It’s no secret depression is a major issue among Americans, affecting children, teenagers and adults of every age, race and income level. Depression was long seen as something to keep in the dark but has recently become part of the national conversation, due in part to the popular Netflix series “13 Reasons Why” and the celebrity suicides of designer Kate Spade and chef Anthony Bourdain just this summer.

It’s not just the rich and famous battling mental illness. A report from the Substance Abuse and Mental Health Services Administration reported that 258,000 residents (6 percent) of the Dallas-Fort Worth metropolitan area on average experienced a major depressive episode during the six-year period from 2005 to 2010.

Additionally, according to a data brief released in February by the Centers for Disease Control and Prevention, 8.1 percent of American adults over age 20 experienced depression in a given two-week period between 2013 and 2016. And while this data is troubling, perhaps even more shocking is that women of all ages are twice as likely to battle depression than men, at a rate of 10.4 percent versus 5.5 percent.

Madge Barnes, M.D., a primary care physician on the medical staff at Texas Health Family Care – Grand Prairie, a Texas Health Physicians Group practice, explains that depression is so much more than just feeling sad.

“Being sad is a normal reaction to the many difficulties in life, but once the difficulties dissipate or are managed, the sadness goes away,” she says. “Depression, like diabetes, high blood pressure or wear-and-tear arthritis, is a chronic medical condition that may cause a range of symptoms that can affect the way you function. It is not an emotional weakness that should just be pushed aside and shaken off.

“Depression is more common in women than men, due to biological, hormonal and social factors unique to women,” she explains. “Women tend to be the nurturers, planners and emotional support for the family. Having to wear all those hats and not feeling they can raise the white flag to ask for help is often a pressure that is self-imposed. When those roles become intolerable, a sense of defeat, along with negative self-talk occurs.”

The U.S. Food & Drug Administration provides a list of the following common depression symptoms:

• Feelings of sadness, irritability or nervousness
• Feelings of guilt, worthlessness or hopelessness
• Crying
• Fatigue
• Sleep issues, including sleeping too much or too little
• Eating issues, including eating too much or too little (including significant weight gain or loss)
• Difficulty focusing or making decisions
• Loss of interest in things that previously brought you happiness
• Social isolation
• New or worsening physical symptoms, including aches and pains, headaches, cramps and/or digestive issues
• Thoughts of self-harm or suicide, or feeling like the world would be better off without you

Women will experience depression differently, so symptoms will vary from person to person, as well as the frequency and severity of symptoms.

There’s no way of knowing whether a person will experience depression during her life, but the Office on Women’s Health provides the following potential causes:

• Family history
• Physical or chemical changes in the brain
• Changes in hormone levels
• Stress, trauma or pain (includes personal loss, major relationship changes, abuse, sexual assault, poverty, etc.)
• Serious medical issues

According to the National Institutes of Health, depression should always be recognized as a real medical condition that hurts a person’s ability to eat, sleep, study, work and just get through the day. It is usually caused by a combination of genetic, biological, environmental and psychological factors. It isn’t a sign of weakness or something the person can control but usually requires medical treatment.

Barnes says the involvement of a primary care physician is crucial in making headway toward improved health.

“Depression in women is NOT a sign of failure or weakness and they cannot just ‘snap out of it,’ a suggestion that well-meaning friends or family may express,” she says. “Primary care providers play a critical role as the first line of evaluation. Every encounter includes depression screening. The results are scored, and the results range from no likelihood of depression to severe depression. It is incumbent upon every provider to address even mild depression.

“Treatment involves two approaches in my practice: counseling with a good support system and medication, depending upon the severity. There are medications known as SSRI (selective serotonin reuptake inhibitors), which increase the amount of the ‘feel good’ chemical serotonin. Dopamine is also a chemical that can affect mood. Women can’t just will themselves to be happy, and although exercise increases these chemicals, the lack of motivation to do so adds to the feelings of worthlessness, particularly when a woman’s energy is already low.”

Hormonal changes can wreak havoc on a female’s system, notably during menstruation, pregnancy, after pregnancy and during menopause. While all women will experience emotional and physical changes during these phases of life differently, some women may struggle with more severe issues including premenstrual dysphoric disorder (PMDD), perinatal depression (depression during pregnancy or post-partum) and/or perimenopausal depression. These types of depression are marked by significant symptoms that don’t improve or go away within a few weeks.

Treatment usually includes the use of medication, psychotherapy or a combination of the two. Many medications take a few weeks to make a positive difference. It could also take a bit of trial and error to find the right medication with the fewest side effects.

“Medications may take from two weeks to months to see an observable improvement, so patience is important,” Barnes explains. “Accepting the diagnosis and getting the help that is needed are important steps in managing depression. It can be controlled, and an improvement will be noticed. There are also testing to determine the best antidepressant based on your condition."

“Any woman that begins to feel sadness lasting longer than a few weeks, experiences an increasing desire to be alone or starts listening to negative self-talk should see these things as red flags. She should listen to herself and take one of the most courageous steps by seeking help. Women often give so much to others, but now it’s time to turn that back on yourself.”

If you or someone you know is struggling with depression or other mental health issues, call the help line at 682-626-8719, which is available 24/7.