Antidepressant prescribing in transgender and nonbinary individuals diagnosed with gender dysphoria and mood or anxiety disorders

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Mind the Gap: Many Trans and Nonbinary Adults with Mental Health Issues Miss Out on Antidepressants

This retrospective, single-center study found that 38% of transgender and nonbinary (TGNB) adults diagnosed with gender dysphoria and co-occurring mood or anxiety disorders did not have an active antidepressant prescription at the time of their gender dysphoria diagnosis. While antidepressant prescribing rates were similar across gender identities, transgender females were more often prescribed bupropion, and transgender males had significantly higher rates of generalized anxiety disorder. This highlights a potential gap in mental health care for TGNB adults and warrants further investigation.

Possible Conflicts of Interest

None identified

Identified Weaknesses

Retrospective Study Design

The study collected data from the past, meaning it cannot establish cause-and-effect relationships or account for all variables that might influence prescribing decisions.

Single-Center Study

All data came from one academic health system, limiting the generalizability of the findings to a broader population or other healthcare settings.

Lack of Comparator Group for Power Calculation

The authors noted the absence of a comparator group, which is crucial for calculating statistical power and confirming the robustness of the study's findings.

Inability to Confirm Etiology of Mood/Anxiety Symptoms

The study could not determine if gender dysphoria was the underlying cause of patients' mood and anxiety symptoms, potentially confounding the results related to antidepressant prescribing.

Unaccounted Confounding Variables

The study did not account for other factors that might alleviate depression and anxiety symptoms, such as gender-affirming care (hormones, surgery), psychotherapy, or other somatic treatments, which could explain why some patients weren't on antidepressants.

Snapshot of Prescribing at GD Diagnosis

The study only captured antidepressant prescribing at the time of gender dysphoria diagnosis, not the full trajectory of mental health treatment, potentially missing subsequent prescribing or reasons for non-prescription.

Limited Sample Size for Subgroup Analysis

While n=131 is reasonable for an exploratory study, it might be too small for robust subgroup analyses across different gender identities and specific antidepressant classes, leading to potentially underpowered findings.

Rating Explanation

This exploratory, retrospective single-center study provides valuable initial insights into antidepressant prescribing patterns in transgender and nonbinary individuals. While it identified a significant potential gap in mental health care, its methodology has several limitations, including its retrospective nature, single-center design, and inability to account for confounding factors like gender-affirming care, which reduce the generalizability and causal inference of its findings.

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