Women and Psychopharmacology

Gail Erlick Robinson, MD, D Psych, FRCP(C)

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In This Article

Abstract and Introduction

Despite the fact that women are the primary consumers of psychotropic medication, little attention has been paid to sex differences in psychopharmacology. Sex differences have been found in the absorption, metabolism, and excretion of many medications. Women tend to respond more favorably to SSRIs than to tricyclics, have more side effects with psychotropic medication, and are more likely to develop tardive dyskinesia. They may also be more concerned about certain side effects such as weight gain from neuroleptic medication. In treating women patients, the clinician must be aware of the possible effect of the menstrual cycle on serum levels of medications. It is also essential to understand the effects of such medication during pregnancy and the postpartum period. Tricyclic and SSRI antidepressants have not been found to cause organic or behavioral teratogenesis when given in pregnancy. Lithium has been associated with Ebstein's anomaly and carbamazepine and valproic acid with the occurrence of neural tube defects. Although small quantities of all psychotropic drugs pass through breast milk, they do not appear to have an immediate effect on the infant. Women also take exogenous hormones. Oral contraceptives differentially affect the blood levels of various benzodiazepines, increasing levels of diazepam, and decreasing levels of temazepam. Drugs such as carbamazepine can interfere with the action of oral contraceptives. Postmenopausal women may require lower doses of antipsychotics. Although hormone replacement therapy in itself does not seem to be a treatment for depression, it may have some benefit in augmenting the effects of antidepressant medication.

Women take more psychotropic medications than men. About two thirds of antidepressants and tranquilizers dispensed in the United States are prescribed to women.[1] Also, more women than men take multiple medications.[1,2] In general, women tend to have more side effects and adverse effects with psychotropic medication than do men.[2] Women's exposure to monthly variations in gonadal hormones may alter the metabolism, distribution, elimination, and, therefore, response to medication. In addition, women become pregnant, breastfeed, go through menopause, and may take hormone replacement therapy (HRT). All of these conditions may have an impact on the psychotropic medication used, dosage required for efficacy, and response. Thus, it is important for the clinician to understand how physiology at various times in the female lifecycle may affect a woman's response to psychotropic treatment.

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