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A Gender Analysis of the Study of Pharmacotherapy of Psychotic Depression (STOP-PD): Gender and Age as Predictors of Response and Treatment-Associated Changes in Body Mass Index and Metabolic Measures

J Clin Psychiatry 2013;74(10):1003-1009

Background: Gender differences exist in psychiatric disorders; however, gender has not been well studied in psychotic depression. This analysis of the largest clinical trial in psychotic depression examined the effects of age and gender on clinical characteristics and predictors of treatment outcome and treatment-associated changes in body mass index (BMI) and metabolic measures.

Method: Secondary analyses were performed on data from 259 subjects with major depressive disorder with psychotic features (DSM-IV-TR) aged 18–93 years in the double-blind randomized controlled trial of olanzapine plus sertraline versus olanzapine plus placebo for psychotic depression (Study of Pharmacotherapy of Psychotic Depression). Sociodemographic factors, clinical characteristics, treatment outcome, and treatment-associated changes in BMI and metabolic measures were analyzed by gender and age. Subjects were enrolled from December 2002 to June 2007.

Results: Female gender was associated with divorced (χ21 = 5.3, P = .03) or widowed (χ21 = 8.1, P .01) marital status. Comorbid anxiety disorders were more common in women than in men (χ21 = 4.9, P = .03). Hallucinations (χ21 = 7.8, P = .005) and delusions with disorganization (t257 = −2.10, P = .04) were significantly associated with female gender, as were higher cholesterol measures (χ21 = 7.15, P = .008). There were no significant interactions between treatment and gender in terms of change in BMI. Gender was not associated with treatment response.

Discussion: This study is the first analysis of gender and age as predictors of treatment outcome and treatment-associated changes in BMI and metabolic adverse effects in psychotic depression. Gender differences exist in patients with psychotic depression, most notably with regard to the presence of hallucinations. Female gender was associated with metabolic measures. Future studies with larger sample sizes may detect small gender differences in treatment outcome and treatment-associated changes in BMI and metabolic measures in psychotic depression.

Trial Registration: ClinicalTrials.gov identifier: NCT00056472

J Clin Psychiatry 2013;74(10):1003–1009

Submitted: February 1, 2013; accepted June 13, 2013 (doi:10.4088/JCP.13m08400).

Corresponding author: Anthony J. Rothschild, MD, Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School/UMass Memorial Medical Center, 328 Shrewsbury St, Worcester, MA 01604 (anthony.rothschild@umassmemorial.org).