Men and women have different strategies to cope with depression, and their doctors should too.
Contrary to what the drug companies would have you believe, there’s no magic “happy pill”. It’s not as easy for us to treat depression with medications as you might think. Many patients need trials on several different kinds of medicine before hitting upon the right one. Often, a medication that has worked for a while stops working; this can be very destructive, as can the process of finding a new one.
Men and women also respond differently to antidepressant medications, something most people don’t know, and I think this is still not sufficiently taken into consideration when doctors are prescribing. For instance, young women are more sensitive to side effects like excessive fatigue on very small doses of medication. Some of these may be due to the effect of estrogen on the brain or to sex-specific ways of metabolizing these medications.
Which drugs work may also be sex-specific. Robert R. Bies, PhD, at the University of Pittsburgh has shown that depressed men with anxiety attacks respond to the older generation of tricyclic antidepressants, such as imipramine (Tofranil), better than women, but women seem to do better with monoamine oxidate inhibitors (MAOIs) such as Parnate.
The fact that men make and metabolize more serotonin may explain why Paxil – a drug that prolongs the amount of time that serotonin lingers in the synapse between neurons – works better in women than men. The difference in response may also be due to a difference in the numbers of receptors for serotonin in the brain between the sexes. There are fewer binding sites for serotonin on men’s blood cells platelets then on women’s.
Something Must Be Done
It should be clear by now that we don’t have a complete picture to explain why women and men suffer depression at such different rates.
What we do know is that this disease has far-reaching effects. Mark Whisman, PhD, and Lauren Weinstock, MS at the university of Colorado started 774 married couples and found something devastating: the level of anxiety and depression in each spouse predicted not only their own marital satisfaction, but their spouse’s as well. Depression influenced both husbands and wives more than anxiety in how they felt about the marriage.
Additionally, the children of depressed mothers are more likely to have behavioral problems, developmental difficulties, and social problems and are themselves more prone to depression than their peers. So when someone is diagnosed with depression, mental health evaluations for the whole family should be the very next step.
The discovery of some basic physiological differences between men and women has helped us to become better doctors and to give better, more individualized care to our patients. Learning the differences between men’s and women’s hearts made us better cardiologists. The same must be true about studying the brain in order to improve what we know about and how we treat mood disorders such as depression. Because this disease has such far-reaching effects, it is absolutely imperative that we do what we can to establish why these differences exist and how they might be remedied.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.