Gender differences in treatment response to sertraline versus imipramine in chronic depression

Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipra mine, a tricyclic antidepressant, in chronic depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R chron ic major depression or double depression (i.e., major depression superimpos ed on dysthymia) were randomly assigned to 12 weeks of double-blind treatme nt with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and typ e of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were se en with imipramine, with women responding significantly more slowly than me n. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to im ipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with chronic depression show differential respon sivity to and tolerability of SSRIs and tricyclic antidepressants. The diff ering response rates between the drug classes in women was observed primari ly in premenopausal women. Thus, female sex hormones may enhance response t o SSRIs or inhibit response to tricyclics. Both gender and menopausal statu s should be considered when choosing an appropriate antidepressant for a de pressed patient.