Depression in Men and Women: Symptoms, Differences, and Treatment

Depression is one of the most common mental disorders worldwide — and at the same time one of those that are often recognised too late. Women are statistically diagnosed more frequently, while men die significantly more often from the consequences of untreated depression, for example through suicide. This discrepancy raises an important question: Is depression researched differently in men and women — and diagnosed earlier (or later) in different ways?

This article therefore focuses on typical differences in the course of depression in men and women, as well as on a gender data gap in depression research. We also describe conventional methods of treatment and the potential benefits of complementary therapies.

Recognising Depression: Signs in Men and Women

Depression does not present in the same way in all affected individuals. Classic symptoms include low mood, loss of interest, lack of drive, sleep disturbances, concentration problems and a loss of enjoyment in life. This combination of symptoms forms the basis of diagnostic criteria in psychiatric classification systems (American Psychiatric Association, 2013; WHO, 2019).

However, large epidemiological studies show a striking pattern: women receive a diagnosis of depression about twice as often as men. A meta-analysis of international population studies confirms this difference across many countries (Salk et al., 2017).

Different Expressions of the Disorder

Statistically, men often show a different symptom profile than women.

Common signs in men include:

·       irritability

·       aggressive or impulsive behaviour

·       increased alcohol or substance use

·       more risk-taking behaviour in everyday life.

In practice, such signs are not always recognised promptly as depression, as many diagnostic criteria are more focused on classic symptoms such as sadness or lack of motivation. Some researchers therefore refer to such symptoms as externalising symptoms in men (Martin et al., 2013).

Women more frequently report “classic” depressive symptoms.

These include in particular:

·       persistent low mood or sadness

·       pronounced feelings of guilt or self-blame

·       excessive rumination

·       sleep disturbances

·       fatigue and lack of energy

·       changes in appetite

·       feelings of hopelessness or being overwhelmed.

Such signs are often described in research as internalising symptoms because they tend to manifest as emotional withdrawal, rumination or self-doubt rather than outward behavioural changes (Kuehner, 2017).

Depression: How and by Whom Is a Diagnosis Made?

Diagnosis is not based on a single test but on an overall clinical assessment.

The professionals most commonly involved are:

·       general practitioners, who are often the first point of contact

·       specialists in psychiatry and psychotherapy

·       psychotherapists

·       in some cases also neurologists.

Typical components of the diagnostic process include:

·       a detailed medical consultation (history taking) covering mood, sleep, motivation, stress factors and life circumstances

·       structured diagnostic criteria according to international classification systems such as DSM-5 or ICD-10 / ICD-11 (American Psychiatric Association, 2013; World Health Organization, 2019)

·       standardized questionnaires, e.g. PHQ-9 (Patient Health Questionnaire), Beck Depression Inventory (BDI)

·       physical examination and laboratory values to rule out other causes.

The diagnosis is made when several typical symptoms are present simultaneously for at least two weeks and significantly impair daily functioning.

Is There a Gender Data Gap in Depression?

Historically, many clinical studies were conducted predominantly on male participants. Hormonal fluctuations in women were long considered a potential “confounding factor” for study results. As a result, data gaps regarding sex-specific differences emerged in many areas of medicine (Holdcroft, 2007).

In depression research, there is also discussion about a possible gender data gap — but in a different way than in other fields. Diagnostic models appear to be more aligned with symptom profiles more commonly reported by women. At the same time, many studies do not systematically analyse results by sex. There are also no sex-specific dosage and administration recommendations, which represents another data gap.

Conventional Medical Treatment Methods for Depression

Naming Problems: Absolutely Necessary

Psychotherapeutic approaches — particularly cognitive behavioural therapy — are among the best studied forms of treatment. Meta-analyses show that psychotherapeutic interventions can significantly reduce depressive symptoms and represent a core component of treatment for many affected individuals (Cuijpers et al., 2020).

