Skip to main content Accessibility help
×
Home

Gender Differences in Major Depressive Disorder and Bipolar Disorder

  • Ellen Leibenluft

Abstract

This paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not been found. In BPD, women are more likely than men to develop a rapid-cycling course. Gender differences in treatment response, particularly in regard to mood stabilizing medications, warrant further study.

Copyright

References

Hide All
1.Robins, LN, Helzer, JE, Weissman, MM, et al.Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41:949958.
2.Kessler, RC, McGonagle, KA, Zhao, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994;51:819.
3.Weissman, MM, Bland, R, Joyce, PR, Newman, S, Wells, JE, Wittchen, H-U. Sex differences in rates of depression: cross-national perspectives. J Affect Disord. 1993;29:7784.
4.Levav, I, Kohn, R, Golding, JM, Weissman, MM. Vulnerability of Jews to affective disorders. Am J Psychiatry. 1997;154:941947.
5.Rice, J, Reich, T, Andreason, NC, et al.The familial transmission of bipolar illness. Arch Gen Psychiatry. 1987;44:441447.
6.Kessler, RC, McGonagle, KA, Nelson, CB, Hughes, M, Swartz, M, Blazer, D. Sex and depression in the National Comorbidity Survey, II: cohort effects. J Affect Disord. 1994;30:1526.
7.Anderson, JC, Williams, S, McGee, R, Silva, PA. DSM-III disorders in preadolescent children: prevalence in a large sample from the general population. Arch Gen Psychiatry. 1987;44:6977.
8.McGee, R, Feehan, M, Williams, S, Anderson, J. DSM-III disorders from age 11 to age 15 years. J Am Acad Child Adolesc Psychiatry. 1992;31:5059.
9.Geller, B, Clark, K, Fox, LW. Rate and predictors of prepubertal bipolarity during follow-up of 6 to 12 year old depressed children. J Am Acad Child Adolesc Psychiatry. 1994;33:461468.
10.Cohen, P, Cohen, J, Kasen, S, et al.An epidemiological study of disorders in late childhood and adolescence, I: age and gender specific prevalence. J Child Psychol Psychiatry. 1993;4:851867.
11.Angold, A, Worthman, C. Puberty onset of gender differences in rates of depression: a developmental, epidemiological, and neuroendocrine perspective. J Affect Disord. 1993;29:145158.
12.Silberg, J, Pickles, A, Rutter, M, et al.The influence of genetic factors and life stress on depression among adolescent girls. Arch Gen Psychiatry. 1999;56:225232.
13.Angold, A, Costello, EJ, Worthman, CM. Puberty and depression: the roles of age, pubertal status, and pubertal timing. Psychol Med. 1998;28:5161.
14.Patton, GC, Hibbert, ME, Carlin, J, et al.Menarche and the onset of depression and anxiety in Victoria, Australia. J Epidemiol Community Health. 1997;50:661666.
15.Kendler, KS, Prescott, CA. A population-based twin study of lifetime major depression in men and women. Arch Gen Psychiatry. 1999;56:3944.
16.Beatty, WW. Gonadal hormones and sex differences in non-reproductive behaviors. In: Gerall, A, Moltz, H, Ward, I, eds. Sexual Differentiation. New York, NY; Plenum Press. 1992:85128.
17.Schmidt, PJ, Nieman, LK, Danaceau, MA, Adams, LF, Rubinow, DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338:209216.
18.Kendler, KS, Karkowski, LM, Corey, LA, Neale, MC. Longitudinal population-based twin study of retrospectively reported premenstrual symptoms and lifetime major depression. Am J Psychiatry. 1998;155:12341240.
19.Leibenluft, E. Women with bipolar illness: clinical and research issues. Am J Psychiatry. 1996;153:163173.
20.Leibenluft, E, Ashman, SB, Feldman-Naim, S, Yonkers, KA. Lack of relationship between menstrual cycle phase and mood in women with rapid cycling bipolar disorder. Biol Psychiatry. In press.
21.Nishizawa, S, Benkelfat, C, Young, SN. Differences between males and females in rates of serotonin synthesis in human brain. Proc Natl Acad Sci USA. 1997;94:53085313.
22.Shaywitz, BA, Shaywitz, SE, Pugh, KR, et al.Sex differences in the functional organization of the brain for language. Nature. 1995;373:607609.
23.Schloesser, R, Hutchinson, M, Joseffer, S, et al.Functional magnetic resonance imaging of human brain activity in a verbal fluency task. J Neurol Neurosurg Psychiatry. 1998;94:492498.
24.Witelson, S. Neural sexual mosaicism: sexual differentiation of the human temporo-parietal region for functional symmetry. Psychoneuroendocrinology. 1991;16:131153.
