The Pharmacologic Treatment of Depression: Is Gender a Critical Factor?[CME]
J Clin Psychiatry 2002;63:610-615
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: In the medical literature, there is a
lack of sex-specific information regarding the efficacy,
metabolism, and side effects associated with
psychopharmacologic treatment. In part, this lack results from
the historic underinclusion of women in clinical trials
during early drug development, but it also occurs
because investigators of treatment and metabolic studies do
not routinely analyze results according to sex. In 1993,
the U.S. Food and Drug Administration (FDA)
announced changes that encourage the inclusion of women in
early pharmacokinetic studies and emphasize the need
for subset analyses using sex and age parameters. In
conjunction with advances in basic science regarding
drug metabolism, these modifications have led to modest
increases in information regarding sex differences in
drug metabolism and efficacy. In this article, current
information regarding potential sex differences in the
pharmacotherapy of major depressive disorder is reviewed.
Data Sources: A MEDLINE search was
conducted using the terms antidepressants, sex-factors,
gender differences, and women for the years 1966 to 2000.
Data Synthesis and Conclusions: There are
data supporting sex differences in the activity of various
antidepressant-metabolizing enzymes. However, there is
a paucity of investigation regarding how these
differences might translate into differences in clinical efficacy.
Notably, there is little work using existing databases to
perform the subgroup analyses recommended by the
FDA. The widespread dissemination of such work is
needed, and, if conducted, investigations in this area have
the potential to enhance psychopharmacologic treatment
for both men and women.