Ercis Mete, Sanchez-Ruiz Jorge A, Webb Lauren M, Solares-Bravo Melissa, Betcher Hannah K, Moore Katherine M, Frye Mark A, Veldic Marin, Ozerdem Aysegul
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
J Affect Disord. 2024 May 1;352:171-192. doi: 10.1016/j.jad.2024.02.038. Epub 2024 Feb 15.
Psychiatric disorders differ in their prevalence, symptom profiles, and disease courses in men and women. However, sex differences in psychiatric disorders have not received enough attention to guide treatment recommendations. This systematic review aims to summarize sex differences in the treatment responses and adverse effects of mood stabilizers and antipsychotics transdiagnostically.
We conducted a systematic review following the PRISMA 2020 statement (CRD42020212478). A literature search was conducted using MEDLINE, Embase, Cochrane Central, PsycINFO, Web of Science Core Collection, and Scopus databases. Studies comparing mood stabilizer or antipsychotic treatment outcomes in men and women were included. JBI critical appraisal checklists were used to assess bias risk.
Out of 4866 records, 129 reports (14 on mood stabilizers, 115 on antipsychotics) with varying designs were included. Sample sizes ranged from 17 to 22,774 participants (median = 147). The most common psychiatric diagnoses were schizophrenia spectrum (n = 109, 84.5 %) and bipolar disorders (n = 38, 29.5 %). Only four studies explored sex differences in mood stabilizer treatment response. In 40 articles on antipsychotic treatment response, 18 indicated no sex difference, while 16 showed females had better outcomes. Women had more adverse effects with both mood stabilizers and antipsychotics. The risk of bias was low in 84 (65.1 %) of studies.
Substantial heterogeneity among the studies precluded performing a meta-analysis.
Number of studies focusing on sex differences in treatment outcomes of mood stabilizers is limited. Women may respond better to antipsychotics than men, but also experience more side effects. The impact of pharmacokinetics on sex differences warrants more attention.
精神疾病在男性和女性中的患病率、症状特征及病程存在差异。然而，精神疾病中的性别差异尚未得到足够重视以指导治疗建议。本系统评价旨在跨诊断地总结心境稳定剂和抗精神病药物在治疗反应及不良反应方面的性别差异。
我们按照PRISMA 2020声明（CRD42020212478）进行系统评价。使用MEDLINE、Embase、Cochrane Central、PsycINFO、Web of Science核心合集和Scopus数据库进行文献检索。纳入比较男性和女性心境稳定剂或抗精神病药物治疗结局的研究。使用JBI批判性评价清单评估偏倚风险。
在4866条记录中，纳入了129篇设计各异的报告（14篇关于心境稳定剂，115篇关于抗精神病药物）。样本量从17至22774名参与者不等（中位数=147）。最常见的精神疾病诊断为精神分裂症谱系障碍（n=109，84.5%）和双相情感障碍（n=38，29.5%）。仅有四项研究探讨了心境稳定剂治疗反应中的性别差异。在40篇关于抗精神病药物治疗反应的文章中，18篇表明无性别差异，而16篇显示女性有更好的结局。女性在使用心境稳定剂和抗精神病药物时均有更多不良反应。84项（65.1%）研究的偏倚风险较低。
研究间存在大量异质性，无法进行荟萃分析。
关注心境稳定剂治疗结局性别差异的研究数量有限。女性对抗精神病药物的反应可能优于男性，但也会经历更多副作用。药代动力学对性别差异的影响值得更多关注。
