Several depressive disorders are unique to women, affecting them at various points in their life cycle. These disorders include premenstrual dysphoric disorder (PMDD), pregnancy-associated depressive disorders, and perimenopausal affective disorders. Recently, the importance of the relationship between depression and the reproductive cycle has been highlighted due to the approval of medications to treat (PMDD). The role of gender difference in the prevalence of depressive disorders has long been recognized. This article will examine whether there are differences between men and women in the clinical presentation of depression, including differences in symptom manifestation, course of illness, comorbidities, and treatment. Systematic evaluation of the role of hormonal and neuroendocrine factors may lead to more appropriate treatment of depressive disorders in women.
1.Kessler RC, McGonagle KA, Swartz M, et al. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. J Affect Disord.1993; 29:85–96.
2.
2.Kornstein SG. Gender differences in depression: implications for treatment. J Clin Psychiatry.1997; 58(suppl 15):12–18-18.
3.
3.Pajer K.New strategies in the treatment of depression in women. J Clin Psychiatry. 1995; 56(suppl 2):30–37.
4.
4.Paykel ES.Depression in women. Br J Psychiatry.1991; 158(suppl 10):22–29.
5.
5.Young MA, Scheftner WA, Fawcett J, et al. Gender differences in the clinical features of unipolar major depressive disorder. J Nerv Ment Dis.1990; 178(3):200–203.
6.
6.Desai HD, Jann MW.Major depression in women: a review of the literature. J Am Pharm Assoc.2000; 40:525–537.
7.
7.Kornstein SG, Schatzberg AF, Yonkers KA, et al. Gender differences in presentation of chronic major depression. Psychopharmacol Bull.1996; 38:129–133.
8.
8.Asnis G, McGinn L, Sanderson W.Atypical depression: clinical aspects and noradrenergic function. Am J Psychiatry.1995; 152: 31–36.
9.
9.Preskorn SH. Professional Communications, Inc.Outpatient Management of Depression: A Guide for the Practitioner.Caddo, OK. 1999.
10.
10.Dawkins K, Potter WZ.Gender differences in pharmacokinetics and pharmacodynamics of psychotropics: focus onwomen. Psychopharm Bull.1991; 27:417–426.
11.
11.Yonkers KA, Kando JC, Cole JO, et al. Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. Am J Psychiatry.1992; 149:587–595.
12.
12.Joffe H, Cohen LS.Estrogen, serotonin, and mood disturbance: where is the thrapeutic bridge?Biol Psychiatry.1998; 44:798–811.
13.
13.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th ed.Washington, DC: American Psychiatric Association: 1994; 717–718.
14.
14. Haynes P, Parry BL.Mood disorders and the reproductive cycle: affective disorders during the menopause and premenstrual dysphoric disorder. Psychopharm Bull.1998; 34(3):313–318.
15.
15.Romano S, Judge R, Dillon J, et al. The role of fluoxetine in the treatment of premenstrual dysphoric disorder. Clin Ther.1999; 21(4):615–633.
16.
16.Freeman EW, Sondheimer SJ, Polansky M, et al. Predictors of response to sertraline treatment of severe premenstrual syndromes. J Clin Psychiatry.2000; 61:579–584.
17.
17.Yonkers KA.The association between premenstrual dysphoric disorder and other mood disorders. J Clin Psychiatry.1997; 58(suppl 15):19–25.
18.
18.Schatzberg AF.New indications for antidepressants. J Clin Psychiatry.2000; 61(suppl 11):9–17.
19.
19.Yonkers KA, Halbreich U, Freeman E, et al. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment: a randomized control trial.Sertraline Premenstrual Dysphoric Collaborative Study Group. JAMA.1997; 278:983–988.
20.
20.Young SA, Hurt PH, Benedek DM, et al. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry.1998; 59:76–80.
21.
21.Pearlstein TB, Halbreich U, Batzar ED, et al. Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry.2000; 61:101–109.
22.
22.Pearlstein TB, Stone AB, Lund SA, et al. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol.1997; 17:261–266.
23.
23.Freeman EW, Rickels K, Sondheimer SJ, et al. Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder; a randomized controlled trial. Arch Gen Psychiatry.1999; 56:932–939.
24.
24.Llewellyn A, Stowe ZN, Nemeroff CB.Depression during pregnancy and the puerperium. J Clin Psychiatry.1997; 58(suppl 15):26–32.
25.
25.Baugh CL, Stowe ZN. Treatment issues during pregnancy and lactation. CNS Spectrums.1999; 4(10): 34–39.
26.
