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Antidepressant medication for women

Written by: Martin Winkler

First version: 22 Jul 2008. Latest revision: 31 Jul 2008.

Question:

 Are there gender differences in treatment response to antidepressant medication for depression?

Do women respond to the same antidepressant as men?

Answer:

One of the biggest problems of psychopharmacology is the lack of sufficient studies about the impact of gender on the effect and side effects of medication. This is caused by the possible risks of pregnancy in these studies, so most companies did try to exclude younger women from their studies. Hormonal influences of the female menstruation cycle do also influence the effect of the medication. So we know rather little about gender effects of antidepressant medication.

Regulations have changed now and we will get much more information in the future.

While there is not enough scientific data we do have clinical experiences. And we do know that there are differences in clinical effect and side effects. And it is important to consider the gender and age if a doctor recommends a medication to a female patients. Maybe the most important aspects are :

  • impact on weight or eating behaviour
  • possible side effects on sexual life
  • risk for a baby or breast feeding

We know that most women respond very well to SSRI medication (Selective Serotonine Reuptake Inhibitors). This may be also influenced by the fact that the PMS symptoms are also influenced by the neurotransmitter serotonine. A recent study in Spain demonstrated a better response to the SSRI sertraline (50-200 mg/d) in females compared to the tricyclic antidepressant imipramine (the old gold standard of antidepressant medication in most studies). The authors concluded that sertraline is more effective and better tolerated by their patients than imipramine in the acute treatment of depression or dysthymia.

Here is the Medline abstract :

Baca E, Garcia-Garcia M, Porras-Chavarino A.
Gender differences in treatment response to sertraline versus imipramine in patients with nonmelancholic depressive disorders.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Jan;28(1):57-65.
There is evidence of gender differences in depressive disorders in terms of epidemiology and clinical manifestations. However, few studies have addressed the gender differences in terms of antidepressant treatment response in clinical practice. The aim of this study was to examine gender differences in the acute antidepressant response to sertraline and imipramine in nonmelancholic depressive disorders. A total of 239 patients with nonmelancholic major depression or dysthymia (DSM-III-R) and a score of >/=18 at baseline on the Hamilton Depression Rating Scale (HAM-D) were randomised in a 1:1 ratio treatment with flexible doses of sertraline (50-200 mg/day) or imipramine (75-225 mg/day) for 8 weeks in a multicenter, randomised, open-labeled, parallel group comparative trial. Depressive and anxiety symptoms were assessed using the HAM-D and the Hamilton Anxiety Rating Scale (HAM-A). Using HAM-D criteria, women were significantly more likely to respond to sertraline than to imipramine (72.2% vs. 52.1%, P=.008), whilst men respond similarly to sertraline and to imipramine (56.5% vs. 59.3%, P>.05). Response analysis based on HAM-A shows similar results (women: 68.9% vs. 43.6%, P=.001; men: 56.5% vs. 51.9%, P>.05). Women taking sertraline show statistically significant higher reductions in HAM-D, HAM-A, and in CGI-S than women taking imipramine. The proportion of women who dropped out due to adverse events was much lower in sertraline than in imipramine (10.9% vs. 27.8%, P=.006), with no differences between treatments in men (8.3% vs. 11.5%, P>.05). It was concluded that sertraline is more effective and better tolerated than imipramine in the acute treatment of nonmelancholic depressive disorders in women, whereas men responded similarly to sertraline and to imipramine.

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Sources, references

 

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