurt. But as they say, 'no pain, no gain'. I have seen many friends/colleagues/family/acquaintances finally exploding over their never-ending bouts of depression, and finally realizing that the weekly merry-go-round with the Psychiatrist - at $250 a pop if you please - and the Russian doll of ever-changing medications is keeping them stuck in the abyss. I really pray for you that this is just your first step, but that you are truly freer. Keep us updated.

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    13. Kim Darcy

      Analyst

      In reply to Nick Stafford

      Nick, did you even know that Epilim is actually a drug to treat epilepsy? Read my post above. These guys/girls are basically drug-dealing withcdoctors.

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    14. Kim Darcy

      Analyst

      In reply to Nick Stafford

      "Finally, the most important thing for me is not to fall into victim thinking. None of the psychiatrists, psychologists and other workers who have undermined my emotional and mental health did it malisciously. They sincerely believe they are doing good."

      Nick, I am an atheist, but I think we should all very grateful to the Christians for teaching humanity the wisdom of two things: 'turn the other cheek'; and 'forgiveness. The profundity of forgiveness is not so much the relief it gives to the forgiven party, but the strength it gives to the forgiver.

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    15. Murray Webster

      Forestry-Ecology Consultant/Contractor

      In reply to Kim Darcy

      The way you guys have opened up is very humbling, and informative. I hope it helps other people in similar situations.

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    16. Nick Stafford

      writer

      In reply to Kim Darcy

      Hi Kim,

      thanks for all your replies. I did not know this about Epilim.

      One of the big problems as I see it, having worked in the drug field for 20 years is that the knowledge nearly all doctors, psychiatrists, and researchers have about all the illegal and pharmaceutical drugs is book knowledge, which is empty knowledge.

      We would not accept being taught how to drive a car by someone who had read lots of books about how to drive a car, but hadn't actually driven one.

      Yet doctors and psychiatrists prescribe drugs they know nothing about, except what they have read in books.

      In my experience when I have told a doctor, psychiatrist or researcher that a drug does this or that, and it does not match what they have read, they just tell me I am wrong!

      One anti-depressant I tried was EXACTLY the same as exstacy for me. But I was told this was an irresponsible thing to say.

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    17. Nick Stafford

      writer

      In reply to Kim Darcy

      The Christian religion, like all the religions, has a lot of wisdom in its teachings.

      Forgiveness is a big one.

      If someone hits you, it hurts for awhile then the pain goes away. If someone hurts you emotionally, it is up to you how long you allow it to hurt.

      Our world is full of people, groups, and nations, who cling onto the hurt others have done to them, for a lifetime, even generations.

      Why we do this, hang onto pain and suffering is a big issue.

      What I have learned lately is…

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    18. Nick Stafford

      writer

      In reply to Murray Webster

      Thank you Murray.

      We have to talk about it. It is the silence and the isolation this brings that leads to far too many people suffering and killing themselves.

      Too many of us treat anyone going through emotional turmoil, disturbance or illness as lepers, not through nastiness but through fear and ignorance.

      I speak up because every time I do people tell me that it helps them understand that they are not a freak, not alone, and not a hopeless case.

      It is not drugs humans need when they struggle, it is love, support, and someone, even just one person, willing to listen, to listen to their story. Not offer advice, just listening.

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    19. john mills

      john mills is a Friend of The Conversation.

      artist

      In reply to Colin Kline

      Hi Colin, I agree with a lot of what your saying , I can see your meaning, I like your passion and realness, sincerity, I understand where your coming from,and i get it. im sorry for being so unkind, I realise im in a bad place because of my obsession with mental health, period, and im just too angry because of it, it possesses me, and i posses it, because it possesses me. and others. Example-I wrote up to posses me on the last line, and was going to stop there, drifted for a second, and all of a…

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  4. Murray Webster

    Forestry-Ecology Consultant/Contractor

    Have the authors, or any readers, any knowledge of the use of neurofeedback for treating depression? There's quite a bit of information out there, but it is mostly by people who I would not describe as independent. I would appreciate an objective point of view.

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  5. Angela Taft

    Associate Professor in Public Health at La Trobe University

    This is an excellent inytroduction to depression for the most part, but as a researcher who, like many others, has spent years working on the links between partner abuse and depression, it is disappointing not to see it even mentioned as one of the major global determinants. The authors mention child abuse and being female, but not adult partner abuse.
    Two Australian references for the authors:
    Hegarty K, Gunn J, et al. (2008). "Physical and social predictors of partner abuse in women attending general practice." British Journal of General Practice 58(484-487).
    Taft AJ and Watson L (2008). "Depression and termination of pregnancy (induced abortion) in a national cohort of young Australian women: the confounding effect of women's experience of violence." BMC Public Health 8(75).
    and perhaps next time...

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  6. Anthony Ware

    Lecturer in International Development at Deakin University

    Adding to reasons people do not seek help for depression is that there can be a major impact on life and disability insurance. Obviously, exclusions can follow from any 'pre-existing condition'. Insurance application forms ask a miriad of questions to ascertain risk, including about mental health. But because so little is understood about mental health exclusions are not limited to only the 'pre-existing condion', but applied across the board. Some companies make a blanket ruling that ANY prior medical diagnosis of ANY mental illness results in a complete exclusion from the cover of protection against any mental health related disability or death. That is wide open for abuse, patently unfair, and a disincentive for people conscious of insurance implactions seeking qualified medical assistance.

