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.
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J Amsterdam F Garcia-Espana J Fawcett F Quitkin F Reimherr J Rosenbaum C Beasley (1999) ArticleTitleFluoxetine efficacy in menopausal women with and without estrogen replacement J Affect Disord 55 11–17 Occurrence Handle10.1016/S0165-0327(98)00203-1 Occurrence Handle1:STN:280:DyaK1MvktFWkuw%3D%3D Occurrence Handle10512601
L Andrade WW Eaton HD Chilcoat (1996) ArticleTitleLifetime co-morbidity of panic attacks and major depression in a population-based study: age of onset Psychol Med 26 991–996 Occurrence Handle1:STN:280:DyaK2s%2Fjt1Cmsw%3D%3D Occurrence Handle8878331 Occurrence Handle10.1017/S0033291700035315
JC Ballenger DE Wheadon M Steiner W Bushnell I Gergel (1998) ArticleTitleDouble-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder Am J Psychiatry 155 36–42 Occurrence Handle1:STN:280:DyaK1c%2FpsV2isg%3D%3D Occurrence Handle9433336
G Barzega G Maina S Venturello F Bogetto (2001) ArticleTitleGender-related differences in the onset of panic disorder Acta Psychiatr Scand 103 189–195 Occurrence Handle10.1034/j.1600-0447.2001.00194.x Occurrence Handle1:STN:280:DC%2BD3MzptlChuw%3D%3D Occurrence Handle11240575
M Battaglia L Bernardeschi E Politi S Bertella L Bellodi (1995) ArticleTitleComorbidity of panic and somatization disorder: a genetic-epidemiological approach Compr Psychiatry 36 411–420 Occurrence Handle10.1016/S0010-440X(95)90248-1 Occurrence Handle1:STN:280:DyaK287kt1ymsw%3D%3D Occurrence Handle8565445
JL Bibb DL Chambless (1986) ArticleTitleAlcohol use and abuse among diagnosed agoraphobics Behav Res Ther 24 49–58 Occurrence Handle10.1016/0005-7967(86)90149-X Occurrence Handle1:STN:280:DyaL287jtVejsg%3D%3D Occurrence Handle3947312
BJ Cox RP Swinson ID Shulman K Kuch JT Reichman (1993) ArticleTitleGender effects and alcohol use in panic disorder with agoraphobia Behav Res Ther 31 413–416 Occurrence Handle10.1016/0005-7967(93)90099-G Occurrence Handle1:STN:280:DyaK3s3ptVKiuw%3D%3D Occurrence Handle8512541
CL Dick RC Bland SC Newman (1994) ArticleTitleEpidemiology of psychiatric disorders in Edmonton. Panic disorder Acta Psychiatr Scand [Suppl] 376 45–53 Occurrence Handle1:STN:280:DyaK2c3jtl2rtA%3D%3D
J Endicott J Nee W Harrison R Blumenthal (1993) ArticleTitleQuality of life, enjoyment and satisfaction questionnaire: a new measure Psychopharmacol Bull 29 321–326 Occurrence Handle1:STN:280:DyaK2c7itVSlsA%3D%3D Occurrence Handle8290681
Guy W (1976) ECDEU Assessment manual for psychopharmacology, revised. Rockville MD: DHEW Publication No. (ABM), pp 76–338.
RJ Hafner (1983) ArticleTitleBehaviour therapy for agoraphobic men Behav Res Ther 21 51–56 Occurrence Handle10.1016/0005-7967(83)90125-0 Occurrence Handle1:STN:280:DyaL3s7lt1ykuw%3D%3D Occurrence Handle6830565
M Hamilton (1959) ArticleTitleThe assessment of anxiety status by rating Br J Med Psychol 32 50–55 Occurrence Handle1:STN:280:DyaG1M%2FmvVWisQ%3D%3D Occurrence Handle13638508
M Hollifield W Katon B Skipper T Chapman JC Ballenger S Mannuzza AJ Fyer (1997) ArticleTitlePanic disorder and quality of life: variables predictive of functional impairment Am J Psychiatry 154 766–772 Occurrence Handle1:STN:280:DyaK2szhtVegtA%3D%3D Occurrence Handle9167503
MR Johnson RB Lydiard (1998) ArticleTitleComorbidity of major depression and panic disorder J Clin Psychol 54 201–210 Occurrence Handle10.1002/(SICI)1097-4679(199802)54:2<201::AID-JCLP9>3.0.CO;2-U Occurrence Handle1:STN:280:DyaK1c7ivV2ntw%3D%3D Occurrence Handle9467764
RC Kessler CG Davis KS Kendler (1997) ArticleTitleChildhood adversity and adult psychiatric disorder in the US National Comorbidity Survey Psychol Med 27 1101–1119 Occurrence Handle10.1017/S0033291797005588 Occurrence Handle1:STN:280:DyaK2svksFKgsg%3D%3D Occurrence Handle9300515
RC Kessler KA McGonagle S Zhao CB Nelson M Hughes S Eshleman H Wittchen K Kendler (1994) ArticleTitleLifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey Arch Gen Psychiatry 51 8–19 Occurrence Handle1:STN:280:DyaK2c7gslSrtA%3D%3D Occurrence Handle8279933
Y Lecrubier A Bakker G Dunbar R Judge (1997) ArticleTitleA comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Collaborative Paroxetine Panic Study Investigators Acta Psychiatr Scand 95 145–152 Occurrence Handle1:CAS:528:DyaK2sXit1eisLs%3D Occurrence Handle9065680
PM Lewinsohn IH Gotlib M Lewinsohn JR Seeley NB Allen (1998) ArticleTitleGender differences in anxiety disorders and anxiety symptoms in adolescents J Abnorm Psychol 107 109–117 Occurrence Handle10.1037/0021-843X.107.1.109 Occurrence Handle1:STN:280:DyaK1c7msF2nsw%3D%3D Occurrence Handle9505043
