Schizophrenia: Women Bear a Disproportionate Toll of Antipsychotic Side Effects

Abstract

BACKGROUND: Men and women with schizophrenia suffer not only from their illness but also from the side effects of their medications. OBJECTIVE: To review the toll of antipsychotic side effects specifically on women. STUDY DESIGN: A review of the literature in the PubMed database since 1990 using search terms: sex difference, antipsychotics, schizophrenia, pharmacokinetics, pharmacodynamics, and pharmacogenomics and retrieving additional publications from the reference lists of the original articles. RESULTS: Findings suggest that, because of differing pharmacokinetics, women are more vulnerable than men to weight gain secondary to antipsychotics and to the consequences (metabolic, cardiovascular, reproductive) of weight gain. They are also more vulnerable to hyperprolactinemia and QTc prolongation. CONCLUSIONS: Dosing guidelines need to be critically appraised. The greater toll of side effects in women may undermine adherence to prescribed treatments, add to the stigma that attaches to mental illness, and diminish the quality of women’s lives. Side effects increase the cost of mental illness and heighten the burden experienced by caregivers. They exacerbate morbidity and raise mortality rates. They affect the children of women treated with antipsychotic medication.