Women With Schizophrenia May Benefit From Adjunctive Estrogen

Adjunctive, transdermal estradiol significantly reduces the positive and general psychopathologic symptoms of acute or chronic schizophrenia in women of childbearing age, according to a clinical study published in this month's Archives of General Psychiatry. The assessment of supplemental estrogen in schizophrenia is based on long-term observations of the delayed onset of disease in women, improved symptoms during pregnancy, and postpartum deterioration.

In the double-blind Australian study, women with acute or chronic schizophrenia (inpatients, 29; outpatients, 73) received randomly assigned transdermal estradiol 100 µg (n = 56) or transdermal placebo (n = 46) for 28 days, in addition to standard psychiatric treatment. Estradiol effects on symptoms were assessed weekly with the standard Positive and Negative Syndrome Scale (PANSS). Despite improved positive symptoms (eg, hallucinations) at 28 days, there was no effect on the negative symptoms (eg, avolition) of schizophrenia.

Larger and longer studies are necessary to confirm these short-term study results and to assess the risk of the known adverse events of estrogen in a population that routinely smokes and is treated with dopamine-blocking antipsychotics. Moreover, stratifying results on the basis of disease state (acute vs chronic) is needed, given the differential effect of short-term estrogen on positive symptoms in this study. Whether estrogen supplementation is worthwhile in men with schizophrenia is a trickier prospect for obvious reasons.

Image of estradiol patch from Mylan.