Selected Issues in the Psychopharmacologic Treatment of Women with Psychiatric Disorders

Abstract

Although more women than men take psychotropic medications, many studies of these agents have excluded women. Research that has been performed demonstrates significant differences in drug disposition between women and men, as well as some pharmacodynamic differences. Women also may be subject to cyclical alterations in drug levels and action. Concerns have been raised about gender specific adverse effects such as the development of radiologically demonstrated polycystic ovaries in women who start taking valproate before the age of 20. Serotonin reuptake inhibitors seem to be the most reliably effective treatments for premenstrual dysphoric disorder. Some psychotropic medications (e.g., anticonvulsants and monoamine oxidase inhibitors) are clearly risky during pregnancy, while others (e.g., tricyclic antidepressants) seem relatively safe. Some nursing mothers may safely continue psychotropic medications. Hormone replacement therapy is clearly effective for menopausal symptoms, but the use of estrogen for more than 5 years increases the risk of breast cancer.