25.McGlone, J. Sex differences in human brain asymmetry: a critical survey. Behav Brain Sci 1980;3:215263.
26.Fox, NA. If it's not left, it's right: electroencephalograph asymmetry and the development of emotion. Am Psychol. 1991;46:863872.
27.Davidson, RJ. EEG measures of cerebral asymmetry: conceptual and methodological issues. Int J Neurosci. 1988;39:7189.
28.Davidson, RJ, Fox, NA. Frontal brain asymmetry predicts infants' response to maternal separation. J Abnorm Psychol. 1989;98:127131.
29.Robinson, RG, Boston, JD, Starkstein, SE, Price, TR. Comparisons of mania and depression after brain injury: causal factors. Am J Psychiatry. 1988;145:172178.
30.Starkstein, SE, Mayberg, HS, Berthier, ML, et al.Mania after brain injury: neuroradiological and metabolic findings. Ann Neurol. 1990,27:652659.
31.Drevets, WC. Functional neuroimaging studies of depression: the anatomy of melancholia. Annu Rev Med. 1998;49:341361.
32.George, MS, Ketter, TA, Parekh, PI, Herscovitch, P, Post, RM. Gender differences in regional cerebral blood flow during transient self-induced sadness or happiness. Biol Psychiatry. 1996;40:859871.
33.Lang, PJ, Bradley, MM, Fitzsimmons, JR. et al.Emotional arousal and activation of the visual cortex: an fMRI analysis. Psychophysiology. 1998;35:199210.
34.Lang, PJ, Greenwald, MK, Bradley, MM, Hamm, AO. Looking at pictures: affective, facial, visceral, and behavioral reactions. Psychophysiology. 1993 30:261273.
35.Isometsä, ET, Henriksson, MM, Aro, H, Heikkinen, ME, Kuoppasalmi, KI, Lönnqvist, JK. Suicide in major depression. Am J Psychiatry. 1994;151:530536.
36.Moscicki, EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997;20:499517.
37.Young, MA, Fogg, LF, Scheftner, WA, Fawcett, JA. Interactions of risk factors in predicting suicide. Am J Psychiatry. 1994;151:434435.
38.Leibenluft, E, Hardin, TA, Rosenthal, NE. Gender differences in seasonal affective disorder. Depression. 1995;3:1319.
39.Ernst, C, Angst, J. The Zurich Study XII. Sex differences in depression. Evidence from longitudinal epidemiological data. Eur Arch Psychiatry Clin Neurosci. 1992;241:222230.
40.Young, MA, Fogg, LF, Scheftner, WA, Keller, MB, Fawcett, JA. Sex differences in the lifetime prevalence of depression: does varying the diagnostic criteria reduce the female/male ratio? J Affect Disord. 1990;18:187192.
41.Frank, E, Carpenter, LL, Kupfer, DJ. Sex differences in recurrent depression: are there any that are significant? Am J Psychiatry. 1988;145:4145.
42.Stunkard, AJ, Fernstrom, MH, Price, A, Frank, E, Kupfer, D. Direction of weight change in recurrent depression: consistency across episodes. Arch Gen Psychiatry. 1990;47:857860.
43.Angst, J, Dobler-Mikola, A. Do the diagnostic criteria determine the sex ratio in depression? J Affect Disord. 1984;7:189198.
44.Young, MA, Scheftner, WA, Fawcett, J, Klerman, GL. Gender differences in the clinical features of unipolar depressive disorder. Nerv Ment Dis. 1990;178:200203.
45.Kornstein, SG, Schatzberg, AF, Yonkers, KA, et al.Gender differences in presentation of chronic major depression. Psychopharmacol Bull. 1996;31:711718.
46.Thase, ME, Reynolds, CF, Frank, E, et al.Do depressed men and women respond similarly to cognitive behavior therapy? Am J Psychiatry. 1994;151:500505.
47.Sargeant, JK, Bruce, ML, Florio, LP, Weissman, MM. Factors associated with 1-year outcome of major depression in the community. Arch Gen Psychiatry. 1990;47:519526.
48.Keitner, GI, Ryan, CE, Miller, IW, Kohn, R, Epstein, NB. 12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression). Am J Psychiatry. 1991;148:345350.
49.Winokur, G, Coryell, W, Keller, M, Endicott, J, Akiskal, H. A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Arch Gen Psychiatry. 1993;50:457465.
50.Simpson, HB, Nee, JC, Endicott, J. First-episode major depression. Arch Gen Psychiatry. 1997;54:633639.
51.Zlotnick, C, Shea, MT, Pilkonis, PA, Elkin, I, Ryan, C. Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up. Am J Psychiatry. 1996;153:10211027.
52.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
53.Tondo, L, Baldessarini, RJ. Rapid cycling in women and men with bipolar manic-depressive disorders. Am J Psychiatry. 1998;155:14341436.
