How to manage major depression in women?

Question

Hello doctor,

I am a 38-year-old woman who has been feeling low for months. I have no energy, and even simple things like cooking or getting out of bed feel difficult. I cry often for no reason. My family tells me to “just stay positive,” but I cannot. My questions are:

Could this be depression? I am worried about taking antidepressants because I have heard they cause weight gain or affect hormones.
Are there safe treatment options for women?
Can therapy really help without medication?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Your symptoms suggest that you are suffering from major depressive disorder. There are other causes as well, such as bipolar disorder, anemia, hypothyroidism, vitamin B12 deficiency, and low vitamin D levels, and these must be ruled out.

I suggest you undergo tests to check your thyroid profile, CBC (complete blood count), Ferritin levels, vitamin B12, and vitamin D levels.

The probable diagnosis for your condition is major depressive disorder after ruling out bipolar disorder. If no organic cause is found, then there are two options for you. One is to start an antidepressant, and the second is psychotherapy, such as CBT (cognitive behavioral therapy). Which option is better depends on the severity of your symptoms.

You can check the severity with the Beck Depression Inventory, a scale easily available on the internet. If the severity shows mild to moderate, then psychotherapy alone is sufficient, but if your symptoms are moderate to severe, then medicines are also very important. The best results are achieved by combining both options.

There is a common myth regarding psychiatric medications that they are not safe, have many side effects, or are addictive, but in reality, they are very safe. A few side effects, such as gastrointestinal symptoms, can appear for a few days and usually improve.

Another is sexual dysfunction, which can occur with SSRIs (selective serotonin reuptake inhibitors), but other options are also available that can even improve sexual function, such as Bupropion. These medications usually do not have any effect on hormones. SSRIs generally do not increase weight, except for Paroxetine.

Choosing an antidepressant that suits you best is important. For example, Vortioxetine can be a good option, as it does not cause sexual dysfunction or weight gain and can also improve focus and energy.

Other lifestyle modifications can help, but they are not alternatives. I suggest you follow these lifestyle modifications:

Exercise for 30 minutes in the evening.
Learn deep breathing or progressive muscle relaxation exercises.
Reduce caffeine intake.
Follow strict sleep and wake patterns.
Maintain good sleep hygiene.
Monitor depressive symptoms through the Beck Depression Inventory.

Before starting antidepressants, rule out bipolar disorder by assessing for previous manic or hypomanic episodes and a family history of bipolar disorder.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.