Do Gender and Ethnicity Affect Depression Treatment Response?

Although widely practiced, psychodynamic psychotherapy has not often been tested. Colleagues and I conducted the first randomized, placebo-controlled efficacy trial of supportive-expressive therapy (SET, a manualized form of short-term dynamic therapy) versus contemporary antidepressant therapy (an SSRI, followed by an SNRI if patients did not respond after 8 weeks).

Patients with depression (N=156) were randomized to 16 weeks of SET, SSRI/SNRI, or placebo conditions. Of the sample, 41% were male, 52% were self-designated as minority, and 76% had incomes of $30,000 per year or less.

All treatments showed evidence of improvement over time on the Hamilton Rating Scale for Depression; rate and magnitude of change were similar. Even among the more severely depressed patients, no significant differences emerged between treatments.

Because we randomized a large number of minorities and men, we decided during the study to examine the role of these factors. We found a significant interaction between minority status and gender on outcome, indicating that minority men improved more rapidly with SET compared to both SSRI/SNRI and placebo. For white men, placebo led to greater improvement than either of the active treatments. For minority women, no differences among treatments emerged. For white women, our expectations were supported, in that SSRI/SNRI and SET were both more effective than placebo. Income and education did not alter the findings, suggesting that those aspects of socioeconomic status did not influence our results.

Thus, it seems that for inner-city, low-income depressed patients, our treatments were not very effective. Nevertheless, differences did emerge in regard to the impact of minority status and gender on treatment outcome. Our results await replication; perhaps other researchers can conduct similar analyses on their trial data. What have your clinical experiences been?

Financial disclosure:Dr Barber has received honoraria for giving grand rounds, receives royalties from Guilford Press and Cambridge University Press, and received research funding from the National Institute of Mental Health and free study medication from Pfizer.​