PD Londborg R Wolkow WT Smith E DuBoff D England J Ferguson M Rosenthal C Weise (1998) ArticleTitleSertraline in the treatment of panic disorder: A multisite, double-blind, placebo-controlled fixed dose investigation Br J Psychiatry 173 54–60 Occurrence Handle1:STN:280:DyaK1M%2FmslWqsg%3D%3D Occurrence Handle9850204 Occurrence Handle10.1192/bjp.173.1.54
W Maier R Buller (1988) ArticleTitleOne year follow-up of panic disorder: outcome and prognostic factors Eur Arch Psychiatry Neurol Sci 238 105–109 Occurrence Handle1:STN:280:DyaL1M%2FptFagtw%3D%3D Occurrence Handle2905266
JR Marshall (1996) ArticleTitleComorbidity and its effects on panic disorder Bull Menninger Clin 60 IssueID2 [Suppl] A A39–A53 Occurrence Handle1:STN:280:DyaK2s%2FhtVeltw%3D%3D Occurrence Handle8857426
DM McNair M Lorr LF Droppleman (1971) Manual for the Profile of Mood States Educational & Industrial Testing Service San Diego
R Noyes J Clancey PR Hoenk DJ Slymen (1980) ArticleTitleThe prognosis of anxiety neurosis Arch Gen Psychiatry 37 173–178 Occurrence Handle6101536
RJ Noyes J Reich J Christiansen M Suelzer B Pfohl WA Coryell (1990) ArticleTitleOutcome of panic disorder: relationship to diagnostic subtypes and comorbidity Arch Gen Psychiatry 47 809–818 Occurrence Handle2393339
RB Pohl RM Wolkow CM Clary (1998) ArticleTitleSertraline in the treatment of panic disorder: a double-blind multicenter trial Am J Psychiatry 155 1189–1195 Occurrence Handle1:STN:280:DyaK1cvgtlKisg%3D%3D Occurrence Handle9734541
MH Pollack MW Otto J Worthington G Manfro R Wolkow (1998) ArticleTitleSertraline in the treatment of panic disorder. A flexible-dose multicenter trial Arch Gen Psychiatry 55 IssueID11 1010–1016 Occurrence Handle10.1001/archpsyc.55.11.1010 Occurrence Handle1:CAS:528:DyaK1cXnsVSmsb4%3D Occurrence Handle9819070
MH Pollack MH Rapaport CM Clary J Mardekian R Wolkow (2000) ArticleTitleSertraline treatment of panic disorder: reponse in patients at risk for poor outcome J Clin Psychiatry 61 922–927 Occurrence Handle1:CAS:528:DC%2BD3MXhtVChtrg%3D Occurrence Handle11206597
LS Schneider GW Small SH Hamilton A Bystritsky CB Nemeroff BS Meyers (1997) ArticleTitleEstrogen replacement and response to fluoxetine in a multicenter geriatric depression trial Am J Geriatric Psychiatry 5 97–106 Occurrence Handle1:STN:280:DyaK2s3lslCgsw%3D%3D
MK Shear TA Brown DH Barlow R Money D Sholomskas S Woods J Gorman L Papp (1997) ArticleTitleMulticenter collaborative panic disorder severity scale Am J Psychiatry 154 1571–1575 Occurrence Handle1:STN:280:DyaK1c%2FhvFekuw%3D%3D Occurrence Handle9356566
JI Sheikh P Londborg et al. (2000) ArticleTitleThe efficacy of sertraline in panic disorder: combined results from two fixed-dose studies (Eng) Int Clin Psychopharmacol 15 IssueID6 335–342 Occurrence Handle1:STN:280:DC%2BD3M3is1OitA%3D%3D Occurrence Handle11110009 Occurrence Handle10.1097/00004850-200015060-00004
V Starcevic A Djordjevic M Latas G Bogojevic (1998) ArticleTitleCharacteristics of agoraphobia in women and men with panic disorder with agoraphobia Depress Anxiety 8 8–13 Occurrence Handle10.1002/(SICI)1520-6394(1998)8:1<8::AID-DA2>3.0.CO;2-9 Occurrence Handle1:STN:280:DyaK1cvitlGntQ%3D%3D Occurrence Handle9750973
MB Stein JR Walker G Anderson A Hazen C Ross G Eldridge D Forde (1996) ArticleTitleChildhood physical and sexual abuse in patients with anxiety disorders and in a community sample Am J Psychiatry 153 275–277 Occurrence Handle1:STN:280:DyaK287lsF2ntg%3D%3D Occurrence Handle8561213
L Turgeon A Marchand G Dupuis (1998) ArticleTitleClinical features in panic disorder with agoraphobia: a comparison of men and women J Anxiety Disord 12 539–553 Occurrence Handle10.1016/S0887-6185(98)00031-0 Occurrence Handle1:STN:280:DyaK1M%2FpsFSrtg%3D%3D Occurrence Handle9879034
KA Yonkers C Zlotnick J Allsworth M Warshaw T Shea M Keller (1998) ArticleTitleIs the course of panic disorder the same in women and men? Am J Psychiatry 155 596–602 Occurrence Handle1:STN:280:DyaK1c3ks1yjsg%3D%3D Occurrence Handle9585708
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Clayton, A., Stewart, R., Fayyad, R. et al. Sex differences in clinical presentation and response in panic disorder: pooled data from sertraline treatment studies. Arch Womens Ment Health 9, 151–157 (2006). https://doi.org/10.1007/s00737-005-0111-y
- Keywords: Sertraline; panic disorder; sex; inhibitors; serotonin reuptake.