Aim:
To compare the efficacy of adjunctive transdermal estradiol with adjunctive placebo in the treatment of acute psychotic symptoms in 100 women with schizophrenia.
Background:
Estrogen has been shown in animal studies to have dopamine downregulation effects and has also been shown to impact the serotonergic system. Additionally, there are clinical case reports of women whose schizophrenic symptomatology is exacerbated at low estrogen phases of the menstrual cycle. Similarly, there are clinical case reports of women with chronic schizophrenia improving during pregnancy when estrogen levels are extremely high.
Methods:
A double-blind, 28-day, placebo-controlled, adjunctive study was conducted comprising two groups of women of childbearing age. While one group of women received 100 mcg transdermal estradiol, the other group received transdermal placebo. The differences in psychopathology between the two groups were subsequently compared. Hormone, psychopathology and cognitive assessments were performed routinely throughout the 4-week trial period.
Results:
Using the Positive and Negative Syndrome Scale (PANSS) rating scale, it was noted that women receiving 100 mcg estradiol improved significantly more in terms of their psychotic symptoms compared with women receiving placebo. Importantly, women who received estradiol improved with regard to positive, negative and general symptoms on the PANSS, in contrast to women on the placebo arm.
Conclusions:
Estradiol appears to be a useful treatment for women with schizophrenia. We are furthering this exciting area of research by conducting a multisite ‘proof-of-concept’ study to determine whether estradiol can be used as an adjunctive treatment of psychotic symptoms in women with schizophrenia.
