Gender differences in 12-week antidepressant treatment outcomes for a naturalistic secondary care cohort: The CRESCEND study Su-Jin Yang a , Sun-Young Kim a , Robert Stewart b , Jae-Min Kim a, ⁎, Il-Seon Shin a , Sung-Won Jung c , Min-Soo Lee d , Seung-Hee Jeong e , Tae-Youn Jun f a Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwangju, Republic of Korea b Section of Epidemiology, Institute of Psychiatry, London, United Kingdom c Department of Psychiatry, Keimyung University, School of Medicine, Daegu, Republic of Korea d Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea e Department of Preventive Medicine, Catholic University of Korea College of Medicine, Seoul, Republic of Korea f Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, Republic of Korea abstract article info Article history: Received 23 July 2010 Received in revised form 4 December 2010 Accepted 10 December 2010 Keywords: Gender differences Antidepressants Depression Treatment outcome Korea This study aimed to determine whether men and women with depression differ in socio-demographic, treatment-related characteristics, and in their responses to treatment with antidepressants, as well as to explore differences in treatment outcomes by menopausal status. From a nationwide sample of 18 hospitals in South Korea, 723 depressive patients were recruited. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re- evaluated at 1, 2, 4, 8, and 12 weeks later. At baseline, women were older, less educated, less likely to be employed, had lower income, were more likely to be married, and had longer illness duration than men. There were no gender differences in the treatment-regime received. After adjustment for baseline status, women were more likely to achieve HAMD remission (OR = 1.51), HAMD response (OR = 1.64), and HAMA response (OR = 1.61). Women also experienced shorter times to HAMD response, HAMA response, and CGI-s remission. Postmenopausal women showed higher HAMA response with newer dual action antidepressants than premenopausal women. Women were found to have better outcomes following antidepressant treatment than men, and postmenopausal women had a better response on anxiety symptoms with newer dual action antidepressants. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Gender differences are well recognized in the etiology and outcome of depressive disorders. The lifetime prevalences of both major depressive disorder and dysthymic disorder are about twice as high in women as in men (Kessler et al., 1993) with an earlier age of onset, increased severity of illness, and greater functional impairment in women (Kornstein et al., 2000b). Gender differences in treatment response have also been suggested (Kornstein and Wojcik, 2000). Early studies found that women experienced poorer response rates and slower clinical improvement with tricyclic antidepressants (TCAs) than men (Prange et al., 1969; Raskin, 1974; Glassman et al., 1977; Frank et al., 1988). In a meta- analysis of 35 studies published between 1957 and 1991, men were concluded to respond more favorably to imipramine than women (Hamilton et al., 1996). Women have been suggested to respond better to selective serotonin reuptake inhibitor (SSRIs). Kornstein et al. (2000a) found a significant interaction between gender and treatment response rates, with the highest response rates occurring in women taking sertraline and in men taking imipramine. They also found differences in response by menopausal status, in that postmenopausal women responded better to TCAs than premenopausal women. However, Quitkin et al. (2002) reviewed records from 840 depression research clinic outpatients taking fluoxetine and found no significant sex differences in response rate or speed of response, and the Danish University Antidepressant Group (Hildebrandt et al., 2003), in a pooled analysis of 292 inpatients with depression treated with five weeks of clomipramine, citalopram, paroxetine or moclobemide also found no sex differences in treatment response, loss to follow-up or side effects. Baca et al. (2004) found that men and women responded equally well to sertraline, but men were more likely than women to discontinue follow-up. Previous studies of gender differences in response to SSRIs treatment have been small in scope and predominantly based on industry-sponsored clinical trials data with multiple exclusions rather than in ‘real world’ patient populations (Zimmerman et al., 2002). A Psychiatry Research 189 (2011) 82–90 ⁎ Corresponding author. Tel.: +82 62 220 6143; fax: +82 62 225 2351. E-mail address: jmkim@chonnam.ac.kr (J.-M. Kim). 0165-1781/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2010.12.027 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres