Gender Differences in Depression and it’s Treatment

gender antidepressants

  • Women are more often affected by depression and this gender difference is consistent across all age groups.
  • Women are more likely than men to attempt suicide, but men are more likely to actually kill themselves.
  • Women are more likely than men to have what are termed atypical symptoms of depression.
  • Women are somewhat more likely than men to have seasonal affective disorder (SAD).
Gorman, J M (2006). Gender Differences in Depression and Response to
Psychotropic Medication Gender Medicine, 3 (2) DOI: 16860269

Gender differences in response to treatment
Several articles have explored the topic of gender differences in terms of response to antidepressants. In a 12-week multicenter, double-blind, randomized, parallel-group comparative trial pre-menopausal females showed higher response rates when taking sertraline, a selective serotonin reuptake inhibitor (SSRI), while men show higher response rates when taking imipramine, a tricyclic antidepressant (TCA), and post-menopausal females show similar response rates for both antidepressants (Kornstein et al., 2000).

It was concluded that women might respond better to SSRIs than to TCAs and that there is indeed a difference in response rate by menopausal status (Kornstein et al., 2000).

The results of most previous studies are comparable to this trial (Martenyi et al., 2001)(Raskin, 1974)(Davidson and Pelton, 1986)(Grigoriadis et al., 2003)(Thase et al., 2005)(Khan et al., 2005)(Berlanga and Flores-Ramos, 2006).

In a recent study with a large sample of real world patients from primary and psychiatric specialty care centers women were more likely to reach remission and response with citalopram than men (Young et al., 2008).

On the other hand, complementary studies have failed to find different response rates to antidepressants between men and women. Quitkin et al., performed a retrospective analysis on depressed outpatients (the majority with atypical depression) and concluded that the statistical significant difference in response rates to TCAs and monoamine oxidase inhibitors (MAOIs) based on gender and menopausal status was not clinically relevant (Quitkin et al., 2002).

Similarly, other studies concluded that there is no difference in antidepressant treatment response based on gender (Scheibe et al., 2003)(Hildebrandt et al., 2003)(Wohlfarth et al., 2004)(Thiels et al., 2005) or on menopausal status (Cassano et al., 2005).

Overall the conclusions regarding the influence of gender and menopausal status on antidepressant treatment response in depressed patients are inconsistent

Berlanga, C. & Flores-Ramos, M. (2006) Different gender response to serotonergic and noradrenergic antidepressants. A comparative study of the efficacy of citalopram and reboxetine. J Affect Disord, 95, 119-23.
Cassano, P., Soares, C. N., Cusin, C., Mascarini, A., Cohen, L. S. & Fava, M. (2005) Antidepressant response and well-being in pre-, peri- and postmenopausal women with major depressive disorder treated with fluoxetine. Psychother Psychosom, 74, 362-5.
Davidson, J. & Pelton, S. (1986) Forms of atypical depression and their response to antidepressant drugs. Psychiatry Res, 17, 87-95.
Grigoriadis, S., Kennedy, S. H. & Bagby, R. M. (2003) A comparison of antidepressant response in younger and older women. J Clin Psychopharmacol, 23, 405-7.
Hildebrandt, M. G., Steyerberg, E. W., Stage, K. B., Passchier, J., Kragh-Soerensen, P. & Danish University Antidepressant Group. (2003) Are gender differences important for the clinical effects of antidepressants? Am J Psychiatry, 160, 1643-50.
Khan, A., Brodhead, A. E., Schwartz, K. A., Kolts, R. L. & Brown, W. A. (2005) Sex differences in antidepressant response in recent antidepressant clinical trials. J Clin Psychopharmacol, 25, 318-24.
Kornstein, S. G. (1997) Gender differences in depression: implications for treatment. J Clin Psychiatry, 58 Suppl 15, 12-8.
Kornstein, S. G., Schatzberg, A. F., Thase, M. E., Yonkers, K. A., Mccullough, J. P., Keitner, G. I., Gelenberg, A. J., Davis, S. M., Harrison, W. M. & Keller, M. B. (2000) Gender differences in treatment response to sertraline versus imipramine in chronic depression. Am J Psychiatry, 157, 1445-52.
Martenyi, F., Dossenbach, M., Mraz, K. & Metcalfe, S. (2001) Gender differences in the efficacy of fluoxetine and maprotiline in depressed patients: a double-blind trial of antidepressants with serotonergic or norepinephrinergic reuptake inhibition profile. Eur Neuropsychopharmacol, 11, 227-32.
Quitkin, F. M., Stewart, J. W., Mcgrath, P. J., Taylor, B. P., Tisminetzky, M. S., Petkova, E., Chen, Y., Ma, G. & Klein, D. F. (2002) Are there differences between women’s and men’s antidepressant responses? Am J Psychiatry, 159, 1848-54.
Rasgon, N. L., Dunkin, J., Fairbanks, L., Altshuler, L. L., Troung, C., Elman, S., Wroolie, T. E., Brunhuber, M. V. & Rapkin, A. (2007) Estrogen and response to sertraline in postmenopausal women with major depressive disorder: a pilot study. J Psychiatr Res, 41, 338-43.
Raskin, A. (1974) Age-sex differences in response to antidepressant drugs. J Nerv Ment Dis, 159, 120-30.
Scheibe, S., Preuschhof, C., Cristi, C. & Bagby, R. M. (2003) Are there gender differences in major depression and its response to antidepressants? J Affect Disord, 75, 223-35.
Thase, M. E., Entsuah, R., Cantillon, M. & Kornstein, S. G. (2005) Relative antidepressant efficacy of venlafaxine and SSRIs: sex-age interactions. J Womens Health (Larchmt), 14, 609-16.
Thiels, C., Linden, M., Grieger, F. & Leonard, J. (2005) Gender differences in routine treatment of depressed outpatients with the selective serotonin reuptake inhibitor sertraline. Int Clin Psychopharmacol, 20, 1-7.
Wohlfarth, T., Storosum, J. G., Elferink, A. J., Van Zwieten, B. J., Fouwels, A. & Van Den Brink, W. (2004) Response to tricyclic antidepressants: independent of gender? Am J Psychiatry, 161, 370-2.
Young, E. A., Kornstein, S. G., Marcus, S. M., Harvey, A. T., Warden, D., Wisniewski, S. R., Balasubramani, G. K., Fava, M., Trivedi, M. K. & Rush, J.A. (2008) Sex differences in response to citalopram: A STAR*D report

Continuing research is needed to determine how gender influences the risk, clinical presentation, and response to treatment of depression. Exploration of sex differences in animals and humans should aid in efforts to treat depression as an organic disorder rather than a psychological maladaptation.