Hormone patch improves schizophrenia symptoms

Medical Tribune October 2008 P5
David Brill

Estrogen – often blamed when women behave irrationally or emotionally – could in fact turn out to be an effective treatment for those with mental illness.

Researchers from Australia have shown that estradiol, delivered in the form of skin patches, can alleviate psychotic symptoms in schizophrenic women of childbearing age.

In a randomized trial with 102 participants, those given the patches alongside their regular medications showed significant reductions in both positive and general psychopathological symptoms compared to those on placebo. In many cases the effects were rapid, with hallucinations improving within 2 or 3 days of starting treatment. Improvements in memory and the ability to think clearly about complex issues were also commonly reported following treatment.

Professor Jayashri Kulkarni, who led the study, said that the benefits of hormone therapy might extend to other mental illnesses such as postnatal depression.

She added that further research into the role of estrogen for treating schizophrenia is still needed, but suggested that the hormone could already be used for certain women who have reached a plateau with antipsychotic drugs.

“Even as the data stand there is enough to suggest that for women who have tried standard treatments and haven’t made a brilliant recovery, it is possible and useful for clinicians in everyday practice to think about using a hormonal approach,” said Kulkarni, who is director of the Alfred Psychiatry Research Centre at The Alfred and Monash University in Melbourne. She added, however, that close monitoring for the long-term side effects of estrogen therapy would be needed in such cases.

Participants in the trial were assigned in a double-blind fashion to receive transdermal patches – containing either placebo or 100 μg estradiol – alongside their regular antipsychotics. [Arch Gen Psychiatry 2008 Aug;65(8):955-60]

The trial lasted for 28 days. No notable differences in adverse effects were recorded between the estradiol and placebo groups. Outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS).

The mechanisms for the estrogen effect are unclear, but the researchers suggest that the hormone could rapidly enhance blood flow to the brain and improve cerebral glucose metabolism. Alternatively the effect may be mediated through modulation of the dopamine or serotonin neurotransmitter systems, or through the remodeling of neural pathways, they wrote.

“The other thing that was really interesting was that we didn’t have much problem recruiting for the study,” Kulkarni added.

“Many women patients have intuitively noted a change in their body menstrual cycle and associated that with changes in their mental state, so when we offered something
that seemed to fit with that sort of intuition it was really taken up very well by the patients,” she said.