Addressing Suicidal Thoughts: A Guide for Suicide Prevention

Post-traumatic stress disorder (PTSD) doesn't discriminate; it can affect anyone who has been directly or indirectly exposed to a traumatic event. However, the way PTSD manifests can differ between men, women, and other gender identities. Understanding these differences facilitates effective treatment and support. In this informational guide, we'll explore how PTSD symptoms vary by gender identity, what triggers them, and personal considerations you might take into account when managing this complex condition. While this content addresses general experiences of PTSD by gender identity and biological sex, it's important to remember that these are generalizations. We acknowledge that every individual is unique and may have different experiences and responses to trauma that differ from what we've outlined here. What is PTSD? PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event, which could include anything from natural disasters and serious accidents to personal assaults and military combat. Individuals with PTSD often relive the traumatic event through flashbacks or nightmares, leading to severe anxiety and emotional distress. PTSD symptoms typically include: Intrusive memories Avoidance behaviors Negative changes in thinking and mood Alterations in physical and emotional reactions These symptoms can be debilitating and interfere with daily life, but they can also vary significantly based on one’s biological sex and/or gender identity. PTSD in men vs. women vs. others PTSD affects individuals differently based on a variety of factors, including biological sex, gender identity, and gender expression: Biological sex: Refers to the physical characteristics (such as reproductive organs, chromosomes, and hormones) that are typically categorized as male or female. Gender identity: Refers to a person's internal sense of their gender, which may be male, female, both, neither, or somewhere along the gender spectrum. Gender expression: Refers to how a person presents their gender outwardly through behavior, clothing, haircut, voice, and other forms of presentation. Sexuality could also play a role, as it can be closely related to one’s gender identity and expression. Individuals who identify as lesbian, gay, or bisexual may face unique stressors and traumatic experiences related to their sexual orientation, which can influence the development and manifestation of PTSD. Each group may experience distinct types of trauma, exhibit different acute responses, and adopt varying coping mechanisms. Understanding these differences helps to tailor effective treatment plans and provide comprehensive care for all individuals affected by PTSD. Prevalence of PTSD Studies show that the condition is more common in females than in males. Approximately 10% of females and 4% of males will develop PTSD at some point in their lives. PTSD in transgender and gender-diverse individuals is significantly higher, with estimates suggesting that up to 42% of transgender and gender-diverse individuals meet the criteria for PTSD​. The high rate may stem from compounded stress from societal stigma, discrimination, and frequent experiences of violence and harassment that transgender and non-binary people face​. Type of trauma The types of trauma that lead to PTSD in men, women, and transgender and non-binary individuals can also differ. Males: More likely to experience trauma related to accidents, physical assault, combat, or witnessing death or injury.  Females: More likely to experience trauma related to sexual assault, childhood abuse, or domestic violence. LGBTQIA+ individuals: In addition to the common traumas related to any relevant gender(s), they are more likely to experience trauma from hate crimes, harassment, homophobic/transphobic violence, and discrimination. Males in this community may also have experienced domestic violence or have endured childhood abuse. Transgender and non-binary individuals: May also experience trauma related to gender dysphoria. These differences in trauma types can influence how PTSD manifests and is treated. Immediate responses to trauma The immediate response to trauma can also vary by gender identity. Those who identify as men generally exhibit more externalizing behaviors, such as aggression, irritability, or substance abuse. In comparison, people who identify as women may show more internalizing behaviors, such as intense fear, helplessness, or anxiety. Gender-diverse individuals might experience a mix of these responses or different reactions altogether, influenced by their unique experiences and societal pressures. These differences in acute responses can affect how quickly PTSD is recognized and diagnosed. Neurobiological stress response  Research indicates that the neurobiological responses to stress and trauma differ between gender identities: Men with PTSD: Tend to have a more pronounced ‘fight or flight’ response, characterized by physiological reactions like increased adrenaline, cortisol levels, and heart rate.  