General practitioners may assist in finding appropriate psychotherapy services. In Germany, appointment service centres of statutory health insurance physicians, online physician directories and therapist registries of psychotherapists’ chambers also provide access to suitable contacts.

Antidepressants: An Approach That Raises Questions

In moderate to severe depression, antidepressants are also frequently used. These include selective serotonin reuptake inhibitors (SSRIs). These medications influence neurotransmitter balance in the brain — particularly the serotonergic system — and are intended to stabilise mood.

However, professional information and regulatory authorities also point to side effects and risks. These include weight gain, sleep disturbances, sexual dysfunction or inner restlessness.

More seriously, analyses of studies led regulatory authorities to introduce a warning that SSRIs may increase the risk of suicidal thoughts or behaviour in children, adolescents and young adults, particularly at the beginning of treatment or when the dose is changed. For this reason, close medical monitoring is recommended in this age group (Stone et al., 2009). A certain degree of caution is therefore justified in some situations, as antidepressants are intended to reduce crises and lower potential suicide risk — not increase it.

Naturopathy and Complementary Medicine in Depression

Many people are interested in naturopathic and holistic strategies.

Here we present some of the best studied substances:

·       St. John’s Wort (Hypericum perforatum)

St. John’s wort is one of the best studied plant-based substances for depression. A Cochrane review shows that standardized extracts may be effective in mild to moderate depression (Linde et al., 2008).

In clinical studies, doses of 500–900 mg standardized extract per day were typically used. Standardization is crucial, as active ingredient levels can vary considerably.

St. John’s wort affects several neurotransmitter systems simultaneously. Effects on serotonin, dopamine and noradrenaline transporters are discussed, thereby influencing signal transmission between nerve cells. In addition, experimental studies suggest anti-inflammatory and neuroprotective properties. Clinically, St. John’s wort is mainly used for low mood, lack of drive, inner restlessness and sleep disturbances in mild to moderate depression.

·       L-Methylfolate

L-methylfolate, the active form of vitamin B9, plays a role in homocysteine and neurotransmitter metabolism. In randomized studies, it has been investigated as an adjunct to antidepressants.

Doses of approx. 7.5–15 mg per day may improve depressive symptoms in patients with an insufficient response to antidepressants (Papakostas et al., 2012).

This effect is explained by the role of L-methylfolate in the synthesis of serotonin, dopamine and noradrenaline. Impaired folate metabolism or elevated homocysteine levels have been ssociated with depressive symptoms in studies.

·       Omega-3 Fatty Acids

Preparations rich in EPA may reduce depressive symptoms. Studied dosages are usually in the range of 1–2 g EPA/DHA per day.

Proposed mechanisms include (Grosso et al., 2014):

·       modulation of inflammatory processes, which are often elevated in depression

·       stabilization of neuronal cell membranes, potentially improving signal transmission

·       effects on serotonin and dopamine systems.

·       Rhodiola (Rhodiola rosea)

Rhodiola is traditionally used as an adaptogen and supports stress resistance and mental performance. Pharmacologically, effects on stress hormones, neurotransmitters and antioxidant systems are described.

According to study findings, Rhodiola extract can alleviate symptoms of moderate depression, including mental fatigue, stress and concentration problems. Doses of approx. 340–680 mg extract per day have been used (Mao et al., 2015).

·       Saffron (Crocus sativus)

Saffron has been studied for its antidepressant effects. Clinical studies show improvements in mood in mild to moderate depression (Akhondzadeh et al., 2004).

The dosage used in studies is typically around 30 mg saffron extract per day.

·       S-Adenosylmethionine (SAMe)

SAMe is an endogenous substance that plays an important role in methylation processes and in the formation of various neurotransmitters. It influences, for example, the synthesis of serotonin, dopamine and noradrenaline, as well as cellular methylation processes in the brain. Effects on membrane fluidity and antioxidant systems are also discussed.

