Sex Differences in the Pharmacokinetics and Pharmacodynamics of Antidepressants: An Updated Review

Background: An increasing number of studies have reported differences in the pharmacokinetics and/or pharmacodynamics of antidepressants between women and men. Objectives: This article updates previously published literature describing sex differences in the pharmacokinetics and pharmacodynamics of antidepressants, and examines specific issues that face women with psychiatric illness. Methods: An English-language literature search was performed with the PubMed database (March 2003-December 2008) using combinations of the search terms sex, gender, and antidepressants. In addition, each antidepressant was identified in the 63rd edition of the Physicians' Desk Reference. Results: The current data suggest that the pharmacokinetics of antidepressants can be substantially different between women and men. Likewise, the response to antidepressants can be quite variable, including sex differences in adverse effects and time to response. Conclusions: Despite the many sex differences reported, there is still little published work systematically evaluating potential sex differences in antidepressant pharmacokinetics and pharmacodynamics. More research is needed to guide the treatment of depression and other mental illnesses. (Gend Med. 2009;6:522-543) (C) 2009 Excerpta Medica Inc.