Effective treatments and timely diagnoses are important factors in managing mental health and neurodevelopmental disorders. Existing research has identified both physical differences in the brain and differences in symptom presentation that relate to sex. While studies that include both men and women have become far more common, much of our understanding of mental illnesses is based on studies that mainly had male participants. Continued research into these sex differences and their effects is crucial to improve treatment approaches.
The article “Sex differences in the transcription of glutamate transporters in major depression and suicide” (Powers et al., 2020) examines how the expression of vesicular glutamate transporters (VGLUTs) and excitatory amino acid transporters (EAATs), differs between male and female subjects with major depressive disorder (MDD). Though the underlying mechanisms of MDD are not well understood, many studies have found evidence that the disorder varies between females and males. The results of this research also support the idea that there are significant differences. Through the analysis of glutamate transporter expression, it was found that EAAT2, VGLUT1, and VGLUT2 had increased levels of expression in the female subjects with MDD compared to the controls. Similarly, when examining the female MDD suicide group, expression was once again higher compared to the female controls. However, there was no significant difference found when comparing the MDD nonsuicide and suicide male groups to the male control. Based on this, the researchers concluded that abnormalities in the expression of glutamate transporters may contribute to why women are diagnosed with MDD more often than men and report more severe symptoms. This study demonstrates the importance of further research into sex differences and the potential for more effective treatments that target mechanisms specific to a patient’s sex.
In addition to sex differences in the neural mechanisms underlying disorders, understanding how symptom presentation varies between men and women is also important. Research conducted by McDonnell et al. (2021) investigated what factors impact the age of diagnosis (AOD) and age of first concern (AOC) in children with autism spectrum disorder (ASD). The importance of their research is illustrated by the impact of early identification and intervention, which can lead to more positive outcomes for people with ASD. The study included 365 children who already had a diagnosis of ASD and the data was analyzed for trends related to sex, cognitive ability, and other demographic factors. The results showed that although the age of first concern was similar between boys and girls, female participants had a later age of diagnosis, particularly if they also had a high verbal IQ. Since other demographic factors could not explain the differences between AOD in girls and boys, the researchers concluded that it is more difficult to identify autistic traits in females given the current diagnostic approaches. One theory that could explain the variation in symptom presentation is that girls are better at camouflaging their symptoms than boys. In addition to making it harder for clinicians to identify ASD, masking can have harmful effects. This study exposes the need for revision of diagnostic criteria, which are predominately based on male symptom presentation, to improve outcomes for girls with ASD.
The studies done by Powers et al. (2020) and McDonnell et al. (2021) both demonstrate that further research into sex differences in neurological illnesses is essential to effectively treat patients. Since both studies involved humans, many additional variables could not be controlled and may have influenced results. The findings of these experiments should be replicated to support their validity. Future studies investigating the effect of a patient's sex on their illness would be very beneficial for improving diagnostic criteria and treatment approaches.
Sources:
Christina G. McDonnell, Elizabeth A. DeLucia, Elizabeth P. Hayden, Melanie Penner, Kristina Curcin, Evdokia Anagnostou, Rob Nicolson, Elizabeth Kelley, Stelios Georgiades, Xudong Liu & Ryan A. Stevenson (2021) Sex Differences in Age of Diagnosis and First Concern among Children with Autism Spectrum Disorder, Journal of Clinical Child & Adolescent Psychology, 50:5, 645-655, DOI: 10.1080/15374416.2020.1823850
Powers, B. E., Joyce, C., Kleinman, J. E., Hyde, T. M., Ajilore, O., Leow, A. D., & Sodhi, M. S. (2020). Sex differences in the transcription of glutamate transporters in major depression and suicide. Journal of Affective Disorders, 277, 244–252. https://doi.org/10.1016/j.jad.2020.07.055
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