Sex steroid hormones status influence on antidepressant pharmacotherapy effect in male and female patients

Abstract

Depression causes immense burden on health care systems worldwide with two time s higher prevalence in women. However, both male and female patients are treated with antidepressants under same protocols. As it was demonstrated that estrogen has a prodepressant and testosterone an antidepressant affect, it is reasonable to assume that pharmacotherapeutic effect might depend also on sex hormones status. The aim of this pilot study was to explore hormonal status of female and male patients upon hospitalization on occurrence of depressive episode and to correlate it with pharmacotherapy effect after four weeks of therapy. Subjects were 42 patients, 14 males, 14 females in the first (follicular) phase of menstrual cycle and 14 females in the second (luteal) phase of menstrual cycle upon hospitalization. The Hamilton scale was used to determine degree of depressive state upon hospitalization an after 28 days. At both time points, blood was sampled and level of testosterone and estrogen for male and estrogen, progesterone and testosterone for female patients was analysed. Results of the study showed that antidepressant effect calculated as a difference in Hamilton scale was highest in male group of patients and significantly higher than in women in the second phase of the cycle (10.4 vs 8.1). This correlated with increase of testosterone in male patients during four weeks treatment (12.08 vs. 9.46), while there was no significant change in the level of testosterone in both female groups of patients. Furthermore, in female patients in the luteal phase of the cycle, with lowest response to antidepressants, both estrogen and progesterone were significantly reduced during four weeks of treatment. In conclusion, results of our pilot study suggest sex differences in response to antidepressant therapy and level of hormonal status should be evaluated for better personalized pharmacotherapy.