Do Depressive Disorders Have a Gender Bias?

Should gender be considered in the identification and treatment of psychiatric disorders? Yes, at least in the case of depression, a common psychiatric illness that affects 10% to 20% of the population. Depression affects women disproportionately, more commonly than men. Women are more likely than men to be diagnosed, and depression in women may manifest earlier. Episodes of depression may be more severe in women; an increased number of suicide attempts has been observed in affected women. Heart diseases, osteoporosis, and autoimmune conditions top the list of ailments well known for their gender bias. Clinicians pay due attention to the gender variations that these conditions show while selecting the treatment modalities. Recent evidences demand the inclusion of psychiatric ailments to the list.

The manifestation of psychiatric disorders such as major depressive disorder (MDD) is not identical in men and women. Women may be more prone to atypical symptoms of depression, suggests the STAR*D study. Even the response to treatment varies; while men may favour tricyclic antidepressants, women show robust response to selective serotonin reuptake inhibitors.

The absorption and distribution of drugs in the body also differs because women have a higher percentage of adipose tissue than men. Women secrete less gastric acid and exhibit decreased gastric motility and emptying times. Differences have also been noted in enzymatic activities that could affect the concentration of medication. Variation in side-effect profile of drugs also warrants increased level of alertness from clinicians; women are at a high risk of osteoporosis with antidepressant use.

The exact cause of the disparity in depression between genders is not clear. It is possibly an interplay of multiple factors that include hormonal and neurobiological variables, as well as social and behavioural factors.

Source: Women and Depression: Does Gender Matter?; Thomas Smith et al; US Pharmacist 2013

Source-Medindia