For decades, one of the most important questions regarding antidepressants was whether a person’s sex played any role in treatment outcomes or choice of treatment. Early studies showed that women responded poorly to tricyclic antidepressants when compared with similarly depressed men. Other studies showed that women experienced more adverse side effects, were more likely to discontinue their medication, and were more frequently treated with several antidepressants before discovering one that worked. Added to this treatment burden is the fact that women experience depression at a rate twice that of men, a statistical anomaly that may be explained by men underreporting their depression symptoms. Statistical anomalies aside, the evidence is clear that men and women respond to antidepressants in different ways, and understanding how sex and neurochemistry come together is a critical line of research.
A recent study focused on the effectiveness of Celexa (citalopram) in the treatment of depression in men and women. In contrast to previous studies, the sample size was very large—nearly 3,000 individuals were enrolled in the study by their primary care physicians. Standard psychiatric testing was performed to determine the level of depression and whether or not the individual qualified for the study. Participants generally reported symptoms of major depressive disorder but were excluded if they showed signs of psychosis. The study itself consisted of a 12- to 14-week course of Celexa, with posttreatment assessment to gauge improvement of symptoms. The primary variable of interest for this study was a person’s sex.
The results provided the strongest evidence yet that women and men respond in significantly different ways to the same psychotropic drugs. Women showed both greater improvement in the symptoms of depression and a greater likelihood of completing the full course of treatment. Interestingly, the type and frequency of side effects was not significantly different between men and women. Therefore, adverse events cannot explain why men responded poorly or dropped out of the study. Clearly, something is happening at the neurochemical level that accounts for these responses.
If there were any lingering doubts before, there can be no doubt now that a person’s sex is an important consideration for physicians of depressed patients. A large-scale, sweeping study of both outpatients and individuals at treatment centers revealed that women respond much more favorably to treatment with Celexa than men. This is not to say that men cannot benefit from the medication, only that women clearly stand to benefit more. Given a history of poor antidepressant response among women, such findings are very encouraging.
Young, E. A., Kornstein, S. G., Marcus, S. M., Harvey, A. T., Warden, D., Wisniewski, S.R., et al. (2009). Sex differences in response to citalopram: a STAR*D report. Journal of Psychiatric Research, 43(5), 503-511.
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