Objective. Gender differences in clinical presentation and response to sertraline treatment were examined for patients diagnosed with DSM-III-R panic disorder with or without agoraphobia.
Method. Data was pooled from 4 double-blind, placebo-controlled outpatient studies (males, N = 335; females, N = 338). Two were 12-week fixed-dose studies (sertraline 50 mg vs. 100 mg vs. 200 mg) and 2 were 10-week flexible-dose studies (sertraline 50–200 mg). Primary outcome measures consisted of the Clinical Global Impression-Improvement scale (CGI-I) and change in panic attack frequency.
Results. The clinical presentation of panic disorder was similar except that men reported an earlier age of onset, shorter duration of illness, and significantly more frequent history of alcohol and/or substance dependence/abuse. Sertraline was significantly more effective than placebo in both women and men on the 2 primary outcome measures. When between-sex efficacy was compared, women achieved significantly greater improvement than men on panic frequency and CGI-I, but had equivalent improvement on all other measures. There was no significant between-sex difference in study completion rates, or in adverse event profiles.
Conclusions. There was a modest but consistent trend for women to show superior efficacy at the end of acute sertraline treatment. This gender effect only occasionally achieved significance, and must be confirmed by future treatment research.
Amsterdam, J, Garcia-Espana, F, Fawcett, J, Quitkin, F, Reimherr, F, Rosenbaum, J, Beasley, C 1999Fluoxetine efficacy in menopausal women with and without estrogen replacementJ Affect Disord551117CrossRefPubMedGoogle Scholar
Andrade, L, Eaton, WW, Chilcoat, HD 1996Lifetime co-morbidity of panic attacks and major depression in a population-based study: age of onsetPsychol Med26991996PubMedCrossRefGoogle Scholar
Ballenger, JC, Wheadon, DE, Steiner, M, Bushnell, W, Gergel, I 1998Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorderAm J Psychiatry1553642PubMedGoogle Scholar
Barzega, G, Maina, G, Venturello, S, Bogetto, F 2001Gender-related differences in the onset of panic disorderActa Psychiatr Scand103189195CrossRefPubMedGoogle Scholar
Battaglia, M, Bernardeschi, L, Politi, E, Bertella, S, Bellodi, L 1995Comorbidity of panic and somatization disorder: a genetic-epidemiological approachCompr Psychiatry36411420CrossRefPubMedGoogle Scholar
Kessler, RC, Davis, CG, Kendler, KS 1997Childhood adversity and adult psychiatric disorder in the US National Comorbidity SurveyPsychol Med2711011119CrossRefPubMedGoogle Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H, Kendler, K 1994Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity SurveyArch Gen Psychiatry51819PubMedGoogle Scholar
Lecrubier, Y, Bakker, A, Dunbar, G, Judge, R 1997A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Collaborative Paroxetine Panic Study InvestigatorsActa Psychiatr Scand95145152PubMedGoogle Scholar
Lewinsohn, PM, Gotlib, IH, Lewinsohn, M, Seeley, JR, Allen, NB 1998Gender differences in anxiety disorders and anxiety symptoms in adolescentsJ Abnorm Psychol107109117CrossRefPubMedGoogle Scholar
Londborg, PD, Wolkow, R, Smith, WT, DuBoff, E, England, D, Ferguson, J, Rosenthal, M, Weise, C 1998Sertraline in the treatment of panic disorder: A multisite, double-blind, placebo-controlled fixed dose investigationBr J Psychiatry1735460PubMedCrossRefGoogle Scholar
Maier, W, Buller, R 1988One year follow-up of panic disorder: outcome and prognostic factorsEur Arch Psychiatry Neurol Sci238105109PubMedGoogle Scholar
Marshall, JR 1996Comorbidity and its effects on panic disorderBull Menninger Clin60A39A53PubMedGoogle Scholar
McNair, DM, Lorr, M, Droppleman, LF 1971Manual for the Profile of Mood StatesEducational & Industrial Testing ServiceSan DiegoGoogle Scholar
Noyes, R, Clancey, J, Hoenk, PR, Slymen, DJ 1980The prognosis of anxiety neurosisArch Gen Psychiatry37173178PubMedGoogle Scholar
Noyes, RJ, Reich, J, Christiansen, J, Suelzer, M, Pfohl, B, Coryell, WA 1990Outcome of panic disorder: relationship to diagnostic subtypes and comorbidityArch Gen Psychiatry47809818PubMedGoogle Scholar
Pohl, RB, Wolkow, RM, Clary, CM 1998Sertraline in the treatment of panic disorder: a double-blind multicenter trialAm J Psychiatry15511891195PubMedGoogle Scholar
Pollack, MH, Otto, MW, Worthington, J, Manfro, G, Wolkow, R 1998Sertraline in the treatment of panic disorder. A flexible-dose multicenter trialArch Gen Psychiatry5510101016CrossRefPubMedGoogle Scholar
Pollack, MH, Rapaport, MH, Clary, CM, Mardekian, J, Wolkow, R 2000Sertraline treatment of panic disorder: reponse in patients at risk for poor outcomeJ Clin Psychiatry61922927PubMedGoogle Scholar
Schneider, LS, Small, GW, Hamilton, SH, Bystritsky, A, Nemeroff, CB, Meyers, BS 1997Estrogen replacement and response to fluoxetine in a multicenter geriatric depression trialAm J Geriatric Psychiatry597106Google Scholar
Sheikh, JI, Londborg, P, et al. 2000The efficacy of sertraline in panic disorder: combined results from two fixed-dose studies (Eng)Int Clin Psychopharmacol15335342PubMedCrossRefGoogle Scholar
Starcevic, V, Djordjevic, A, Latas, M, Bogojevic, G 1998Characteristics of agoraphobia in women and men with panic disorder with agoraphobiaDepress Anxiety8813CrossRefPubMedGoogle Scholar
Stein, MB, Walker, JR, Anderson, G, Hazen, A, Ross, C, Eldridge, G, Forde, D 1996Childhood physical and sexual abuse in patients with anxiety disorders and in a community sampleAm J Psychiatry153275277PubMedGoogle Scholar
Turgeon, L, Marchand, A, Dupuis, G 1998Clinical features in panic disorder with agoraphobia: a comparison of men and womenJ Anxiety Disord12539553CrossRefPubMedGoogle Scholar
Yonkers, KA, Zlotnick, C, Allsworth, J, Warshaw, M, Shea, T, Keller, M 1998Is the course of panic disorder the same in women and men?Am J Psychiatry155596602PubMedGoogle Scholar