Estrogen in severe mental illness - A potential new treatment approach

Context: Accumulating evidence suggests that estrogens may have therapeutic effects in severe mental illnesses, including schizophrenia, via neuromodulatory and neuroprotective activity. Objective: To compare the efficacy of adjunctive transdermal estradiol with that of adjunctive placebo in the treatment of acute psychotic symptoms. Design: Randomized, double- blind study. Setting: Patients were recruited from inpatient acute hospital wards and outpatient clinics of 2 metropolitan Melbourne general hospitals. Participants: One hundred two women of childbearing age with schizophrenia. All participants were in an acute or chronic phase of their illness; 73 participants were outpatients and the rest were inpatients. Intervention: Patients were randomized to receive 100 g of transdermal estradiol ( n= 56) or transdermal placebo ( n= 46) for 28 days. Main Outcome Measures: Psychopathological symptoms were assessed weekly with the Positive and Negative Syndrome Scale. Results: The addition of 100 mu g of transdermal estradiol significantly reduced positive ( P <. 05) and general psychopathological ( P <. 05) symptoms during the 28day trial period compared with women receiving antipsychotic medication alone. Conclusion: Estradiol appears to be a useful treatment for women with schizophrenia and may provide a new adjunctive therapeutic option for severe mental illness.