Handbook of Clinical Gender Medicine. Группа авторов

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      Rebecca Knickmeyer, PhD

      Department of Psychiatry, Medical Wing C, Room 343

      School of Medicine, University of North Carolina at Chapel Hill

      336 Emergency Drive

      Chapel Hill, NC 27599 (USA)

       Tel. [phone], E-Mail [email protected]

      Central Nervous System and Clinical Applications

      Schenck-Gustafsson K, DeCola PR, Pfaff DW, Pisetsky DS (eds): Handbook of Clinical Gender Medicine.

       Basel, Karger, 2012, pp 92–98

      ______________________

Depression

      David R. Rubinow · Claire D. Craft

      Department of Psychiatry, Neurosciences Hospital, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA

      ______________________

      Abstract

      The translation of observed sex differences in depression and its treatment into clinical practice is in an immature stage of development. Indeed, the literature to date provides no compelling clear-cut guidelines for the selection or avoidance of any psychotropic medication on the basis of sex alone. The current lack of translation, however, is counterbalanced by a voluminous body of literature suggesting that sex, as one of several critical contextual factors, impacts the regulation and dysregulation of affect.

      Copyright © 2012 S. Karger AG, Basel

      Sex differences that may impact the presentation and treatment of depression will often remain undisclosed unless clinicians remain vigilant to their possible influence. For instance, victims of sexual abuse, who are most often women, frequently exhibit dysregulation of the hypothalamic-pituitary-adrenal axis and experience depressions that typically are responsive to psychotherapy. However, without specific inquiries, this contextual information will often go undisclosed. Similarly, drug abuse, which is more prevalent in men, can greatly complicate the presentation and treatment of depression. Finally, there are culture-bound sex differences in presentation that often reflect the relative reluctance in men to endorse symptoms of sadness. Consequently, the likelihood of overlooking clinically relevant depressive episodes in men will be substantial unless the physician makes a concerted effort to elicit evidence of either a past or a present depressive disorder. Failure to detect comorbid depression is particularly problematic, as it results in increased treatment costs for the primary illness, greater pathological progression of illness, and an increased likelihood of death.

      The goal of individualized medicine is the prediction of therapeutic interventions that will have the greatest efficacy and the least adverse effects. This goal will be met only when our clinical databases are sufficiently populated and integrated to permit identification of relevant contextual predictors (be they genomic, historical, psychological, or physiological). Currently available genetic, psychobiological, brain imaging, and pharmacological evidence for the existence of meaningful sex differences makes unimaginable a future in which sex will not be viewed as one of the most powerful predictors of vulnerability to and expression of depression and other affective disorders.

      Epidemiology

It is widely documented that women are twice as likely as men to meet criteria for lifetime major depressive disorder, a finding that has been confirmed across many countries, cultures, and ethnic groups [1]. Depression occurs at approximately the same rate in boys and girls; however, small sex differences emerge between the ages of 13 and 15. This gap further widens later in adolescence, and the depression rate in women remains elevated until midlife [2].

      Although women are more prone to initially develop depression, there are no clear-cut sex differences in the duration or recurrence of the disorder [2]. Sex differences in rates of comorbid psychiatric disorders and prevalence of certain symptoms, however, have been identified. Women are two-to three-fold more likely than men to exhibit atypical depression. This condition is characterized by mood reactivity, appetite and weight increase, hypersomnia, and interpersonal sensitivity. Atypical depression is associated with higher rates of comorbid psychiatric illness and typically has an early onset and chronic course. Its greater prevalence in women may contribute to sex differences in presentation reported in some studies. Additionally, depression often occurs in tandem with other disorders that may complicate evaluation and treatment response in men and women. Common comorbidities that alter treatment response in depression include anxiety disorders, eating disorders, and substance abuse. While women with depression are more likely to endorse symptoms associated with general anxiety disorder and bulimia, depressed men are more likely