By 2020, the World Health Organisation (WHO, 1997) has predicted that depression will be the “second leading cause of global disability burden” and that as many as one in four women will suffer from a mood disorder during their lifetime.

Women have an increased vulnerability to depressive disorders during their child-bearing years. During this time, they are also more likely to experience sexual and domestic violence, social and financial inequities, and often to undertake many different roles with attendant responsibilities. The child-bearing years are associated with specific hormonal changes related to menstrual cycle variations, contraception, pregnancy and the postpartum period and the menopause. Increasingly there are also the iatrogenic hormonal manipulations associated with contraception and assisted reproductive technologies.

Clearly, these sex-specific factors deserve special consideration in the understanding and management of depression in women. The reader is also referred to Chapter 1 for an overview of depression in adolescence, Chapter 9 for a more detailed discussion of mood disorders in pregnancy and postpartum and Chapter 11 for a review of mood in the menopausal period.

Epidemiology

Worldwide, major depression is at least twice as common in women as men (Weissman et al., 1993), accounting for 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men; these data appear consistent with current UK figures (Office for National Statistics (ONS), 2001).