Most people with depression experience at least a few of these hallmark symptoms, though they may not have them all and they may have others. Research has suggested that individual factors combine to determine what someone’s experience of depression looks and feels like. No two people with depression will have identical experiences, but understanding how each contributing factor affects a person’s risk and symptoms could lead to more effective treatment.
Biological Sex, Gender Identity, and Depression
Biological sex and gender identity are among these contributing factors. It’s long been thought that men and women experience and express depression in different ways, but that doesn’t mean the condition could be divided into two distinct forms. It’s more akin to the way mental illness can manifest differently in children and teens than it does in adults. On their own, biological sex and gender differences may not have a powerful impact. When combined with other factors, such as life stressors, sexism, toxic masculinity, trauma, and co-occurring mental health conditions like anxiety, substance use disorders, or eating disorders, these influences may make a person more prone to depression.
Biological Sex
In 2018, a study published in the journal Biological Psychiatry proposed that there are molecular differences in the brains of men and women with depression; the study only looked at the brains of cisgender men and women. For the study, researchers examined postmortem brain tissue samples from 50 subjects to see if there were any differences between the brains of people who had been diagnosed with major depressive disorder and those who had not. Although previous studies had set out to explore the same question, most only looked at the brains of cis men. The 2018 study looked at both cisgender men and cisgender women. The researchers evaluated the level of gene expression in the brain tissue, specifically looking at how genes were expressed in three regions of the brain linked to mood regulation. According to their findings, brains contained different gene variants. These variants were also different from those of people who didn’t have depression. Most of the genetic changes the researchers noted occurred in only the male or female brains, but not both. One of the major differences researchers noted was that the female brains expressed more of the genes that determine synaptic activity (the electrical impulses that brain cells use to communicate). Researchers made an interesting discovery about the genes that were altered in both male and female brains: The same gene might have changed, but those changes weren’t necessarily the same. In fact, in some cases, the change observed in the male brain was the opposite of the change seen in the female brain. For example, if a certain region showed increased gene expression in the female brain, gene expression in that region of the male brain was decreased. The findings were intriguing, but the researchers concluded that more research is needed to understand their value. The study did have limitations—most notably that the brains were only examined after death. Therefore, it’s not clear what genetic changes in the brain would mean for people living with depression. While molecular and physical evidence of a difference is fairly new, doctors and mental health professionals have long suspected that men and women experience and express depression in different ways. A 2019 study published in the journal Progress in Neurobiology proposed that biological sex differences could influence not just how depression manifests in men and women, but how it responds to treatment. The researchers paid specific attention to the effect of pregnancy and the postpartum period on depression risk for biologically female subjects. The results of the study provided supportive evidence that a person who is biologically female is more at risk for depression directly after giving birth than at any other period in their life. It’s likely that the hormonal changes of pregnancy, childbirth, and lactation, combined with the psychological stress of becoming a parent, increase a postpartum individual’s vulnerability to depression. Similarly, menopause—another time of hormonal change—was also associated with an increased risk of depression. Research has repeatedly indicated that women are twice as likely as men to be diagnosed with depression. One possible explanation is that hormonal changes that are specific to the female body could influence the onset of depression. Studies in support of the theory also indicate that there is a disparity in depression risk between males and females that peaks in adolescence. Teens and young adults of either sex face a cascade of shifting hormones and social stressors that can contribute to depression, as well as other mental health conditions like anxiety, eating disorders, substance use disorders, and suicide.
Gender Roles and Identity
It may not be that a greater number of women are depressed, but rather, that a woman is more likely to receive a diagnosis. Research has indicated that women who are depressed are more likely to show “typical” (or recognizable) emotional symptoms, such as crying. Women also tend to show more symptoms of depression than men. This observation is one example of how social factors influence the way people experience and express their emotions. While there may be a pattern, it’s not a strict relationship: Some women struggle to express their feelings while some men may be comfortable doing so. But broadly speaking, Western society’s traditional gender roles accept women openly expressing their feelings. Women tend to be more likely to talk about how they feel with a partner or friend, as well as seek help for symptoms of depression by sharing their concerns with a doctor or therapist. Conversely, society often pressures men to take a more stoic approach. Men can be less likely to express or demonstrate their emotions openly and are often more reluctant to ask for help. Follow Now: Apple Podcasts / Spotify / Google Podcasts When someone cannot freely express their feelings, these emotions may emerge in other forms. For example, sadness that’s been pushed down might eventually “bubble up” to the surface as anger. Research has indicated that men are often more likely to express depression in ways that differ from the more “classic” presentation. This difference may be one reason why depression in men is often missed or attributed to other causes. Men may be more likely to express depression in the following ways:
Misusing alcohol or other substances Irritability, frequent outbursts, or “explosive” anger Risk-taking (such as reckless driving or substance-impaired driving) Escapism (e.g., working late, spending more time at the gym, playing video games for hours)
If you suspect a loved one needs treatment for depression, but they are abusive, you need to put your safety first. There are resources available that can help you stay safe and get your loved one the help they need.
Sexual Minorities
Biological and social stressors can also be overwhelming for people in sexual minority groups. Studies have consistently shown that the rates of depression, anxiety, and suicide are high in the LGBTQ+ community. Research also indicates that the increased risk of depression in transgender people, including those who are nonbinary, starts young. A 2018 study found that the prevalence of depression, anxiety, and suicidal ideation in transgender and gender non-conforming youth was sevenfold higher than their cisgender peers. Studies have also shown that kids and teens experiencing gender dysphoria and/or questioning their sexual orientation are more vulnerable to depression. To further compound these difficulties, people in sexual minority groups often lack equitable access to health care, including mental health services. While they may begin in youth, these disparities can persist into adulthood. The rate of depression in transgender adults is high and often linked to cissexism (the assumption that most people are cisgender) and transphobia, as well as a lack of knowledge in health care providers. Transgender people seeking gender affirmation surgery who are unable to access support and treatment are at an even greater risk for depression and suicide. However, research has shown that gender-affirming hormone therapy can improve the mental and physical well-being of people navigating gender dysphoria.
Impact on Depression Treatment
One of the foremost questions for researchers is whether studies on the effect of biological sex and gender could lead to improved treatment for everyone with depression. While each person’s experience of depression depends on many factors—not just biological sex or gender identity—identifying important differences could help doctors prescribe treatments or even lead to new treatments. For example, many medications (including those commonly prescribed to treat mental illness) are dosed according to weight. Female bodies tend to have a higher body fat percentage than male bodies, which can affect how medications are metabolized. Hormonal fluctuations that occur throughout the lifespan of a person with a functioning uterus can also influence how medications work. The specific events that are often associated with changes, such as puberty, pregnancy, and menopause, need to be considered when deciding on any form of treatment for depression. Every person dealing with depression can benefit from learning about the different approaches to treating the condition, including psychotherapy, medication, and interventions like cognitive behavioral therapy (CBT) or electroconvulsive therapy (ECT). If you’re dealing with depression, the first step is to discuss your symptoms and concerns with your doctor or mental health care provider. From there, you can consider the risks and benefits of each treatment and make an informed decision about the safest and most effective choice for you. For more mental health resources, see our National Helpline Database.
