Sex Differences in Responses to Antidepressant Augmentations in Treatment-Resistant Depression.
Antidepressive Agents
/ therapeutic use
Depression
Depressive Disorder, Major
/ drug therapy
Depressive Disorder, Treatment-Resistant
/ drug therapy
Female
Humans
Male
Psychiatric Status Rating Scales
Sex Characteristics
Sleep Initiation and Maintenance Disorders
/ chemically induced
Treatment Outcome
Antidepressants
antipsychotics
major depressive disorder
mood stabilizers
treatment-resistant depression
Journal
The international journal of neuropsychopharmacology
ISSN: 1469-5111
Titre abrégé: Int J Neuropsychopharmacol
Pays: England
ID NLM: 9815893
Informations de publication
Date de publication:
21 06 2022
21 06 2022
Historique:
received:
04
12
2021
revised:
31
01
2022
accepted:
14
02
2022
pubmed:
16
2
2022
medline:
24
6
2022
entrez:
15
2
2022
Statut:
ppublish
Résumé
Women are nearly twice as likely as men to suffer from major depressive disorder. Yet, there is a dearth of studies comparing the clinical outcomes of women and men with treatment-resistant depression (TRD) treated with similar augmentation strategies. We aimed to evaluate the effects of the augmentation strategies in women and men at the McGill University Health Center. We reviewed health records of 76 patients (42 women, 34 men) with TRD, treated with augmentation strategies including antidepressants (AD) with mood stabilizers (AD+MS), antipsychotics (AD+AP), or in combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology (QIDS-C16), and Clinical Global Impression rating scale (CGI-S) at the beginning and after 3 months of an unchanged treatment. Changes in individual items of the HAMD-17 were also compared between the groups. Women and men improved from beginning to 3 months on all scales (P < .001, η p2 ≥ 0.68). There was also a significant sex × time interaction for all scales (P < .05, η p2 ≥ 0.06), reflecting a greater improvement in women compared with men. Specifically, women exhibited greater improvement in early (P = .03, η p2 = 0.08) and middle-of-the-night insomnia (P = .01, η p2 = 0.09) as well as psychomotor retardation (P < .001 η p2 = 0.16) and psychic (P = .02, η p2 = 0.07) and somatic anxiety (P = .01, η p2 = 0.10). The combination of AD+AP/MS generates a significantly greater clinical response in women compared with men with TRD, supporting the existence of distinct pharmacological profiles between sexes in our sample. Moreover, they emphasize the benefit of augmentation strategies in women, underscoring the benefit of addressing symptoms such as insomnia and anxiety with AP and MS.
Sections du résumé
BACKGROUND
Women are nearly twice as likely as men to suffer from major depressive disorder. Yet, there is a dearth of studies comparing the clinical outcomes of women and men with treatment-resistant depression (TRD) treated with similar augmentation strategies. We aimed to evaluate the effects of the augmentation strategies in women and men at the McGill University Health Center.
METHODS
We reviewed health records of 76 patients (42 women, 34 men) with TRD, treated with augmentation strategies including antidepressants (AD) with mood stabilizers (AD+MS), antipsychotics (AD+AP), or in combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology (QIDS-C16), and Clinical Global Impression rating scale (CGI-S) at the beginning and after 3 months of an unchanged treatment. Changes in individual items of the HAMD-17 were also compared between the groups.
RESULTS
Women and men improved from beginning to 3 months on all scales (P < .001, η p2 ≥ 0.68). There was also a significant sex × time interaction for all scales (P < .05, η p2 ≥ 0.06), reflecting a greater improvement in women compared with men. Specifically, women exhibited greater improvement in early (P = .03, η p2 = 0.08) and middle-of-the-night insomnia (P = .01, η p2 = 0.09) as well as psychomotor retardation (P < .001 η p2 = 0.16) and psychic (P = .02, η p2 = 0.07) and somatic anxiety (P = .01, η p2 = 0.10).
CONCLUSIONS
The combination of AD+AP/MS generates a significantly greater clinical response in women compared with men with TRD, supporting the existence of distinct pharmacological profiles between sexes in our sample. Moreover, they emphasize the benefit of augmentation strategies in women, underscoring the benefit of addressing symptoms such as insomnia and anxiety with AP and MS.
Identifiants
pubmed: 35167671
pii: 6528994
doi: 10.1093/ijnp/pyac017
pmc: PMC9211005
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
479-488Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of CINP.