Women with PTSD: Might exhibit a stronger emotional response, potentially due to hormonal variations like estrogen and cortisol, and can often have a ‘tend and befriend’ response, involving nurturing behaviors and seeking social support, driven by the hormone oxytocin. LGBTQIA+ individuals with PTSD: May have unique stress responses influenced by how they express their gender identity and the ongoing societal pressures and discrimination they face. Stress responses can influence the development and severity of PTSD symptoms, so it’s important to recognize and consider them based on how you identify. Comorbidity rates PTSD often occurs alongside other mental health conditions, and these comorbidity rates can vary by gender identity. Men with PTSD: More likely to have concurrent issues with substance abuse or anger management. Women with PTSD: More likely to experience depression, anxiety disorders, or eating disorders. PTSD in transgender and non-binary individuals: Higher rates of co-occurring mental health conditions such as anxiety, depression, and substance abuse. Understanding these — as well as other — comorbidities is important for developing comprehensive treatment plans. Coping styles Men, women, and gender-diverse individuals will often use different coping styles to manage PTSD symptoms. Males: More likely to use active (‘fight or flight’) coping strategies where they either confront the trauma head-on or avoid it altogether, both of which can provide temporary relief but also often exacerbate PTSD symptoms in the long run. Females: More likely to use relational (‘tend and befriend’) coping strategies, such as seeking support from friends and family or engaging in caregiving activities, which can be beneficial for emotional healing but may not address the root causes of PTSD symptoms. Transgender and non-binary individuals: Coping mechanisms can vary and may include both active and relational strategies. These coping styles can influence the effectiveness of different PTSD treatment approaches. Seeking help Across the spectrum of genders, there are significant differences in one’s willingness to seek help or ability to access help for PTSD. Men with PTSD: Could delay seeking help due to societal expectations of toughness and self-reliance, though mental healthcare is becoming more and more accepted among this group. Women with PTSD: Generally more willing to seek professional help and participate in therapy. LGBTQIA+ individuals with PTSD: Might hesitate to seek help due to previous negative experiences with the healthcare system or fears of encountering homophobia, discrimination, or prejudice from providers. PTSD in non-binary and transgender individuals: May face additional barriers to seeking help, including lack of access to gender-affirming care. These differences can impact treatment outcomes and highlight the importance of tailored outreach and support strategies. PTSD treatment considerations Treating PTSD effectively requires understanding the unique needs of each individual, which can vary based on gender identity, type of trauma experienced, and personal history.  Treatment options for PTSD  Treatment for PTSD in women, men, and gender-diverse individuals often involves a combination of options. These are some of the commonly prescribed medications and frequently used types of therapy: Medication: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are often prescribed to help manage PTSD symptoms. They can help stabilize mood and reduce anxiety, augmenting other forms of therapy. Cognitive behavioral therapy (CBT): This type of therapy focuses on changing negative thought patterns and behaviors associated with PTSD. Prolonged exposure therapy (PE): PE involves repeated, detailed imagining or recounting of the trauma in a safe environment to reduce the distress it causes. Eye movement desensitization and reprocessing therapy (EMDR): EMDR uses guided eye movements to help the brain process and integrate traumatic memories. Therapies such as CBT, PE, and EMDR offer structured ways to process and manage trauma. Both therapy and medications like SSRIs can provide symptom relief. Transgender and non-binary PTSD treatment  To provide effective PTSD treatment for transgender and non-binary individuals at Cerebral, we focus on providing gender-affirming mental healthcare, including using correct pronouns and preferred names, creating a safe and inclusive environment, and being knowledgeable about the unique experiences of transgender and non-binary individuals. Our mental health professionals can also tailor treatment plans to address the specific types of trauma and stressors faced by transgender and non-binary individuals. This might include addressing issues related to gender dysphoria and societal discrimination. At Cerebral, we are committed to delivering personalized care by professionals who recognize that each person's path to mental wellness is unique to them, and that absolutely includes individualized mental healthcare for the LGBTQIA+ community. Images by freepik, freepik, and freepik on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.