SAMe is mainly studied in relation to depressive mood, lack of drive and cognitive slowing. A systematic Cochrane review provides evidence that SAMe may alleviate such symptoms. Typical dosages range from 800–1600 mg per day. (Galizia et al., 2016).

·       Vitamin D

Vitamin D is increasingly being studied in relation to mental health. Vitamin D deficiency has been associated with depressive symptoms in several studies (Vellekkatt & Menon, 2019; Spedding, 2014).

Vitamin D acts not only as a vitamin but as a hormone precursor with receptors in the brain — effects on neurotransmitters, inflammatory processes and neurotrophic factors are therefore possible (Spedding, 2014).

In clinical studies, doses of 1,000–2,000 IU per day are commonly used, although a consistent antidepressant effect has not been demonstrated in all studies (Okereke et al., 2020).

Alternative Approaches

If the term “healing methods” is considered misleading — the following approaches alone do not cure depression. However, meditation, yoga, and mindfulness-based approaches can measurably alleviate depressive symptoms and reduce the risk of relapse (Goldberg et al., 2018).

They primarily act through stress regulation, improved sleep and emotional regulation. In our second article on fibromyalgia, you can learn more about how such exercises are performed and where professional guidance and courses can be found.

Conclusion: The Key Is Comprehensive Treatment of Depression!

Depression is complex — with biological, psychological and social causes.

The comparison between men and women shows that symptoms may present and be interpreted differently. At the same time, it becomes clear that sex-specific differences are not yet sufficiently considered in research.

Conventional medical therapy, lifestyle factors and naturopathic approaches are not mutually exclusive — they can complement each other meaningfully. However, early diagnosis and professional treatment remain crucial.

FAQ – Frequently Asked Questions About Depression and Naturopathic Treatment

1. What is the difference between low mood and clinical depression?

Low mood is usually temporary and often occurs as a reaction to stress. Clinical depression, on the other hand, is a diagnosable condition in which several symptoms — such as low mood, lack of drive, sleep disturbances or concentration problems — significantly impair daily life. Diagnosis is based on standardized criteria (e.g. DSM-5 or ICD-10).

2. Can depression cause physical symptoms in addition to sleep disturbances?

Yes, in addition to sleep disturbances, typical symptoms include chronic fatigue, diffuse pain (e.g. back, head or muscle pain), gastrointestinal complaints and changes in appetite. These somatic symptoms may contribute to depression initially going unrecognized. Studies show that a significant proportion of affected individuals primarily report physical complaints even though the underlying cause is depression (Kroenke et al., 2009; Bair et al., 2003).

3. Which simple measures can help with low mood?

In mild to moderate depression — not only in low mood — simple measures can already have a noticeable effect and play an important role in self-regulation. These include regular physical activity, daylight exposure, structured sleep routines, social activity and stress reduction (Schuch et al., 2018).

4. What role do inflammation processes play in depression?

Some research suggests that chronic inflammatory processes may contribute to the development of depression by influencing neurotransmitters, stress axes and neuronal plasticity (Miller & Raison, 2016).

5. Can diet influence depression?

Yes. Nutritional psychiatry examines the relationship between diet and mental health. Studies show that a diet rich in vegetables, fruit, fish, nuts and high-quality fats is associated with a lower risk of depression, while highly processed foods and high sugar intake may have negative effects (Lai et al., 2014).

6. Can gut bacteria and the composition of the gut microbiome influence depression and depressive mood?

Gut bacteria can influence mood and behaviour via neural pathways, immune processes and metabolic products. Initial studies are therefore investigating probiotics and prebiotics as complementary approaches to depressive symptoms — with promising results (Dinan & Cryan, 2017).

7. Is light therapy useful outside the winter months?

Yes. Although light therapy is primarily used for seasonal depression, studies show that it can also be effective in non-seasonal depression. Morning light exposure can stabilise the circadian rhythm, which may have positive effects on mood and sleep (Lam et al., 2016).

