Psychopharmacology and Women

Abstract

Psychopharmacological treatment has been one of the main therapeutic alternatives in psychiatry in the last five decades. However, some issues regarding the peculiarities of the populations being treated have been neglected throughout this history. Women represent the majority of patients with psychiatric diagnoses and also predominate among users of psychoactive drugs. However, since the preclinical development of the drugs, there has been a trend toward standardization of drug indications and doses, which clearly does not consider the differences between sexes. The complexity of women’s hormonal physiology translates into mood instability related to the menstrual cycle, the extremely complex physiological changes of pregnancy, and, finally, menopause. The purpose of this chapter is to review the peculiarities of psychopharmacological treatment in women. In order to achieve this objective, the following structure was adopted: section “Introduction” is meant to provide a brief introduction to the topic, section “Pharmacodynamics and Women” to cover pharmacodynamics and address gender differences regarding the mechanisms of action, and section “Pharmacokinetics and Women” to discuss pharmacokinetics and to review peculiarities in terms of absorption, distribution, metabolization, and excretion. In section “Specific Groups of Drugs and Gender Differences in Psychopharmacology, " we discuss specific issues about the main classes of psychotropic drugs in nonpregnant women in the period between puberty and menopause, and in section “Psychopharmacological Issues in Pregnancy and Breastfeeding, " we address psychopharmacological treatment in pregnancy and breastfeeding. Finally, in section “Conclusion, " we have the chapter completion, summarizing the relevance of the previously described issues.