MRC SGDP Centre, Institute of Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, UK.
Int Rev Psychiatry. 2010;22(5):485-500. doi: 10.3109/09540261.2010.496448.
Epidemiological studies suggest there are considerable differences in the prevalence and presentation of depression in men and women. Women are more than twice as likely to be diagnosed with depression and may also report more atypical and anxiety symptoms than men. Men and women also differ in the metabolism and distribution of antidepressants and the presence of oestrogen in women of childbearing age may interfere with the mechanism of action of a number of antidepressants. These differences have led many researchers to question whether antidepressants are equally effective and tolerated in men and women. While some reports suggest that selective serotonin re-uptake inhibitors (SSRIs) are more effective and result in fewer adverse drug reactions in women than tricyclic antidepressants (TCAs), gender differences in antidepressant response remains a controversial topic. The potential effects of antidepressant exposure in utero and in breast milk further complicate treatment options for antenatal and postnatal depression. While some research suggests the SSRI paroxetine is teratogenic, further carefully designed naturalistic studies are required to fully evaluate these effects. Finally, response to antidepressants and the occurrence of adverse drug reactions is marked by inter-individual variability which may be in part due to genetic differences. Future studies should therefore consider genotypes of the mother, foetus and infant in antidepressant response.
流行病学研究表明，男性和女性的抑郁症患病率和表现存在相当大的差异。女性被诊断出患有抑郁症的可能性是男性的两倍多，而且可能比男性报告更多的非典型和焦虑症状。男性和女性在抗抑郁药的代谢和分布上也存在差异，育龄妇女体内的雌激素可能会干扰许多抗抑郁药的作用机制。这些差异使得许多研究人员质疑抗抑郁药在男性和女性中的疗效和耐受性是否相同。虽然一些报告表明，选择性 5-羟色胺再摄取抑制剂（SSRIs）在女性中的疗效优于三环类抗抑郁药（TCAs），且不良反应较少，但抗抑郁药反应的性别差异仍然是一个有争议的话题。抗抑郁药在子宫内和母乳中的暴露对围产期和产后抑郁症的治疗选择进一步复杂化。虽然一些研究表明 SSRIs 帕罗西汀有致畸作用，但需要进一步精心设计的自然主义研究来充分评估这些影响。最后，对抗抑郁药的反应和不良反应的发生存在个体间的差异，这可能部分归因于遗传差异。因此，未来的研究应考虑母亲、胎儿和婴儿的基因型在抗抑郁药反应中的作用。