According to the National Institute of Mental Health, 21.0 million adults in the United States had at least one major depressive episode in 2021. While professional, high quality therapy and/or medication are essential when treating depression, incorporating walking into your routine can also support your mental well-being. This free and simple health hack makes it an accessible and complementary practice between sessions. {MiniWidget:Depression} The Relationship Between Endorphins and Mental Health When you walk, your body releases endorphins, the "feel-good" hormones that can enhance your mood and reduce stress. Endorphins interact with receptors in your brain to reduce the perception of pain. This endorphin release is one of the key reasons walking can help combat depression. Walking can also trigger numerous biochemical processes in your brain, leading to increased production of neurotransmitters like serotonin and dopamine which are important for mood regulation. The Benefits of Walking for Mental Health Reduces Stress Walking helps lower cortisol levels, the hormone associated with stress. A regular walking routine can help you manage stress levels, promoting a calmer, more balanced state of mind. Enhances Cognitive Function Walking has been shown to improve cognitive function, including memory and attention. A study from the University of British Columbia found that aerobic exercise, including walking, increases the size of the hippocampus, the brain area involved in learning and memory. Improves Sleep Quality Regular walking can lead to better sleep patterns, which are often disrupted in those with depression. According to a study in Sleep Health, individuals who walked regularly experienced improved sleep quality, falling asleep faster and waking up less during the night. Provides a Sense of Accomplishment Setting and achieving walking goals can boost your self-esteem and provide a sense of accomplishment. Tracking your progress with a fitness app or pedometer can help maintain motivation and show tangible results, reinforcing your efforts to improve your mental health. Encourages Social Interaction Walking can also be a social activity. Joining a walking group or inviting friends or family to join you can provide social interaction and support, which can help combat feelings of loneliness and isolation that’s common in depression. {MiniWidget:Depression} How Much You Need to Walk to See Benefits The amount of walking needed to see mental health benefits can vary, but The American Psychological Association suggests that 30 minutes a day, five days a week, is a good starting point. Even shorter, more frequent walks can be beneficial.  The key is consistency—making walking a regular part of your routine will yield the best results. Depression manifests physically which can make it more difficult to find the motivation to get started. While it’s hard to cycle to break, moving even just a little bit can help. Do I Have Depression? Feeling down is something most of us experience at some point in life. However, when low mood disrupts daily life and causes an overwhelming sense of hopelessness, it may be a sign of something more clinically significant. Knowing the difference between depression and sadness, as well as the signs of depression can help you determine when to seek professional help. For more insights, take our free online screening tool to see if you may be living with depression. Seek help immediately if you're thinking about acting on suicidal thoughts, in a crisis, or experiencing extreme emotional distress. Call or text 988 for the National Suicide Prevention Hotline. Call 911 if you’re having a mental health emergency. Text HOME to 741-741 if you're emotionally distressed and need immediate support. Professional Support Through Cerebral While daily walking can support mental wellness, professional support can help in treating depression. Cerebral takes a personalized approach to mental healthcare by creating a tailored care plan including therapy and/or medication management based on your unique needs and goals. We believe access to high quality care can transform lives. And our clients’ successes speak for themselves: 74% of clients experienced reduced depression within 3 months 63.8% of clients with moderate or severe depression reported meaningful improvements in their mental health Clients on average completed their first therapy appointment within 4 days Clients on average completed their first prescriber appointment within 2 days Want to give Cerebral a try? Schedule your first session today.

You've diligently saved up, and now you're considering exotic trips or brainstorming activities to enrich your days. However, several weeks or even months after you leave behind the daily grind — the team collaboration, the to-do list, and the well-defined schedule — you might find yourself feeling unexpectedly adrift. If that’s you, you’re not alone. Retirement is a significant transition, and it can be a challenging period for many people. For some, this major life change brings about feelings of loss, uncertainty, and isolation, leading to signs or feelings of depression. This informational article explores the relationship between retirement and depression, its causes, and offers some general advice on navigating this transitional phase of life. {MiniWidget:Depression} Retirement is a big life change Retirement is more than just an exit from the workforce; it's a major life transition that involves significant changes in everything from schedules to self-identity. It requires adaptation and adjustment, and that can take time. While traditionally seen as a reward after decades of hard work, retirement changes daily routines, social interactions, and can even affect self-perceptions. The shift from a structured work life to a less-defined way of living can lead to feelings of loss and disorientation, which could contribute to post-retirement depression. What is depression? Depression is more than just ordinary sadness; it's a prolonged period of significant hopelessness and lack of interest in pastimes or subjects that used to give you joy, excitement, pleasure, or happiness. A significant indicator of a depressive disorder is a combination of symptoms that disrupt everyday life and persist for an extended period, ranging from several weeks to months or even years. Symptoms of depression can vary widely but often include: Persistent sadness or feeling ‘empty’ Irritability Fatigue Changes in sleep patterns A loss of interest in previously enjoyed activities Changes in appetite or weight Feeling worthless or guilty Difficulty concentrating, indecisiveness, or memory problems  Thoughts of suicide or death For retirees, these depressive symptoms can become worse because of the sudden drop in social interactions and the lack of routine that work once provided. You might be thinking, ‘I don’t think I have a disorder, but I do feel depressed.’ There’s also something between sadness and depressive disorders, and you could be experiencing situational depression prior to or after retiring. It’s an adjustment disorder with a depressed mood triggered by specific life events, including a major life transition. Situational depression shows symptoms similar to those of clinical depression, also known as major depressive disorder (MDD), including persistent sadness, a lack of energy, feelings of despair, and a diminished interest in previously enjoyed activities, yet it’s temporary and often gets better as you adjust to your new circumstances or as the triggering situation is resolved. Explore more:Understanding the Different Types of Depression How common is depression in retirement? Depression in retirement is surprisingly common yet often overlooked. Studies suggest that close to 1 in 3 retirees experience some form of depression, a rate that is higher than in the general adult population. Research also indicates that those whose retirement was mandatory or due to an illness have higher rates of depression in retirement. Retirees who have already been diagnosed with a depressive disorder can have mixed experiences. Retirement may make symptoms of depression worse for some, while others may experience improvements, likely due to less stress, more independence, and the ability to do more of the things that they love with their newfound free time.  {MiniWidget:Depression} Why you may be retired and feel depressed The transition to retirement can trigger symptoms of depression for several reasons: Loss of purpose and routine: Work provides more than just income; it offers a purpose and a daily structure. Losing these can leave a void that is hard to fill. Reduced social interaction: People's social lives may have been closely tied to their work, so retirement could lead to feelings of isolation and loneliness. Health and mobility concerns: Aging might bring health issues that limit mobility or cognitive functions, contributing further to depressive feelings. Financial concerns: Worrying about finances after retiring can also be a significant stressor, impacting mental health. It’s fair to say that we’d assume someone who loved their career would be more likely to become depressed because of that loss of purpose and social connection. However, people who disliked their jobs could be just as likely to experience depression in retirement. They may have put up with an unsatisfying or stressful job because it provided financial stability, and with that gone, money worries could affect their mental well-being. The responsibility of holding down a job could also have kept them from exhibiting more obvious signs of depression, such as not being able to get out of bed for days because they knew they had to get to work. Mental health conditions can also manifest or be diagnosed later in life, such as late-onset bipolar disorder, MDD, or anxiety disorders. Understanding the triggers is key to addressing them, and some causes of depression in retirement could even be prevented with proactive measures. Free mental health resource: Logging Depression worksheet Coping with depression in retirement To start addressing retirement and depression, consider these coping strategies and lifestyle changes: Preparation is essential: Start planning your retirement early. Think about how you will spend your time and manage your finances. New pursuits: Develop hobbies and interests outside of work before you retire. This can smooth the transition by giving you alternative sources of satisfaction and purpose. Stay social: Maintain old friendships and be open to forming new connections. Consider joining clubs or groups that align with your interests. Physical activity: Keeping physically active not only boosts your mood but also keeps you healthy. Volunteer: Giving back to the community can provide a new sense of purpose and fulfillment. If you're approaching retirement or are already there and feel overwhelmed, talk about it. Discuss your feelings with family, friends, or a mental health professional. Free mental health resource: Self-Care for Depression Seeking professional help Depression is treatable, but it's vital to recognize when you might need professional help. Therapists can offer coping strategies specifically tailored to the challenges of retirement, and medication like antidepressants may also be advised. As you navigate the transitions associated with retirement, embracing modern solutions like online therapy and virtual medication management can be incredibly helpful. Services like Cerebral, which provide these online options, offer benefits that address some of retirees’ needs, including: The convenience of care from anywhere: For those who split their time between multiple residences or travel frequently, online services allow for continuous and consistent access to mental health support. The ease of an appointment from home: This is particularly valuable if you live in a region with scarce mental health services or if your mobility is limited, making traditional clinic visits challenging.  The benefit of not needing to commute: This mode of support eliminates the need for physical travel and reduces the logistical stress associated with arranging transportation and managing schedules.  Video calls and texting have all enriched our lives, and there’s no doubt you’ve used them to keep in touch with kids, grandkids, friends, and other loved ones. Cerebral makes connecting with a licensed prescriber or therapist just as easy. By leveraging technology, you can maintain regular contact with mental health professionals, fostering a supportive therapeutic relationship that can significantly enhance your quality of life during these golden years. You deserve to enjoy the retirement you've worked so hard for. If you find that symptoms of depression are standing in your way, help is available. Just retired and feeling depressed? If you’re looking for more answers or thinking about mental health support, consider taking Cerebral’s free 3-minute online depression screener to assess your symptoms. Images by freepik, pressfoto, and freepik on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.