Mental health doesn’t exist in a vacuum, and for women, the risks, symptoms, and stakes shift significantly with age. We sat down with Raghid Charara, MD, Neuropsychiatrist in Cleveland Clinic’s Department of Psychiatry and Psychology, to unpack why women are disproportionately affected by anxiety and depression, what makes diagnosis so tricky in older adults, and the evidence-based steps every woman can take to protect her brain health for the long haul.
Read the interview with Dr. Charara below.
WAM: As is the case with dementia and Alzheimer’s disease, women are more likely than men to be diagnosed with anxiety and depression. What drives that disparity — is it biological, social, or both?
Dr. Charara: Both biology and social factors. Biologically, the gender gap emerges at puberty and tracks with hormonal flux (menstrual cycles, postpartum, perimenopause) when estrogen shifts can prime the brain for mood vulnerability. Socially, women face disproportionate exposure to interpersonal violence and caregiving burden and are more prone to rumination. Diagnostic patterns also play a role: women present with classic symptoms and seek help more often, while men’s depression frequently manifests as irritability or substance use and goes uncounted.
WAM: Although depression is not a normal part of aging, older adults often experience challenges related to health or changes in life circumstances, possibly putting them at increased risk for depression. How common are mental health conditions in older women and how is it recognized?
Dr. Charara: They are common but under detected. A study of 42,000+ women aged 65+ found psychiatric disorders in 37%, mostly mood and anxiety [1]. Major depression affects ~2% of adults 55+, with another 10–15% having significant subthreshold symptoms [2].
Recognition is difficult because older women tend to report fatigue, pain and memory problems rather than sadness, leading clinicians to attribute symptoms to aging or medical illness. Screening tools like the PHQ-9 help but require follow-up evaluation to distinguish depression from medication effects, grief or early dementia.
WAM: Why does it matter for older women that mental health conditions get properly diagnosed and treated?
Dr. Charara: Because untreated depression shortens life and accelerates disability. Depression worsens cardiovascular outcomes, reduces treatment adherence and accelerates frailty, with the impact even stronger in women.
The good news: depression in older adults is treatable with medication, cognitive behavioral therapy and exercise. It is not an inevitable part of aging, and treating it preserves years of healthy, independent life.
WAM: Research shows that chronic depression can increase a woman’s risk of developing dementia later in life. What do we understand about that connection, and does treating depression reduce that risk?
Dr. Charara: Depression is associated with a 50% higher risk of dementia, with persistent and worsening symptom trajectories carrying the greatest risk. The relationship is likely bidirectional: chronic depression appears to be a genuine risk factor through neuroinflammation and vascular damage, while late-onset depression may sometimes be early prodromal dementia. Treatment does help, with the greatest benefit when initiated before symptoms become chronically severe.
WAM: For a woman in her 40s, 50s, or 60s who wants to protect her mental health as she ages, what are the two or three most evidence-based things she can do starting today?
Dr. Charara: Exercise regularly. Women meeting moderate-intensity activity guidelines had half the odds of high depressive symptoms over 10 years, and a meta-analysis confirmed large benefits from aerobic and mind-body exercise at least three times weekly. Midlife exercise also protects cognition [3].
Stay socially connected. Strong social engagement is linked to lower dementia risk, while loneliness raises it considerably. Social participation specifically reduces depressive symptoms in older women.
Address mood and sleep problems early. Untreated depression accumulates brain vulnerability over time. Cognitive behavioral therapy is effective for depression, anxiety and sleep disturbance during the menopause transition and is recommended by multiple professional societies.
Sources:
[1] Beydoun HA, Beydoun MA, Hale L, Wallace RB, Jung SY, Saquib N, Szymkowiak D, Derefinko K, Zonderman AB, Brunner R, Tsai J. Psychiatric disorders among older U.S. women by socioeconomic and veteran status. J Affect Disord. 2025 Dec 15;391:120011. doi: 10.1016/j.jad.2025.120011. Epub 2025 Aug 7. PMID: 40782919; PMCID: PMC12439202.
[2] Kok RM, Reynolds CF. Management of Depression in Older Adults: A Review. JAMA. 2017;317(20):2114–2122. doi:10.1001/jama.2017.5706
[3] Li S, Dou Y, Li Y. Exercise as a therapeutic strategy for depression in menopausal women: a metaanalysis of randomized trials. Front Psychiatry. 2025 Sep 19;16:1641082. doi: 10.3389/fpsyt.2025.1641082. PMID: 41048912; PMCID: PMC12492449.