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The Psychodynamic Psychotherapist's Guide to the Interaction among Sex, Genes, and Environmental Adversity in the Etiology of Depression for Women

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From menarche to menopause, women are highly vulnerable to major depression. While biological and psychosocial differences between men and women have been established, the reason for the preponderance of depression in women has yet to be fully elucidated. Women may be predisposed to depressive illness because of biological factors related to brain structure, function, and the impact of reproductive life stages. They may also be at increased risk because they are differentially disadvantaged with respect to environmental stressors including interpersonal violence, socioeconomic instability, and caregiving burden, among others. However, not all women develop depression, nor do all individuals who suffer from adverse life events. This narrative review focuses on emerging research related to the interaction between sex, genetics, and environmental factors that may help offer clues about why some individuals suffer from depression, and why others may be resilient to this outcome. While many questions remain unanswered, the psychodynamic psychotherapist can use this information to help patients suffering from depression understand some of the complexities of the determinants of risk and resilience, with the goal of moving forward toward recovery.