Sex differences in depressed substance abusers

OBJECTIVE: The main goal of this article is to highlight gender-specific differences in the epidemiology, clinical nature, and treatment responses of comorbid depression and substance abuse. The second goal is to make recommendations for future research in the area of gender-specific aspects of comorbid depression and substance abuse. DATA SYNTHESIS: A literature review was conducted using the keywords sex, gender, depression, and substance use disorders for the time period 1980 to the present. We first outline the well-known sex differences in the epidemiology of depressed substance abusers and discuss the clinical significance of substance abuse in depression. Two distinct ways of understanding the role of substance abuse in depression are presented. The first is the role that depression may play in escalation of substance use, and the second is depression as a common sequela of chronic substance abuse. These 2 manifestations that are not mutually exclusive, often co-occurring in female substance abusers, have important treatment implications. Research on treatment response for the above clinical presentations is discussed followed by a summary of the factors that may influence sex differences in the association between depression and substance abuse. CONCLUSION: Recommendations for future research examining sex differences in animal models of depression, substance abuse, and therapeutic response to medications were made. The need for gender-specific clinical research on the association between depression, stress, and substance abuse is also highlighted.