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  7. Peter Hewson

    Citizen

    Having 'lived with' (to use the PC expression) depression for my adult life (40+ years) I'd observe that this article doesn't go near 'What is depression?' from this sufferers viewpoint but I'll allow that explaining depression is like explaining pain.

    The latest generation of researchers certainly have more empathy but that is due to more people screaming at a patronising profession that it really didn't get it. Unfortunately many still don't get it.

    Antipreressants are hit and miss and my…

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    1. Kim Darcy

      Analyst

      In reply to Peter Hewson

      Peter, it sounds like you might one the rare "melancholic" depressives, which means you were basically born with it, it's part of you, you're more or less stuck with it. If that is the case, your time would be probably better spent becoming an expert on every drug that's out there to boost your mood, energy levels, whatever. Yapping to a whitecoat will rarely help the melancholic. But it could be a very satisfying side-dish to the happy pills.

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    2. Katie Lee

      Medical researcher and sometime journalist

      In reply to Kim Darcy

      Kim and Peter, my experience is that yapping to the whitecoat is a useful adjunct to antidepressants - depending on the therapy offered. The psychologist who wanted to analyse my childhood wasn't too helpful. The doctor who helped me learn how to recognise the physical symptoms of a rising anxiety or depression episode so I can take action, discuss what non-drug actions seem to work to balance me back up and what others I could try, and learn to identify and redirect unhelpful though patterns, was frankly a godsend. I know from experience that I can't function without the happy pills, but I am still very sub-optimal even with them if I don't take this holistic approach to managing my health.

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  8. Roger Crook

    Retired agribusiness manager & farmer

    The answer to the headline is nobody knows.
    Having been the keeper of the 'black dog' for many years (now only occasionally) and having been subjected to (I am sure) every drug, which is available for 'depression', and having been told 'these may take a couple of weeks to kick in'.
    Then the waiting for them to 'kick in' and feeling no worse or feeling even worse when they did 'kick in' but certainly no better. Then going back to the GP and then the specialist and being given more, additional stronger…

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    1. Kim Darcy

      Analyst

      In reply to Roger Crook

      Unless your depression is of the melancholia type - which basicaly means you were born with it, it's part of you - you should only ever need drugs if you are in such a state that you can'get out of bed, or similar. Most SSRI-type drugs will get you out of bed, and up and about again within 5 days or so. But to stay on drugs for a much longer period will in most cases be irresponsible overkill by the medico. If your (unipolar) depression is not something you've had all your life, and just creeps up on you, once you're out of bed, the focus needs to be on what happened in your life recently that saw you take this unusual turn of sadness and inability to get out bed? That answer will not come from a year's supply of Prozac, let alone a lifetime supply!

      OTOH, if the whitecoats says you melancholic, and in your bones you agree, then just throw down as many happy pills as they'll feed you.

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  9. Catherine Scott

    Senior lecturer, Melbourne Graduate School of Education at University of Melbourne

    Am not talking here about the relatively uncommon biologically based depressions. Some things not mentioned but potentially important:

    1. The interaction between personality and circumstances. 'Self critical' is only one characteristic that makes for vulnerability. The Black Dog Institute is very good on this. http://www.blackdoginstitute.org.au/public/depression/causesofdepression/personality.cfm

    2. The enteric nervous system, the importance of which is increasingly understood The ENS is a major source of neuro-transmitters and it seems likely that diet has an important role to play in regulating these. http://www.psyking.net/id36.htm

    It could be argued that the emphasis on low fat food, for instance, make people more vulnerable to depression because of effect son neuro-transmitters in the gut. And the tendency to Vitamin D deficiency that goes with a low fat diet is definitely known to lower mood.

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  10. Kim Darcy

    Analyst

    Colin Kline is correct. Psychiatry is not Science. It is more a marketing industry. Sure, Psychiatry draws on scientific knowledge, and in practice tries very hard to mimic actual Science, but it has a long way to go.

    What we are dealing with is a human being suddenly/slowly change substantially in their approach to life - happiness, aggression, withdrawal, deluded, whatever. The rest of society tries to respond to help the person; to make them "better again". In 2013, the people we give the most…

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  11. Tom Hennessy

    Retired

    Actually , as a detective , one should start with what is KNOWN , already , to CAUSE depression , an analogy being , "are there any registered offenders living close by ?"

    Iron is known to cause depression and when properly addressed the depression is alleviated.
    Sweden , when they removed iron from their food fortification program , had a noticable drop in depression prescription medication.
    In those with KNOWN increases of iron , do their prescription depression medication start near to their presumed onset of loading iron ?
    Menopause ?
    Do women BEGIN to use depression medication MORE at menopause , menopause being known to cause three times increase in iron stores due to the loss of menses which normally would have allowed iron to be lost at a fairly high rate.
    Do women who receive hysterectomies manifest depression at a higher rate ?
    Do women who lose their menses due to birth control manifest depression at a higher rate ?

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    1. Tom Hennessy

      Retired

      In reply to Tom Hennessy

      Do women BEGIN to use depression medication MORE at menopause ?
      "Clinical depression was also found to be two-and-a-half times more likely during the transition to menopause."

      Do women who receive hysterectomies manifest depression at a higher rate ?
      "Conclusion: Hysterectomy increases the risk of MDE"

      Do women who lose their menses due to birth control manifest depression at a higher rate ?
      "New research shows women taking the oral contraceptive pill are almost twice as likely to be depressed…

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