26.Altshuler LL, Hendrick V, Cohen LS.Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry.1998; 59(suppl 2):29–33.
27.
27.Kornstein SG, McEnany G.Enhancing pharmacologic effects in the treatment of depression in women. J Clin Psychiatry.2000; 61(suppl 11):18–27.
28.
28.Altshuler LL, Cohen L, Szuba MP, et al. Pharmacologic mangement of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry.1996; 153:592–606.
29.
29.Ericson A, Kallen B, Wiholm BE.Delivery outcome after the use of antidepressants in early pregnancy. Eur J Clin Pharmacol.1999; 55:503–508.
30.
30.Chambers CD, Johnson KA, Dick LM, et al. Birth outcomes in pregnat women taking fluoxetine. N Engl J Med.1996; 335:1010–1015.
31.
31.Pastuszak A, Schick-Boschetto B, Zuber C, et al. Pregnancy outcome following first-trimester exposure to fluoxetine. JAMA.1993; 269:2246–2248.
32.
32.Kulin NA, Pastuszak A, Sage SR, et al. Pregnancy oucome following maternal use of the new serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA.1998; 279:609–610.
33.
33.Nulman I, Rovet J, Stewart DE, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Eng J Med.1997; 336:258–262.
34.
34.Misri S, Kostaras D, Kostaras X. The use of selective serotonin reuptake inhibitors during pregnancy and lactation: current knowledge. Can J Psychiatry.2000; 45:285–287.
35.
35.Goldstein DJ, Corbin LA, Sundell KL.Effects of first trimester fluoxetine exposure on the newborn. Obstet Gynecol.1997; 89:713–718.
36.
36.Cohen LS, Rosenbaum JF.Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry.1998; 59(suppl 2):18–28.
37.
37.Wisner KL, Gelenberg AJ, Leonard H, et al. Pharmacologic treatment of depression during pregnancy. JAMA.1999; 282:1264–1269.
39.Llewellyn A, Stowe ZN.Psychotropic medications in lactation. J Clin Psychiatry.1998; 59(suppl 2): 41–52.
40.
40.Appleby L, Warner R, Whitton A, et al. A controlled study of fluoxetine and cognitive-behavioral counselling in the treatment of postnatal depression. Br Med J.1997; 314:932–936.
41.
41.Wisner KL, Perel JM, Findling RL.Antidepressant treatment during breast-feeding. Am J Psychiatry.1996; 153:1132–1137.
42.
42.Iqbal MI.Effects of antidepressants during pregnancy and lactation. Ann Clin Psychiatry.1999; 11(4):237–256.
43.
43.Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psych.1999; 60(suppl 20):9–15.
44.
44.Dennis CS.Therapeutic options in treating depression. US Pharmacists.1999; 65–74.
45.
45.Moskowitz D.Changing views: the emergence and efficacy of natural hormones in the treatment of menopause. JAMA.2000; 3:36–44.
46.
46.Young E, Korszun A.Psychoneuroendocrinology of depression.Hypothalamic-pituitary-gonadal axis. Psychiatr Clin North Am.1998; 21:309–323.
47.
47.Halbreich U.Role of estrogen in postmenopausal depression. Neurology.1997; 48:16–20.
48.
48.Pearlston T, Rosen K, Stone A.Mood disorders and menopause. Endocrinol Metab Clin.1997; 26:279–294.
49.
49.Geffken F, Ward H, Staab J, et al. Psychiatric morbidity in endocrine disorders. Psychiatr Clin North Am.1998; 21:473–485.
50.
50.Hutto B.The symptoms of depression in endocrine disorders. CNS Spectrums.1999; 4:51–61.
51.
51.DiPiro JT, Talbert RL, Yee GC, et al. Pharmacotherapy. A pathophysiologic approach.3rd Ed.Appleton & Lange;1997.
52.
52.Dellasega C, Klinefelter J, Halas C.Clinician Reviews.2000; 10: 53–74.
53.
53.Jeffery S, Feldman S.Identification and treatment of geriatric depression. Clinical Consult.2000; 15:3.1–3.18.
54.
54.DeVane CL, Pollack BG.Pharmacokinetic considerations of antidepressant use in the elderly. J Clin Psychiatry.1999; 60(suppl 60):38–44.
55.
55.Gumnick J, Nemeroff C.Problems with currently available antidepressants. J Clin Psychiatry.2000; 61(10):5–15.
56.
56.Pollack BG.Adverse reactions of antidepressant in elderly patients. J Clin Psychiatry.1999; 60(suppl 20):4–8.
