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Women and Schizophrenia

© Ian Chovil

Women have a different experience of schizophrenia then men. In most societies women tend to develop schizophrenia later then men do. I've repeatedly heard that the average age of onset in men is 18 but in women it is 25. Dr. Mary Seeman at the University of Toronto, who has done a lot of research on women and schizophrenia, says women get some protection from estrogens which block dopamine receptors. Blood levels of estrogen in women vary according to their menstrual cycle. Theoretically women should vary the amount of antipsychotic they take in cycle with their period although this is impractical in practice. When a woman is pregnant her estrogen levels are very high, and they rarely have trouble with symptoms until after they have given birth when their estrogen levels drop again.

The net result of estrogen is that generally women experience a much milder schizophrenia then men for the first ten years of their illness. At age 40 women start to enter menopause and estrogen levels drop so that women have a more severe schizophrenia as they get older. The opposite is true for men because their psychotic symptoms tend to fade after they reach age 40.

Dr. Jeffrey Lieberman found that the age of onset in China is the same for men and women, and thinks it may be because men and women marry at a younger age in China. Marriage may be protective for men, in the same way estrogen is for women. Adolescent men and women are in a unique developmental stage. They are primed for childbearing, something the men and women approach quite differently physiologically.

Dr Lieberman has pointed out that typically, women who develop schizophrenia tend to have better premorbid functioning. The length of the prodrome (prepsychotic period of decreased functioning) is shorter, and the progression of the illness tends to be milder. Early in the illness women tend respond more quickly and more thoroughly than men to antipsychotic medication. Men are more likely to have had obstetric problems in their history. Generally schizophrenia is less overtly disabling for women.

As they age though women lose their relative advantage. Dr. Lieberman's group found no gender difference in drug effectiveness in a treatment resistant group of patients. Treatment resistance is to some degree dependent on the duration of the illness and the number of psychotic episodes an individual experiences. There is twice the risk of agranulocytosis for women taking Clozpaine relative to men, which leaves less effective treatment options for women with treatment resistant schizophrenia.

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