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.