In the United States, roughly 12 million women suffer some form of depression. Symptoms of depression include changes in mood, sleep patterns and eating habits, along with decreased pleasure in many activities, fatigue, agitation, feeling worthless, helpless and alone, and difficulty concentrating. Although not everyone suffers from all these symptoms, women who have some of the symptoms should get proper care.

Unfortunately, only about half of women with depression receive any psychological or medical treatment. Some are getting the best possible care. But sadly, far too many are being treated by poorly trained, or even unlicensed and untrained, practitioners. Even with the best treatment, there is no guarantee that worsening depression, or even suicide, can be completely prevented. There is, however, a guarantee that the lack of availability of proper treatment results in higher rates of substance use and suicide among those who are clinically depressed. 

We know that there are a variety of factors that contribute to the presentation of depression, including abuse, stress, physical illness and predisposing genetic factors. These elements add to the fact that depression, and mood disorders in general, are pervasive. Depression is part of the human condition. And while it is true that men frequently hide depressive symptoms, they are not alone. Despite the prevalence of depression, many women also may never show any clear or obvious outward signs or symptoms. The women who hide their depressions can often be mistakenly viewed as lazy, aloof, disengaged, or worse, “off the derech,” and may be shunned and discarded.

When people do not get proper treatment for depression, their symptoms get worse over time. Some depressed women secretly turn to alcohol and other substances to self-medicate away their pain. The nicotine in cigarettes or e-cigarettes acts an anti-depressant, though it is limited in its efficacy and comes with a variety of risks, from addiction to cancer. Similarly, marijuana acts to calm an agitated person, but it to can lead to worsening depression and, for some, acts as a gateway to more addictive substances. Alcohol is also used by some to self-treat their mood disturbance, but alcohol is itself a depressant that, in the end, adds to a worsening case of depressive symptoms. This form of distorted self-care, smoking and drinking, is more easily overlooked – even excused – among young men. When women act similarly, they are judged far more harshly and are further alienated.

The best treatment for depression includes a comprehensive evaluation and following the recommended treatment protocols. Therapy and medication are often recommended individually or in combination. Taking the treatment is critical for care, but it is insufficient. People suffering from depression are usually feeling lonely and isolated. To the degree that they can tolerate, it is therapeutic for them to feel that they are part of something larger than themselves – family, friends and community. Acceptance in those familial and social groups can be difficult.

It is always surprising when we hear of tragic situations involving women suffering from a mental illness. On the other hand, those of us who work in the field of mental health are often surprised that there are not more tragic cases. We know that far too many women are not getting the correct care and end up alone, isolated, away from their homes and from their communities. It is the lucky ones who manage to move on to other supportive groups, even if it seems that in the process they are rejecting their family. The real tragedy exists when changes in behavior are treated as something to be punished, stifled or ignored.

It is at the first sign of change that a professional assessment should be undertaken to determine if the cause is depression. If the care is properly administered, the treatment is more likely to be effective. After all, we jump for treatment the minute there is any indication of a physical ailment; mental illness should be no different.

While we are starting to see a greater understanding in our communities, there is more that can be done. It is time that there be a reversal of the trend toward less parity for mental illness and the provision of proper mental health care, or we will have to cope with losses that are ever more tragic to our community.

Dr. Michael J. Salamon, Ph.D. is a fellow of the American Psychological Association and the author of numerous articles and books, including most recently Abuse in the Jewish Community (Urim Publications).Visit his website, www.psychologicalhelp.org.