54.Wehr, TA, Goodwin, FK. Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry. 1987;144:14031411.
55.Altshuler, LL, Post, RM, Leverich, GS, Mikalauskas, K, Rosoff, A, Ackerman, L. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry. 1995;152:11301138.
56.Angst, J. The course of affective disorders, II: typology of bipolar manic-depressive illness. Arch Psychiatr Nervenkr. 1978;26:6573.
57.Roy-Byrne, P, Post, RM, Uhde, TW, Porcu, T, Davis, D. The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatr Scand 1985;71(suppl):532.
58.Taschev, T. The course and prognosis of depression on the basi9 of 652 patients deceased. In: Angst, J, ed. Classification and Prediction of Outcome of Depression. Stuttgart, Germany: Schattauer Verlag; 1973:157172.
59.Kukopulos, A, Reginaldi, D, Laddomada, G, Floris, G, Serra, G, Tondo, L. Course of the manic-depressive cycle and changes caused by treatments. Pharmakopsychiatr Neuropsychopharmakol. 1980;13:156157.
60.Winokur, G, Coryell, W, Akiskal, HS, Endicott, J, Keller, M, Mueller, T. Manic-depressive (bipolar) disorder the course in light of a prospective ten-year follow-up of 131 patients. Acta Psychiatr Scand. 1994;89:102110.
61.McElroy, SL, Keck, PEJ, Pope, HGJ, Hudson, JI, Faedda, GL, Swann, AC. Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry. 1992;149:16331634.
62.McElroy, S, Strakowski, S, Keck, PJ, Tugrul, K, West, S, Lonczak, H. Differences and similarities in mixed and pure mania. Compr Psychiatry. 1995;36:187194.
63.Dawkins, K, Potter, WZ. Gender differences in pharmacokinetics and pharmacodynamics of psychotropics: focus on women. Psychopharmacol Bull. 1991;27:417426.
64.Yonkers, KA, Kando, JC, Cole, JO, Blumenthal, S. Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. Am J Psychiatry. 1992;149:587595.
65.Raskin, A. Age-sex differences in response to antidepressant drugs. J Nerv Ment Dis. 1974;159:102130.
66.Glassman, AH, Perel, JM, Shostak, M, Kantor, SJ, Fleiss, JL. Clinical implications of imipramine plasma levels for depressive illness. Arch Gen Psychiatry. 1977;34:197204.
67.Davidson, J, Pelton, S. Forms of atypical depression and their response to antidepressant drugs. Psychiatry Res. 1986;17:8795.
68.Steiner, M, Wheadon, DE, Kreider, MS, et al. Antidepressant response to paroxetine by gender. Presented at: 146th Annual Meeting of the American Psychiatric Association; May, 1993; San Francisco, Calif.
69.Yonkers, KA, Bradshaw, KD. Hormone replacement and oral contraceptive therapy: do they induce or treat mood symptoms? In: Leibenluft, E, ed. Gender Differences in Mood and Anxiety Disorders: From Bench to Bedside. Washington, DC: American Psychiatric Press. In press.
70.Zweifel, JE, O'Brien, WH. A meta-analysis of the effect of hormone replacement therapy upon depressed mood. Psychoneuroendocrinology. 1997;22:189212.
71.Schneider, LS, Small, GW, Clary, C, et al. Estrogen replacement therapy status and antidepressant response to sertraline. Presented at: 151st Annual Meeting of the American Psychiatric Association; May 1998; Toronto, Ontario, Canada.
72.Schneider, LS, Small, GW, Hamilton, SH, Bystritsky, A, Nemeroff, CB, Barnett, S. Estrogen replacement and response to fluoxetine in a multicenter geriatric depression trial. Am J Geriatr Psychiatry. 1997;5:97106.
73.Wilder, BJ. Pharmacokinetics of valproate and carba-mazepine. J Clin Psychopharmacol. 1992;12:64S68S.
74.Mattson, RH, Cramer, JA, Darney, PD, Naftolin, F. Use of oral contraceptives by women with epilepsy. JAMA. 1986;256:238240.
75.Vincent, A, Brauch, P, Vincent, P. Early onset of lithium-associated hypothyroidism. J Psychiatry Neurosci. 1993;18:7477.
76.Isojärvi, JIT, Laatikainen, TJ, Pakarinen, AJ, Juntunen, KTS, Myllylä, VV. Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy. N Engl J Med. 1993;329:13831388.
77.Isojärvi, JIT, Laatikainen, TJ, Knip, M, Pakarinen, AJ, Juntunen, KTS, Myllylä, VV. Obesity and endocrine disorders in women taking valproate for epilepsy. Ann Neurol. 1996;39:579584.
78.Isojärvi, JIT, Rättyä, J, Myllyä, VV, et al.Valproate, lamotrigine, and insulin-mediated risks in women with epilepsy. Ann Neurol. 1998;43:446451.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed