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A Potential New Treatment Approach

Jayashri Kulkarni, MBBS, MPM, FRANZCP, PhD; Anthony de Castella, MAppSci; Paul B. Fitzgerald, MBBS, MPM, PhD, FRANZCP; Caroline T. Gurvich, PhD; Michael Bailey, PhD; Cali Bartholomeusz, MAppSci; Henry Burger, MBBS, FRACP, MD

Arch Gen Psychiatry. 2008;65(8):955-960.

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 µg 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 µg of transdermal estradiol significantly reduced positive (P < .05) and general psychopathological (P < .05) symptoms during the 28-day 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.

Trial Registration  clinicaltrials.gov Identifier: NCT00206570

Author Affiliations: Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychology, Psychiatry, and Psychological Medicine (Drs Kulkarni, Fitzgerald, and Gurvich; Mr de Castella; and Ms Bartholomeusz); Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Dr Bailey); and Prince Henry's Institute, Monash Medical Centre (Dr Burger), Melbourne, Australia.

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