Depression in women. ACOG technical bulletin number 182--July 1993.

Depression is a common, often overlooked, illness in women that should be recognized and treated. The obstetrician-gynecologist should be aware of factors that contribute to the high prevalence of depression in women, and particular attention should be given to family and work roles, victimization, early childhood loss of parent, personality variables, and reproductive-related events such as pregnancy, childbirth, and menopause. It is also important to distinguish between a grief reaction and major depression. Grief occurs secondary to losses such as abortion, miscarriage, still-birth, or infertility and is generally self-limiting; self-esteem is preserved. In major depression, changes in sleeping patterns, appetite, energy, and mood persist, along with loss of self-esteem. As a part of patient education, it should be emphasized that depression is a medical illness and not a character defect or weakness and that in most cases it can be treated effectively. However, the risk of recurrence is significant; patients should be alert to early signs and symptoms of recurrence and seek treatment. Antidepressants that are well tolerated are now available, and appropriate use of these medications, along with psychotherapy as needed, will provide effective treatment for most patients.