In the United States, most drug prescriptions are written for women. The irony is that most clinical drug trials have been conducted on men.
Although that's been slowly changing over the last decade, few if any studies account for how medications may be absorbed differently in women as their bodies ride monthly waves of hormonal changes or undergo such dramatic metamorphoses as pregnancy and menopause. Indeed, drugs that have been proven effective at particular dosages for a man may be ineffective in a woman or cause unwanted side effects due to differences in such factors as muscle-to-fat ratios and enzyme availability.
Psychologists need to keep those facts in mind in order to provide the best psychological care, said Maj. Debra Dunivin, PhD, at a workshop on women and pharmacotherapy during APA's 2001 Annual Convention.
In fact, said Dunivin, deputy chief of the department of psychology at Walter Reed Army Medical Center in Washington, D.C.--and one the nation's few psychologists with the authority to prescribe--psychologists are well-positioned to help monitor the impact of psychotropic medications on patients. With their knowledge of mental health disorders and human behavior, and their skill at conducting detailed patient assessments, psychologists can play a larger role on the health-care team in determining what combination of psychological and pharmacological interventions will best treat a woman with a psychological disorder.
"I hope you realize how effective psychologists are in this kind of work," said Dunivin. "You're used to talking to patients and teaching them how to cope with different situations. This is both a way to improve women's health care and an opportunity for psychologists."
In her presentation, Dunivin gave an overview of the mental health conditions women may experience across their life spans and the medications that might be part of their course of treatment. She emphasized that psychologists must assess several women-specific factors to ensure the best care. They included:
Assessing the possible link between a woman's symptoms to the menstrual cycle. "If a woman tells you that her medication is working differently during different parts of her cycle, pay attention to it and try to get her to chart it," said Dunivin. "Then you can start to see if you need to make some adjustments."
Asking about her pregnancy status, use of contraception and plans for pregnancy. "If pharmacotherapy is a component of treatment during childbearing years, effects of the medication on the developing fetus must be considered," she said. If a women with a psychological disorder is pregnant, "psychotherapy and psychosocial interventions should take preference over any pharmacotherapy whenever possible." Sometimes the risks of not treating may outweigh the risks of treatment, she noted. "Again, this is an area where psychologists are very effective in helping a woman to make this kind of complicated decision. In some cases, the goal is not to cure, but to maintain psychological stability, while minimizing the risk to the developing fetus."
Assessing the patient's medication regimen, including use of over-the-counter medications. Find out what medications a patient is taking--a point that is important to treatment regardless of gender. Such an analysis can help determine whether a patient's symptoms are related to a mental health condition or are drug side effects. For example, decongestants, steroids, aspirin and ibuprofen may cause side effects that are also symptoms of anxiety or panic, such as nervousness and sweating.
These topics, said Dunivin, illustrate just how well psychologists can incorporate knowledge of clinical psychopharmacology into their psychological practices. "I hope it will stimulate ideas about how you might utilize such information in your research and practice activities," she said.
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