Références
J Psychiatr Res. 2009 Feb;43(5):503-11
pubmed: 18752809
J Clin Psychopharmacol. 2022 Mar-Apr 01;42(2):118-124
pubmed: 35067518
BMC Psychiatry. 2018 Mar 16;18(1):68
pubmed: 29548306
Am J Psychiatry. 1988 Jul;145(7):804-8
pubmed: 3381922
Eur Psychiatry. 2015 Sep;30(6):778-88
pubmed: 26052073
Am J Psychiatry. 2006 Nov;163(11):1905-17
pubmed: 17074942
J Affect Disord. 2005 Aug;87(2-3):141-50
pubmed: 15982748
J Neural Transm (Vienna). 2021 Jun;128(6):827-843
pubmed: 33977402
Int Rev Psychiatry. 2010;22(5):485-500
pubmed: 21047161
J Affect Disord. 2013 Sep 5;150(2):384-8
pubmed: 23759278
Br J Psychiatry. 1996 Mar;168(3):308-13
pubmed: 8833684
Biol Psychiatry. 2003 Sep 1;54(5):573-83
pubmed: 12946886
Compr Psychiatry. 2008 May-Jun;49(3):238-46
pubmed: 18396182
Can J Psychiatry. 2016 Sep;61(9):540-60
pubmed: 27486148
Clin Pharmacokinet. 1997;32 Suppl 1:22-30
pubmed: 9068932
Neuropsychopharmacology. 2019 Jan;44(1):140-154
pubmed: 30082889
J Clin Psychiatry. 2007 Jul;68(7):1062-70
pubmed: 17685743
World J Biol Psychiatry. 2016;17(2):165-70
pubmed: 26444701
Arch Gynecol Obstet. 2016 May;293(5):1007-13
pubmed: 26437957
Psychiatry Res. 2016 Jun 30;240:421-430
pubmed: 27155594
J Clin Psychiatry. 1999 Aug;60(8):508-18
pubmed: 10485632
Am J Psychiatry. 2000 Sep;157(9):1445-52
pubmed: 10964861
Cochrane Database Syst Rev. 2019 Dec 17;12:CD010557
pubmed: 31846068
Psychosom Med. 2004 Sep-Oct;66(5):698-706
pubmed: 15385694
Depress Anxiety. 2010 Jul;27(7):675-86
pubmed: 20583298
Int Clin Psychopharmacol. 2018 Jan;33(1):34-43
pubmed: 28906325
Am J Psychiatry. 2021 Oct 1;178(10):896-902
pubmed: 34592843
Br J Psychiatry. 1979 Apr;134:382-9
pubmed: 444788
J Affect Disord. 2021 Feb 15;281:547-556
pubmed: 33401143
Am J Psychiatry. 1999 Mar;156(3):480-2
pubmed: 10080570
Am J Psychiatry. 2001 Oct;158(10):1617-22
pubmed: 11578993
Arch Gen Psychiatry. 2011 Apr;68(4):351-60
pubmed: 21135313
World J Biol Psychiatry. 2015 Feb;16(2):76-95
pubmed: 25677972
Neuropsychopharmacology. 2019 Jan;44(1):111-128
pubmed: 30061743
J Psychopharmacol. 2016 Jun;30(6):495-553
pubmed: 26979387
Psychiatry Res. 1995 Sep 8;58(1):1-12
pubmed: 8539307
Eur Neuropsychopharmacol. 2016 Dec;26(12):1960-1971
pubmed: 27816317
Ann Clin Psychiatry. 2007 Oct-Dec;19(4):247-55
pubmed: 18058282
J Womens Health (Larchmt). 2013 Mar;22(3):219-29
pubmed: 23480315
J Affect Disord. 2009 Oct;117 Suppl 1:S26-43
pubmed: 19674794
Psychol Bull. 2017 Aug;143(8):783-822
pubmed: 28447828
Am J Psychiatry. 2001 Oct;158(10):1652-8
pubmed: 11578998
Int J Psychiatry Clin Pract. 2017 Mar;21(1):13-23
pubmed: 27848269
Int Rev Psychiatry. 2010;22(5):429-36
pubmed: 21047157
J Control Release. 1999 Nov 1;62(1-2):25-31
pubmed: 10518631
Can J Psychiatry. 2007 Jan;52(1):46-54
pubmed: 17444078
J Affect Disord. 2001 Jan;62(1-2):7-15
pubmed: 11172869
Dialogues Clin Neurosci. 2016 Dec;18(4):447-457
pubmed: 28179816
Lancet Psychiatry. 2018 Aug;5(8):644-652
pubmed: 29929874
JAMA. 1996 Jul 24-31;276(4):293-9
pubmed: 8656541
Addiction. 2019 Jul;114(7):1274-1282
pubmed: 30938020
J Psychopharmacol. 2015 May;29(5):459-525
pubmed: 25969470
Psychiatr Clin North Am. 2001 Mar;24(1):165-78
pubmed: 11225506
J Affect Disord. 1993 Oct-Nov;29(2-3):85-96
pubmed: 8300981
Depress Anxiety. 2021 Sep;38(9):896-906
pubmed: 34110066
Psychol Bull. 1968 Oct;70(4):213-20
pubmed: 19673146
Psychopathology. 2010;43(3):159-69
pubmed: 20197709
Aust N Z J Psychiatry. 2008 Jan;42(1):3-12
pubmed: 18058438
J Affect Disord. 2015 Jan 15;171:137-41
pubmed: 25305428
Drugs. 1995 Aug;50(2):222-39
pubmed: 8521756
J Pharmacol Exp Ther. 2006 Mar;316(3):1328-34
pubmed: 16291874
Eur Arch Psychiatry Clin Neurosci. 2002 Oct;252(5):201-9
pubmed: 12451460
J Affect Disord. 2006 Oct;95(1-3):119-23
pubmed: 16782204
JAMA. 2003 Jun 18;289(23):3095-105
pubmed: 12813115
J Affect Disord. 2011 Jan;128 Suppl 1:S3-10
pubmed: 21220079
J Clin Psychiatry. 2009 Feb;70(2):177-84
pubmed: 19192471