Abstract
Twice as many women experience depression as men. Family physicians should take gender-related biopsychosocial differ-ences and phases of the reproductive cycle into consideration when evaluating and treating depression in women. Although the same diagnostic criteria are used for both genders, the presentation and course may differ in women. Women may more often experience hypersomnia, hyperphagia, guilt, anxiety, weight gain, and comorbid eating disorders. Women may require lower dosages of antidepressants than men because plasma antidepressant concentrations may be higher due to biological differences such as hormone levels and body fat to muscle ratio. The potential effects of antidepressants on a fetus or neonate are a consideration for many depressed women. No increased teratogenic risk from in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants has been shown by research studies. SSRIs have been shown effective in treating premenstrual dysphoric disorder and other comorbid conditions associated with depression. In women with mild-to-moderate depression, psychotherapy may be the sole treatment, or psychotherapy may be used adjunctively with antidepressant drug therapy. Every patient with depression should be screened for suicidal thoughts, intent, and plan during the initial visit. According to the authors, severely depressed women who have active suicidal thoughts or plans should usually be managed in conjunction with a psychiatrist.