Major depression in women: a review of the literature.

OBJECTIVE: To promote pharmacists' understanding and recognition of major depression in women and to review gender/sex-specific differences in its prevalence, etiology, risk factors, clinical features, course, and management. DATA SOURCES: Clinical literature on this topic in the English language since 1990, searched through MEDLINE. STUDY SELECTION: Selected review articles and clinical trials from peer-reviewed journals. DATA SYNTHESIS: Epidemiologic data from diverse cultures indicate that the lifetime prevalence of major depression is twice as high in women as in men. The artifact, biological, and psychosocial hypotheses have each been proposed to explain the predominance of lifetime depression in women. Major depression is a multifactorial disorder and is influenced by numerous risk factors, including age, socioeconomic status, childhood history of sexual abuse, and recent stressful life events. Clinical course and presentation tend to differ between women and men. Women may experience different types of depression during various reproductive or life stages, including premenses, pregnancy, postpartum, and menopause. Treatment for major depression includes psychosocial therapy, pharmacotherapy, and electroconvulsive therapy. The literature indicates that major depression is often underrecognized and undertreated. CONCLUSION: Biological and psychosocial factors contribute to the higher vulnerability of women to major depression. The biological-psychosocial origins of depression in women may require a multidimensional approach to treatment. By providing education about this disease, referring individuals with signs and symptoms of depression for evaluation, and encouraging appropriate use of antidepressants, pharmacists can improve the detection and treatment of major depression.