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Estradiol effective for women with schizophrenia
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Women with schizophrenia assigned to estradiol showed greater improvement in psychotic symptoms than women assigned to antipsychotic medications alone, according to recent data.
“Estrogen treatment is a promising new area for future treatment of schizophrenia and potentially for other severe mental illnesses,” the researchers from Melbourne, Australia wrote.
The researchers assigned patients to either 100 mcg of adjunctive transdermal estradiol (n=56) or transdermal placebo (n=46) for 28 days.
Estradiol reduced general psychopathological symptoms and positive symptoms which represent a distortion of normal functions (P<.05). There was no difference for negative symptoms which occur when normal functions are lost or diminished.
The lack of effect for negative functions was consistent with literature indicating that these symptoms are less responsive than other schizophrenia symptoms, according to the researchers.
“It is possible that longer-term treatment is required for negative symptoms to respond to treatment; alternatively, brain regions implicated in negative symptoms may be less responsive to gonadal hormone effects,” they wrote.
Arch Gen Psychiatry. 2008;65:955-960.
The recent study by Kulkarni and colleagues demonstrated that estrogen can be a useful treatment option for women with schizophrenia, a common and debilitating psychiatric condition. Although the exact mechanism for this benefit is not clear, the study is consistent with epidemiologic evidence that women with schizophrenia tend to have better outcomes than men with the condition (although there is no sex predilection to getting the disorder) and that symptoms fluctuate with the menstrual cycle in some women. Estrogen, of course, has multiple other effects throughout the body, and is not likely to be a major treatment approach in schizophrenia in women and even less so in men. But this study is important in that it proves the principle of estrogen's anti-schizophrenia activity. Future work may show that estrogen receptor modulating agents have more specific and beneficial effects.
– Dost Öngür, MD, PhD
Director, Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, Mass.
Assistant Professor of Psychiatry, Harvard Medical School, Boston