Sex Differences in Antidepressant Acceptability According to Filled Prescription Sequences in a Nationwide Cohort Study

Charles Ouazana Vedrines, MD; Nicolas Hoertel, MD, PhD; Thomas Lesuffleur, MSc; Pierre Denis, MSc; Mark Olfson, MD, PhD; Carlos Blanco, MD, PhD; Frédéric Limosin, MD, PhD; Antoine Rachas, MD, PhD; Philippe Tuppin, MD, PhD; Cédric Lemogne, MD, PhD

J Clin Psychiatry 2024;85(4):23m15128

Abstract

Objective: The prevalence of depressive and anxiety disorders is higher in women than in men. In contrast, there is still no clear consensus on the existence of sex-related differences in the effectiveness of antidepressant treatments for these disorders. This real-world study used filled prescription sequences to compare antidepressant medications between women and men at a medication level according to their acceptability (ie, combination of efficacy and tolerability).

Methods: In a nationwide cohort from the French national health data system (Système National des Données de Santé [SNDS]), 1.2 million people were identified as new antidepressant users for any condition in 2011. The outcome was clinical acceptability as measured by the continuation/change ratio over the 6- month period following the introduction of the first-line treatment. Continuation was defined as at least 2 refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood stabilizer. Adjusted odds ratios (aORs) were computed through multivariable binary logistic regressions.

Results: Overall, after the first prescription of an antidepressant, the continuation/ change ratio was slightly higher for women than men (aOR [95% CI], 1.06 [1.05–1.08]), with escitalopram ranking first in both. Sex-by-medication interactions were significant for paroxetine (0.91 [0.88–0.95]) and fluoxetine (1.19 [1.12–1.26]) only. Specifically, fluoxetine was significantly more acceptable in female than in male participants (0.73 [0.70–0.75] vs 0.63 [0.60–0.67]), whereas paroxetine was more acceptable in male than in female participants (0.75 [0.72–0.78] vs 0.68 [0.66–0.70]).

Conclusion: These real-world data may help practitioners and policymakers prioritize choice of antidepressant medications in women and men.

J Clin Psychiatry 2024;85(4):23m15128

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