That’s how Jimmy Brown knew he was in trouble. The New York City firefighter survived the collapse of the World Trade Center. He managed to dig himself out and miraculously suffered no serious physical injuries. But the psychological trauma lingered, and he began drinking, even at work, though he knew it could cost him his job. During breaks, he’d sneak back to his car for a beer. One beer a day turned into two, then three, and then a six-pack. “You’d have all these beers and still not be calmed down,” he recalls. Luckily, Brown had worked as a peer counselor with the police department and was able to see that he needed help. He went on “light duty” and began therapy.
“Many men turn to substance abuse as a way to ward off depression,” says Pollack. Men have two to four times the rate of substance-abuse problems as women, and Pollack contends that if this was recognized as a sign of depression, the gender gap would substantially narrow.
That’s what some researchers have found when they’ve taken alcohol out of the equation. In studies of two communities that prohibit alcohol or have very low rates of use — the Amish and Orthodox Jews — researchers have found that male and female rates of depression were the same.
But not all the evidence supports Pollack’s argument. Most experts are convinced that women’s higher rate of depression is not just a statistical illusion, but that it reflects real differences between the sexes. “I suspect that when you control for all the varying aspects of how the illness presents,” says NIMH’s Dr. Insel, “it will still be more common in women than men.”
An emerging body of research is also pointing to biological differences that may underlie the depression disparity. Female hormones, many researchers believe, likely play a central role, starting in adolescence. In studying girls between the ages of 9 and 15, Duke University psychiatrist Adrian Angold, MD, found that the greatest risk factor for depression was whether a girl had crossed the threshold to maturity, hormonally speaking.
Mood manipulators and DNA
“Just going from childhood levels of estrogen and testosterone to adult levels placed girls in a higher risk group,” Dr. Angold says. “This is likely to be a direct effect of those hormones on the brain.” Though it’s far from clear how estrogen or testosterone affect mood, he suspects the hormones may switch on genes that carry a predisposition toward depression. Hormone changes at puberty, however, do not appear to increase depression in boys.
Estrogen also enhances the actions of some of the brain’s chemical messengers that help regulate mood, such as serotonin. And there is intriguing evidence that women are most vulnerable to depression when estrogen levels are most in flux, such as postpartum or at menopause.
Sherri Walton of Paradise Valley, Arizona, hit an all-time low after the birth of her first daughter. “I used to stand in the shower and just sob because I had all this overwhelming fear and emotion that I did not know what to do with.” And when she reached her 40s and entered perimenopause, she says, “My symptoms went off the chart.” It took antidepressants and therapy to restore her sense of joy. Celebrities like Marie Osmond and Brooke Shields have gone on record about their own battles with postpartum depression.
Men don’t experience those dramatic hormonal ebbs and flows. Around age 30, testosterone levels undergo a long, slow decline. And it’s unclear whether dropping testosterone levels affect men’s moods. Studies have found conflicting results.
Sex hormones aren’t the only mood manipulators, however. The hormones that regulate our response to stress also get in on the act, and once again there’s early evidence that they operate differently in men and women. UCLA psychiatrist Robert Rubin, MD, compared how depressed men and women responded to a drug that stimulates stress hormones. The depressed women were more sensitive to stress chemicals than the men. Normally, young men have greater stress responses than women, but the depressed men had the least response of all. Though the findings need to be replicated, Dr. Rubin says they could help explain the greater incidence of depression in women: Some women may be predisposed to react to stress more acutely, making it tougher for them to shake off the problems and crises life brings.
Another key factor is the DNA you inherit. Depression often runs in families, as do conditions such as anxiety disorders (which occur more in women), and alcoholism (which affects more men). Researchers have studied twins from families with a history of depression in an effort to understand those genetic influences. The studies suggest that genes have a big say not only in your risk for depression, but also in whether that risk depends on your gender.