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Romanescu M, Buda V, Lombrea A, Andor M, Ledeti I, Suciu M, Danciu C, Dehelean CA, Dehelean L. Sex-Related Differences in Pharmacological Response to CNS Drugs: A Narrative Review. J Pers Med 2022; 12:jpm12060907. [PMID: 35743692 PMCID: PMC9224918 DOI: 10.3390/jpm12060907] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 02/07/2023] Open
Abstract
In the last decades, both animal and human studies have neglected female subjects with the aim of evading a theorized intricacy of feminine hormonal status. However, clinical experience proves that pharmacological response may vary between the two sexes since pathophysiological dissimilarities between men and women significantly influence the pharmacokinetics and pharmacodynamics of drugs. Sex-related differences in central nervous system (CNS) medication are particularly challenging to assess due to the complexity of disease manifestation, drugs’ intricate mechanisms of action, and lack of trustworthy means of evaluating the clinical response to medication. Although many studies showed contrary results, it appears to be a general tendency towards a certain sex-related difference in each pharmacological class. Broadly, opioids seem to produce better analgesia in women especially when they are administered for a prolonged period of time. On the other hand, respiratory and gastrointestinal adverse drug reactions (ADRs) following morphine therapy are more prevalent among female patients. Regarding antidepressants, studies suggest that males might respond better to tricyclic antidepressants (TCAs), whereas females prefer selective serotonin reuptake inhibitors (SSRI), probably due to their tolerance to particular ADRs. In general, studies missed spotting any significant sex-related differences in the therapeutic effect of antiepileptic drugs (AED), but ADRs have sex variations in conjunction with sex hormones’ metabolism. On the subject of antipsychotic therapy, women appear to have a superior response to this pharmacological class, although there are also studies claiming the opposite. However, it seems that reported sex-related differences regarding ADRs are steadier: women are more at risk of developing various side effects, such as metabolic dysfunctions, cardiovascular disorders, and hyperprolactinemia. Taking all of the above into account, it seems that response to CNS drugs might be occasionally influenced by sex as a biological variable. Nonetheless, although for each pharmacological class, studies generally converge to a certain pattern, opposite outcomes are standing in the way of a clear consensus. Hence, the fact that so many studies are yielding conflicting results emphasizes once again the need to address sex-related differences in pharmacological response to drugs.
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Affiliation(s)
- Mirabela Romanescu
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
| | - Valentina Buda
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-755-100-408
| | - Adelina Lombrea
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Minodora Andor
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.A.); (L.D.)
| | - Ionut Ledeti
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
- Advanced Instrumental Screening Center, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Maria Suciu
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
| | - Corina Danciu
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Cristina Adriana Dehelean
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.R.); (A.L.); (I.L.); (M.S.); (C.D.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Liana Dehelean
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Street, 300041 Timisoara, Romania; (M.A.); (L.D.)
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Huang WL, Hwang BT, Lai CT, Li JY, Kuo TBJ, Yang CCH. Is Heart Rate Variability Related to Season of Birth? Clin Cardiol 2015. [PMID: 26212374 DOI: 10.1002/clc.22410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Season of birth (SOB) has been found to be related to cardiovascular mortality, but the mechanisms are unclear. It is suggested that birth in winter is a protective factor for the circulatory system, and this should be able to be observed using heart rate variability (HRV) measurements. The phenomenon may have a sex difference and is likely to be modulated by climatic factors. This study focused on this problem and investigates healthy school-age children to minimize confounding factors. HYPOTHESIS Birth in winter is protective to cardiovascular system via autonomic modulation. There is a gender difference in the relationship between SOB and autonomic activity. Climatic factors are the cause of SOB effects on autonomic system. METHODS A total of 381 healthy school-age children were recruited for this study. Their HRV profiles were measured once and climatic information related to their month of birth was gathered. The HRV profiles of the 2 sexes and 4 seasons of birth were compared. Correlation and regression analysis were performed to clarify the relationship between climatic factors and the HRV results. RESULTS Boys born in winter have higher high-frequency power (HF) but a lower ratio of low-frequency power to high-frequency power (LF/HF) than do males born in other seasons. This result is not found for girls. Age and the temperature of the SOB are predictive factors for HF among boys. The humidity of SOB is a predictive factor for normalized low-frequency power (LF%) and LF/HF among girls. CONCLUSIONS Season of birth is related to both parasympathetic and sympathetic activity among school-age children, especially boys. Temperature and humidity are potential causes of this SOB phenomenon.
