Pigott T A
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, 77555-0191, USA.
J Clin Psychiatry. 1999;60 Suppl 18:4-15.
Women are more likely than men to develop anxiety disorders. Yet, relatively few studies have investigated whether women with anxiety disorders have characteristics that are distinct from those of men with the same disorders. The cause of the enhanced vulnerability to anxiety for women remains largely undetermined. Recent data suggest that female reproductive hormones and related cycles may play an important role. In addition to etiologic functions, reproductive hormones may substantially influence the clinical course of preexisting anxiety conditions in women. Psychotropic medications are more likely to be prescribed to women, and gender differences have been identified in the pharmacokinetics of psychotropic medication. Yet, relatively few systematic data are available concerning the potential clinical relevance or possible treatment implications of gender differences in the treatment of women with anxiety disorders. This article reviews the unique characteristics of primary anxiety disorders in women, summarizes the neurobiological effects associated with estrogen and progesterone, discusses gender differences in medication metabolism and the potential relevance of these differences in the pharmacologic management of women with anxiety disorders, and reviews issues specific to women (e.g., hormone therapy, oral contraceptives, menstrual cycle, pregnancy, lactation) that may impact treatment with psychotropic medication.
女性比男性更易患焦虑症。然而，相对较少的研究调查了患有焦虑症的女性是否具有与患有相同疾病的男性不同的特征。女性对焦虑症易感性增强的原因在很大程度上仍未确定。最近的数据表明，女性生殖激素和相关周期可能起重要作用。除了病因学作用外，生殖激素可能会对女性已有的焦虑状况的临床病程产生重大影响。精神药物更有可能开给女性，并且在精神药物的药代动力学方面已发现性别差异。然而，关于在治疗患有焦虑症的女性时性别差异的潜在临床相关性或可能的治疗意义，相对较少有系统的数据。本文回顾了女性原发性焦虑症的独特特征，总结了与雌激素和孕激素相关的神经生物学效应，讨论了药物代谢中的性别差异以及这些差异在患有焦虑症女性的药物治疗中的潜在相关性，并回顾了可能影响精神药物治疗的女性特定问题（例如，激素治疗、口服避孕药、月经周期、怀孕、哺乳）。
