Thank you very much for that.
First of all, I completely agree with my colleagues that medicine isn't always the answer, but sometimes it is. If we are going to medicate, we need to be careful to make sure that we are translating studies correctly.
Years ago, we used to think that children were just little men and women. We used to give them medication based on weight, without understanding their liver and things. Years and years ago, we used to exclude women almost all of the time because of menstruation, because they might get pregnant, because they might get.... We had very good justifications for not including them because you couldn't control for time of month and things like that, but then when the medications get released, we give the same medications to women as well.
The problem ends up being that, when we include and analyze by gender, we tend not to have enough money to have enough women, especially in military veteran studies, and then you don't really report on them because they're not significant.
There have been laws passed in the U.S., such as the NIH Revitalization Act of 1993, but I think these things haven't really been followed. In 2013, the FDA cut in half the dose of Ambien, which is like our zopiclone, because they found out that women were clearing the medication less, which means they had a higher dose in the morning when they were supposed to be up. Guess what? That's when you're driving the kids to school; that's when you're getting breakfast, and so mom is kind of stoned in the morning.
We have to really look at making sure that the studies...that we don't just GBA-analyze and say, “Yes, we've considered it” but actually report on the differences, because menopause happens; pregnancy happens; postpartum depression happens; menstruation happens. That yucky biology does make studies harder, but then we end up applying the medications to those people.
I just think that's really important for us to move forward. The funders can ask for it, but if we end up having 90 men and 10 women, and our differences aren't statistically significant, it's not helpful. That's one of the points I wanted to make, just from a pure biological psychiatry perspective.