Combination therapy and the depressed woman

Abstract

While the question of the relative efficacy of combination pharmacotherapy and psychotherapy vs. either therapy alone has received some research attention within the last 25 years, the authors attempt to narrow the focus of this question by discussing the possibility that combination therapy may be of special value for women with major depression. Theoretical models explaining why combination therapy, in general, might be expected to be more effective are described. The authors then discuss reasons why combination therapy might be a particularly efficacious treatment for depressed women, including greater psychosocial stress prior to and resulting from depression and increased cognitive distortion, both of which are more associated with depression in females. Despite a reasonable theoretical rationale for the superiority of combination in comparison to either monotherapy, examination of the available literature on acute, continuation, and maintenance treatment studies generally failed to find benefits for the use of combination therapy. Similarly, examination of the literature for gender differences among patients treated with combination therapy failed to find a specific benefit of this treatment for women. Possible reasons for these findings and suggestions for future studies are discussed. Depression 3:91–98 (1995). © 1995 Wiley‐Liss, Inc.

Sex differences and the neurobiology of affective disorders

“…With some exceptions, the age of onset [4,5,[23][24][25][26] (but also see [27][28][29][30]), type of symptoms, severity, and likelihood of chronicity and recurrence [4,5,26,27,[31][32][33] (but also see [34][35][36][37][38][39][40]) display few consistent differences between men and women. Clinically, the following are more likely in women: present with anxiety, atypical symptoms, or somatic symptoms [7,26,27,37,39,41,42]; report symptoms, particularly in self-ratings [7,26,41]; report antecedent stressful events [43,44]; and display increased comorbidity of anxiety and eating disorders [30,45,46], thyroid disease [47,48], and migraine headaches [49], as well as lower lifetime prevalence of substance abuse and dependence [27,30,50]. Some sex differences in treatment response characteristics have also been observed, with women (...…”

Women's increased vulnerability to mood disorders: Integrating psychobiology and epidemiology

“…Elsewhere, there is evidence that women experience more life events than men (Kessler and McLeod, 1984). Karp and Frank (1995) report more life events 6 months prior to the onset of a depressive episode in women than men in a treated sample and raise the possibility that women experience higher rates of reactive depression than men. Such research may provide a link between epidemiologic risk findings and specific vulnerability factors in a large percentage of women.…”

The comparison of effectiveness of two modalities of mental health nurse follow‐up programmes for female outpatients with depression in Taipei, Taiwan

“…Accordingly, these factors promote a self‐perception of powerlessness, contributing to states of dependency, repression and vulnerability to depression. More than two‐thirds of women experience a severe life event preceding the onset of depression (Brown & Harris 1989, Karp & Frank 1995, Nazroo et al. 1997, Kornstein & Clayton 2002).…”