Gender and Antidepressants

This chapter discusses the role of gender in administration of antidepressant drugs. There are marked gender differences in the epidemiology of depression, however antidepressants, like most other medications, are developed regardless ofthe sex of the patient. The prior exclusion of women of childbearing age from pharmacokinetic (PK) studies is especially pertinent for antidepressants because of the marked gender differences in the epidemiology of depression. From puberty until menopause, nearly twice as many women (12%) as men (7%) are affected by a depressive disorder each year. Women also exhibit more atypical symptoms of depression, with greater somatization, increased suicide attempts, and comorbid anxiety, whereas men tend to have more comorbid alcohol or drug abuse and completed suicides. Although the evidence is limited, gender-related differences in pharmacodynamics and PK have been shown for several agents. Medications could also have effects on the metabolizing pathways for various hormones. The resulting changes in hormone concentrations could contribute to attenuated responses or the occurrence of an adverse event or have a protective effect. An additional underexplored topic is whether exogenous hormone therapy (i.e., oral contraceptives and hormone replacement therapy) may be affected by antidepressants or vice versa.