Gender differences in response to antidepressant treatment prescribed in primary care. Does menopause make a difference?

doi:10.1016/j.jad.2006.02.010

Journal of Affective Disorders

Volume 93, Issues 1–3, July 2006, Pages 53-60

https://doi.org/10.1016/j.jad.2006.02.010 Get rights and content

Abstract

Background

Epidemiological surveys have consistently reported that the prevalence of major depression in women is almost twice as high as it is in men. While it seems that no major gender differences have been observed in the severity and symptomatology of depression, results regarding differences in antidepressant treatment response are controversial, especially when considering menopause in treatment response.

Methods

A total of 242 women (95 in their menopause), and 59 men beginning antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI; Citalopram, Fluoxetine, Paroxetine or Sertraline) from 16 primary care (PC) centres were followed up during 6 months. Menopause effect and gender differences in antidepressant treatment response were evaluated. Additionally, severity and symptomatology of depression were compared among genders.

Results

Overall results suggest that menopause is related to a worse treatment response and to a poorer self-evaluation of global health status. No gender differences were observed in treatment response, depression severity, and symptomatology.

Limitations

Since our sample included PC participants, a wide spectrum of depression severity was considered. Additionally, menopause was assessed by means of participants' self-report.

Conclusions

Menopause seems to negatively affect SSRI treatment response of depressed women treated in PC.

Introduction

Epidemiological and clinical studies consistently show that, compared to men, women present higher prevalences of depression across cultures. (Haro et al., in press, Weissman et al., 1993). It has been estimated that lifetime prevalence of major depression (MD) is 16.5% for women and 8.9% for men (Alonso et al., 2004). Studies developed at primary care (PC) have also reported higher proportions of depressed women. However, differences are lower when compared to general population-based studies (Gabarrón et al., 2001, Gater et al., 1998).

Although women show higher prevalences of MD, it seems that there are no differences between genders in the severity and symptomatology of the depressive pathology (Hildebrandt et al., 2003a, Kornstein et al., 2000a).

However, a controversial issue regarding gender differences in depression is antidepressant treatment response. While analyses of randomised clinical trials (RCT) have shown contradictory results (Baca et al., 2004, Hildebrant et al., 2003b, Kornstein et al., 2000b), retrospective and prospective naturalistic uncontrolled studies (Parker et al., 2003, Thiels et al., 2005) have consistently failed to find gender differences. Most of the studies have analysed gender differences in response to different antidepressant drug classes [e.g. trycyclics vs. selective serotonin reuptake inhibitors (SSRIs)] (Baca et al., 2004, Kornstein et al., 2000b, Martényi et al., 2001, Parker et al., 2003) finding that, while men seem to respond better to trycyclics, women show better response to SSRIs (Kornstein et al., 2000b, Martényi et al., 2001). Among women, it has been found that they are more responsive to SSRIs during their reproductive period (usually under 40 or 44 years old) than during their peri/post-menopausal period (Grigoriadis et al., 2003, Kornstein et al., 2000b, Martényi et al., 2001). However, one major problem of several of these studies is that the menopausal status had been derived from age and not from the prolonged cessation of the menstrual cycle.

The present study was developed to evaluate the effect of menopause and gender in antidepressant treatment response to various SSRIs (Citalopram, Fluoxetine, Paroxetine, Sertraline) in a sample of participants with depressive disorders beginning antidepressant treatment at PC. Additionally, differences in depression severity and symptomatology were evaluated.

Section snippets

Participants

Eligible for participation were patients (aged 18 to 75 years old) from 16 PC centres from the Barcelona area (Spain), beginning pharmacological antidepressant treatment for a depressive disorder. Exclusion criteria included (1) being under pharmacological or psycho-therapeutical antidepressant treatment for the previous 2 months; (2) cognitive impairment severe enough to preclude an adequate interview; (3) history of psychotic or bipolar disorder; and (4) history of alcohol or drug abuse or

Results

Socio-demographic variables are summarized in Table 1. A total of 95 women were menopausal (39.26% of women) and 6 of them were under hormone replacement therapy. There were no significant differences between genders regarding marital status, current DSM-IV (APA, 1994) diagnosis, and presence of previous MD episodes. However, differences emerged in age, employment status, years of education, and mean age of onset of the first MD episode. While menopausal women were older and more frequently

Discussion

The main finding of the present study is that menopause negatively affects SSRI antidepressant treatment response, considering both a depression severity index (PHQ-9), and patients' evaluation of their own global health status. On the contrary, no differences were observed between genders (women vs. men) in antidepressant treatment response, and no differences were observed among non-menopausal women, menopausal women and men in depression severity and in most of the SCID MD symptoms.

Acknowledgements

This study was supported by a grant from the Catalan Agency for Health Technology Assessment and Research (063/26/2000) and forms part of the IRYSS Network (Investigación en Resultados de Salud y Servicios Sanitarios) (FIS GG03/202).

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Research reportGender differences in response to antidepressant treatment prescribed in primary care. Does menopause make a difference?

Abstract

Background

Methods

Results

Limitations

Conclusions

Introduction

Section snippets

Participants

Results

Discussion

Acknowledgements

Prog. Neuro-psychopharmacol. Biol. Psychiatry

Biol. Psychiatry

Aten. Prim.

J. Affect. Disord.

J. Affect. Disord.

Eur. Neuropsychopharmacol.

J. Affect. Disord.

J. Clin. Epidemiol.

J. Affect. Disord.

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Acta Psychiatr. Scand., Suppl.

Diagnostic and Statistical Manual of Mental Disorders

Practice guideline for the treatment of patients with major depressive disorders (revision)

Am. J. Psychiatry

Comparability of telephone and in-person structured clinical interview for DSM-III-R (SCID) diagnoses

Assessment

User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders. Research Version

Research report
Gender differences in response to antidepressant treatment prescribed in primary care. Does menopause make a difference?