Chapter 8 242 Our findings underscore large gaps in the field of neuroendocrinology and psychiatry: prospective, controlled administration studies on sex hormones and the effect of short-term hormonal changes on sleep and mood are lacking. This is remarkable given that millions of people use hormonal medications worldwide, such as hormonal contraceptives, sex hormone replacement and hormone suppressors. Furthermore, men are underrepresented in this area of research. 4.5. Future recommendations Since sleep problems and depression are common and impact on quality of life, it is useful to understand if and how sex hormones contribute to these problems. Therefore more studies on endogenous sex hormones and exogenous sex hormone changes over time are needed. The studies that were currently included used a wide range of observations and interventions, as a consequence these data were deemed unfit for a meta-analysis. If the body of research in this field grows, this will make it possible to do meta-analyses to assess effects of specific interventions or endogenous hormones on sleep and depression (e.g. hormone suppression, oral contraceptives or endogenous hormone changes). Further studies in this area are warranted to understand which groups may possibly benefit from sex hormone use, and which groups may be more vulnerable for negative effects of changes in sex hormone levels, contributing to the field of “precision psychiatry”. These studies should also take into account that depressive episodes in times of changes in sex hormone levels (such as during pregnancy and postpartum, PMDD or menopause) may have a different entity, which may require different therapeutic approaches. Some sex-specific and sex-sensitive therapeutic approaches for depression and sleeping problems have already been described. It was shown that a single dose of the antipsychotic olanzapine increases SWS and deep sleep in women, whereas it decreases SWS and deep sleep in men (Giménez et al., 2011). The American Food and Drug Administration (FDA) renewed its guideline for the benzodiazepine Zolpidem to a 50% lower dose in women because it metabolizes more slowly in women, the first ever sex-specific guideline for benzodiazepines (Cubała et al., 2010; Food and Drug
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