The estrogen estradiol, in combination with antipsychotic medications,
appears to improve treatment for women with schizophrenia, according to
an article releasedon August 4, 2008 in Archives of General
Psychiatry, one of the JAMA/Archives journals.
Previously, mental illness has been studied in conjunction with many
different hormones, especially estrogen in women. However, the use of
estrogen as a therapy for these diseases has only gained focus
recently. According to the authors, "Epidemiologic observations of sex
differences in the onset and course
of schizophrenia prompted exploration of estrogen's role in
schizophrenia." Estradiol is the member of the estrogen family best
represented in the human body. While it is usually associated with
female secondary sex characteristics, both males and females maintain
levels of estradiol.
To explore this association, Jayashri Kulkarni, M.B.B.S., M.P.M.,
F.R.A.N.Z.C.P., Ph.D., of The
Alfred and Monash University and The Alfred Hospital, Melbourne,
Australia, and colleagues performed a randomized, double blind study in
women of child-bearing age with schizophrenia. A total 102 women were
randomly assigned to one of two groups, receiving the following in
combination with their regular medication regimens: 100 micrograms of
estradiol via a skin patch, or a placebo skin patch. The patients were
evaluated for psychotic symptoms, including hallucinations and
delusions, using a standard scale.
After examination, it was found that in combination with the regular
the estradiol group showed improvement in their psychotic symptoms in
comparison to the group taking the placebo. However, there was also a
decline in the displayed positive symptoms, representing a loss or
distortion of normal functions. In light of this, the two groups had
similar rates of negative symptoms, which might occur when normal
functions are diminished.
The authors suggest some potential mechanistic explanations for this
relationship: "Estrogen's neuroprotective and psychoprotective actions
may be mediated by a variety of routes, ranging from rapid actions,
including antioxidant effects and enhancement of cerebral blood flow
and cerebral glucose utilization, to slower, genomic mechanisms, which
may include permanent modification of neural circuits." They continue,
focusing on the negative symptoms experienced by the women. "The lack
of effect for negative symptoms is consistent with literature reporting
that negative symptoms are less responsive to treatment than other
symptoms of schizophrenia. 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."
The authors note that this therapy might be especially effective for
women affected by schizophrenia who undergo hormonal changes, which
seem to cause deterioration of their conditions. Examples of events
that could cause this are childbirth and menopause. The authors
conclude: "Estrogen treatment is a promising new area for future
treatment of
schizophrenia and potentially for other severe mental illnesses."
Estrogen in Severe Mental Illness: A Potential New Treatment
Approach
Jayashri Kulkarni; Anthony de Castella; Paul B. Fitzgerald; Caroline T.
Gurvich; Michael Bailey; Cali Bartholomeusz; Henry Burger
Arch Gen Psychiatry. 2008;65(8):955-960.
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Anna Sophia McKenney
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