Gender Issues and Psychotropic Medication

Here’s a breakdown of the role that gender plays in psychotropic medication response:

Antidepressants: There do not appear to be any significant gender issues in response to antidepressants.

Antipsychotics: Women respond better to antipsychotics during their first episode of illness. They require half as much medication for maintenance than men. Because women have higher body fat content, long acting injections can be given less frequently.

Anticonvulsants: Polycystic ovary syndrome (PCOS) is a metabolic condition that occurs in 7-15% of reproductive-aged women. These women have elevated testosterone, chronic anovulation, insulin resistance, elevated LDL’s with low HDL’s, and a 3x risk of endometrial cancer. (They do not necessarily have polycystic ovaries.) Women with epilepsy and women with bipolar disorder have a high risk of anovulatory disorders and PCOS.

Pregnancy: There is no such thing as a drug that is “no risk” to the fetus. All psychoactive drugs pass through the placenta. All drugs are secreted in breast milk. The more a drug is studied, the more risky it is found to be. Anticonvulsants are especially problematic. Depakote is suspected of causing developmental delays in children without birth defects. Lamictal is now linked to a small incidence of cleft lip and cleft palate (GlaxoSmithKline).

Side effects: Acute dystonia occurs more frequently in women. Tardive dyskinesia is more common in elderly men than elderly women. Men are more disturbed by side effects that detract from their performance. Women are disturbed by side effects that affect their appearance. Women are more likely to gain weight from psychotropics.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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