The newly published fifth volume of our “Codex Humanus” is now available in our online shop. The other four volumes of the series are also available there, as well as all volumes of the “Medizinskandale” series. You can also find further information on depression and many other topics on our blog.

Sources:

·       American Psychiatric Association (2013): “Diagnostic and Statistical Manual of Mental Disorders (DSM-5),” American Psychiatric Publishing.

·       World Health Organization (2019): “International Classification of Diseases 11th Revision (ICD-11).

·       Salk, R. H. et al. (2017): “Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms,” Psychological Bulletin.

·       Martin, L. A. et al. (2013): “The experience of symptoms of depression in men vs. women: Analysis of the National Comorbidity Survey Replication,” JAMA Psychiatry.

·       Kuehner, C. (2017): “Why is depression more common among women than among men?,” The Lancet Psychiatry.

·       Holdcroft, A. (2007): “Gender bias in research: how does it affect evidence based medicine?,” Journal of the Royal Society of Medicine.

·       Cuijpers, P. et al. (2020): “The effects of psychotherapies for depression on response, remission, reliable change and deterioration: A meta-analysis,” World Psychiatry.

·       Stone, M. et al. (2009): “Risk of suicidality in clinical trials of antidepressants in adults: Analysis of proprietary data submitted to the U.S. Food and Drug Administration,” BMJ.

·       Linde, K. et al. (2008): “St John’s wort for major depression,” Cochrane Database of Systematic Reviews.

·       Papakostas, G. I. et al. (2012): “L-methylfolate as adjunctive therapy for SSRI-resistant major depression: Results of two randomized, double-blind, parallel-sequential trials,” American Journal of Psychiatry.

·       Grosso, G. et al. (2014): “Role of omega-3 fatty acids in the treatment of depressive disorders: A comprehensive meta-analysis of randomized clinical trials,” PLoS ONE.

·       Mao, J. J. et al. (2015): “Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial,” Phytomedicine.

·       Akhondzadeh, S. et al. (2004): “Comparison of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: a pilot double-blind randomized trial,” BMC Complementary and Alternative Medicine.

·       Galizia, I. et al. (2016): “S-adenosyl methionine (SAMe) for depression in adults,” Cochrane Database of Systematic Reviews.

·       Vellekkatt, F.; Menon, V. (2019): “Efficacy of vitamin D supplementation in major depression: A meta-analysis,” Journal of Postgraduate Medicine.

·       Spedding, S. (2014): “Vitamin D and depression: A systematic review and meta-analysis comparing studies with and without biological flaws,” Nutrients.

·       Okereke, O. I. et al. (2020): “Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores: a randomized clinical trial,” JAMA.

·       Goldberg, S. B. et al. (2018): “Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis,” Clinical Psychology Review.

·       Kroenke, K. et al. (2009): “An ultra-brief screening scale for anxiety and depression: The PHQ-4,” Psychosomatics.

·       Bair, M. et al. (2003): “Depression and pain comorbidity: A literature review,” Archives of Internal Medicine.

·       Schuch, F. B. et al. (2018): “Physical activity and incident depression: A meta-analysis of prospective cohort studies,” American Journal of Psychiatry.

·       Miller, A. H.; Raison, C. L. (2016): “The role of inflammation in depression: from evolutionary imperative to modern treatment target,” Nature Reviews Immunology.

·       Lai, J. S. et al. (2014): “A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults,” American Journal of Clinical Nutrition.

·       Dinan, T. G.; Cryan, J. F. (2017): “Gut instincts: microbiota as a key regulator of brain development, ageing and neurodegeneration,” Journal of Physiology.

·       Lam, R. W. et al. (2016): “Efficacy of bright light treatment for nonseasonal major depressive disorder: A randomized controlled trial,” JAMA Psychiatry.

·       = International Units.

1 µg vitamin D = 40 IU