The Facts About Schizophrenia, Bipolar Disorder and Treatment-Resistant Depression

What women need to know about these mental illnesses

by Ginny Graves
mental illness illustration image
Photograph: Illustration by Gérard Dubois


Classic symptoms Hallucinations, paranoia and delusions.

Who gets it The illness strikes about 1 percent of the population. “There are two ages of onset for women: one in the twenties and thirties, and one in the forties and fifties,” says Catherine Gonzalez, MD, a clinical instructor of psychiatry at Harvard Medical School.

Midlife connection “We think female hormones are somewhat protective, so schizophrenia may first appear in some women as their levels of estrogen begin to ebb,” Gonzalez says.

Most effective treatments The first line of treatment is often atypical antipsychotic medications, such as Zyprexa and Seroquel. Their structure and mechanism of action are different from those of older antipsychotics, and they cause fewer side effects. The downside: Both can cause significant weight gain. “A variety of different types of psychotherapy can also help, including cognitive behavioral therapy and others that teach you skills to cope with stress and daily challenges,” says Gonzalez.

Prognosis The earlier after onset you start taking medicine, the better. Overall, about 25 percent of people see significant improvement, 50 percent -continue to have symptoms but do pretty well, and 25 percent don’t show improvement or actually deteriorate somewhat over time.


Classic symptoms Because persistent low moods are a key symptom, bipolar is often misdiagnosed as depression; many people with the disorder don’t receive appropriate treatment. “What distinguishes bipolar disorder from unipolar depression is one or more episodes of mania: feelings of elation and high levels of activity,” says Dorothy Sit, MD, assistant professor of psychiatry at the University of Pittsburgh School of Medicine.

Who gets it About 1 percent of people. Bipolar 2, which is characterized by frequent episodes of major depression, may be more common in women. Both types of bipolar disorder typically start in childhood or adolescence.

Midlife connection Some experts suggest that symptoms can escalate during the menopausal transition.

Most effective treatments A mood stabilizer like Tegretol, a drug also used for seizure disorders, or lithium, a salt. A typical antipsychotics are commonly prescribed as well. “Lamictal, an anticonvulsant, is good for preventing bipolar depression,” says Sit. A combination of meds and talk therapy may be the best approach.

Prognosis About a third of people achieve significant benefit with medication, about a third can achieve a moderate level of functioning, and about a third don’t respond well to treatments or remain ill because they don’t take their medication.


Classic symptoms This is serious depressionthat doesn’t respond to standard treatments like selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, or serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta.

Who gets it “About 20 to 30 percent of people with depression fail to respond to two trials of medications,” says Wayne Katon, MD, professor of psychiatry at the University of Washington in Seattle.

Most effective treatments For people who appear treatment resistant, “the doctor may augment an SSRI with a drug like Wellbutrin, an antidepressant with a different mechanism,” says Katon. Other medications to augment SSRIs include the newer atypical antipsychotics and mood-stabilizing drugs like Lamictal and lithium. A combination of medication and therapy is often most effective. One backup plan for those who don’t respond: transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells in the brain, or electroconvulsive therapy, which induces a seizure and, after eight to 10 treatments, seems to reset the brain to a happier state.

Originally published in the May 2013 issue

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