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Affiliation(s)
- Wei-Lieh Huang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Be-Tau Hwang
- Department of Pediatrics, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Ting Lai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jia-Yi Li
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Duzzioni M, Duarte FS, Leme LR, Gavioli EC, De Lima TC. Anxiolytic-like effect of central administration of NOP receptor antagonist UFP-101 in rats submitted to the elevated T-maze. Behav Brain Res 2011; 222:206-11. [DOI: 10.1016/j.bbr.2011.03.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 03/20/2011] [Accepted: 03/24/2011] [Indexed: 11/30/2022]
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Heijnen WTCJ, van den Broek WW, Mulder PGH, Birkenhäger TK. Prevalence of trait anxiety in a sample of depressed inpatients and its influence on response to antidepressants. J Psychopharmacol 2010; 24:559-63. [PMID: 19028834 DOI: 10.1177/0269881108099213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression and anxiety frequently occur together or in extension of each other. According to a previous study in depressed inpatients, a high trait anxiety level correlated with a positive response to the diazepam test (DT) and a low trait anxiety level with a negative response to the test. The aim of this study is to investigate whether positive reaction to the DT is related to a positive response to fluvoxamine and whether a negative reaction to the test is related to positive response to imipramine. The DT was performed in 130 patients diagnosed with a depressive disorder. Following the DT, the patients were randomly assigned to double-blind treatment with either imipramine or fluvoxamine. Doses of both antidepressants were adjusted to attain predefined blood levels, and the outcome was evaluated 4 weeks after attaining these blood levels. Twenty-two patients had a positive response to the DT, whereas 108 patients had a negative response. Although a positive DT is correlated with a high level of trait anxiety, no differences in depressive symptomatology and antidepressant response were found between patients with a positive and a negative DT.
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Affiliation(s)
- W T C J Heijnen
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
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Karasz A, Watkins L. Conceptual models of treatment in depressed Hispanic patients. Ann Fam Med 2006; 4:527-33. [PMID: 17148631 PMCID: PMC1687176 DOI: 10.1370/afm.579] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/11/2006] [Accepted: 02/27/2006] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Though patient variables are likely to play an important role in the undertreatment of depression, little is known of patients' perceptions of standard depression treatments. In an effort to understand their perspective, we investigated depressed Hispanic patients' perceptions of primary care treatments and the specific benefits associated with them. METHODS We undertook semistructured interviews with 121 depressed Hispanic medical patients waiting for their appointments. We developed and implemented a coding scheme using standard iterative procedures. RESULTS More than one half of the patients viewed physician consultation and medication as helpful. Almost all patients considered psychotherapy to be helpful. Supportive talk was the most commonly mentioned specific benefit of physician consultation. The most common benefit of medication was its anxiolytic, sedative effect; energizing effects were less common. The most common benefits associated with psychotherapy included support, advice, and catharsis. Patients currently taking medication for depression had a more favorable view of pharmacological treatment; differences by language of interview were noted. CONCLUSIONS Patients' perceptions of the specific efficacies of depression treatment did not match priorities implicit in current treatment guidelines. Such perceptions may play a key role in shaping patients' decisions to initiate and maintain treatment.
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Affiliation(s)
- Alison Karasz
- Department of Family Medicine, Albert Einstein College of Medicine, 3544 Jerome Avenue, Bronx, NY 10467, USA.
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Cassidy EL, Lauderdale S, Sheikh JI. Mixed anxiety and depression in older adults: clinical characteristics and management. J Geriatr Psychiatry Neurol 2005; 18:83-8. [PMID: 15911936 DOI: 10.1177/0891988705276060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The frequent comorbidity of anxiety and depression, particularly among elderly, is widely recognized by clinicians, but the debate continues as to whether the combined diagnostic designation is merited. This article reviews the debate over the mixed diagnosis, discusses treatment implications, and reviews a small treatment study undertaken with elderly patients. Ten community-dwelling, older adults diagnosed with generalized anxiety disorder and subsyndromal depression (n = 6) or generalized anxiety disorder and major depressive disorder (n = 4) were started on a 12-week, open-label trial of nefazodone. Clinicians' ratings on the Clinical Global Impression of Change and patients' self-ratings of symptoms on the Beck Depression Inventory and the Beck Anxiety Inventory identified statistically significant gains in patients' overall pre/post functioning. Nefazodone was efficacious in symptom alleviation in patients with comorbid anxiety and depression. Further double-blind, randomized investigations with newer antidepressant medications are required to extend these preliminary findings with nefazodone.
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Affiliation(s)
- Erin L Cassidy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
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Borodin JI, Kudryavtseva NN, Tenditnik MV, Rachkovskaya LN, Shurlygina AV, Trufakin VA. Behavioral effects of novel enterosorbent Noolit on mice with mixed depression/anxiety-like state. Pharmacol Biochem Behav 2002; 72:131-41. [PMID: 11900780 DOI: 10.1016/s0091-3057(01)00735-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this work was to examine the behavioral effects of a novel lithium-based enterosorbent, Noolit (665 mg/kg), on male mice with mixed depression/anxiety-like state evoked by exposure to repeated social defeats in daily agonistic confrontations. The lithium component allows Noolit to be used as a psychotropic drug. Two experiments are described, in which the therapeutic and preventative effects of chronic Noolit treatment were examined. Response to Noolit was assessed in the plus maze, open field, partition test, and Porsolt's test. In both experiments, Noolit produced obvious anxiolytic and antidepressant effects. Treatment with Noolit fully restored some behavioral parameters in the plus maze and open field in depressed mice and prevented depression that would otherwise have developed. It has been suggested that enterosorbent Noolit can be a potent drug for the treatment of mixed anxiety/depression pathologies and for prevention of mood disorders.
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Affiliation(s)
- Ju I Borodin
- Institute of Clinical and Experimental Lymphology, Siberian Division of the Russian Academy of Medical Sciences, Novosibirsk, Russia
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