Gender issues in depression.
BACKGROUND
Gender differences in depression have been documented for many years and thought to be insignificant to treatment selection until recently.


METHODS
This article reviews gender differences in the prevalence, presentation, etiology, and antidepressant treatment of depressive disorders.


RESULTS
The high female to male sex ratio in the prevalence of depression, especially during the reproductive years, is one of the most replicated findings in epidemiology. Women more often have a seasonal component, anxious and atypical depression. Explanations for the differences include psychological, neurochemical, anatomic, hormonal, genetic, and personality factors. Gender differences in antidepressant treatment response have not been found consistently. Hormonal status may be an important variable in addition to the effects of the menstrual cycle, pregnancy, perimenopause and menopause.


CONCLUSIONS
Women have higher rates of depression and can often present differently than do men. Further research can ascertain which combination of factors increase women's risk. The effect of pregnancy and the impact of the menstrual cycle on the course of all depressive disorders need increased attention. Large prospective randomized controlled trials with gender differences in treatment response as the primary endpoint are necessary in order to answer the now controversial question of gender differences in antidepressant treatment response.
Department of Psychiatry, University of Toronto, University Health Network, and Women's College Hospital, Toronto, ON, Canada. sophie.grigoriadis@uhn.on.ca
Sophie
S
Grigoriadis
Gail Erlick
GE
Robinson
D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019208:Brain-Derived Neurotrophic Factor / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D000242:Cyclic AMP / Q000378:metabolism; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D015995:Prevalence; D012737:Sex Factors
D000928:Antidepressive Agents; D019208:Brain-Derived Neurotrophic Factor; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D000242:Cyclic AMP