Hormone modulation: a novel therapeutic approach for women with severe mental illness.
OBJECTIVE
Accumulating evidence describes the effects of oestrogen and other gonadal hormones on the central nervous system and, in particular, on the mental state of women. Evidence supporting the psychotherapeutic effects of exogenous oestrogen has started to emerge only over the past two decades. The purpose of the present paper was to provide an overview of different applications of adjunctive hormones, as treatments for symptoms of severe mental illness in women.


METHODS
Three case reports are presented: in each case the woman selected had participated in large, double-blind, randomized controlled trials exploring hormone modulation. Case study 1 presents a premenopausal woman with schizophrenia, who received an 8 week trial of daily adjunctive 200 microg transdermal oestradiol. Case study 2 presents a postmenopausal woman with schizophrenia on a 12 week trial of adjunctive raloxifene hydrochloride 120 mg per day. Case study 3 presents a woman with schizoaffective disorder, in the manic phase, who received tamoxifen 40 mg per day for 28 days.


RESULTS
Adjunctive oestradiol was associated with an improvement in symptoms of psychosis in a premenopausal woman with schizophrenia; adjunctive raloxifene was associated with an improvement in cognitive functioning in a postmenopausal woman with schizophrenia; and adjunctive tamoxifen was associated with an improvement in symptoms of mania in a woman with schizoaffective disorder.


CONCLUSIONS
These findings are consistent with preliminary research trials suggesting that adjunctive hormone modulation is a promising area of gender-specific treatment for serious mental illness.
Alfred Psychiatry Research Centre, Level 1, Old Baker Building, Alfred Hospital, Melbourne, Vic, Australia 3004. jayashri.kulkarni@med.monash.edu.au
Jayashri
J
Kulkarni
Caroline
C
Gurvich
Heather
H
Gilbert
Fatima
F
Mehmedbegovic
Ling
L
Mu
Natasha
N
Marston
Emmy
E
Gavrilidis
Anthony
A
de Castella
D000279:Administration, Cutaneous; D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D020849:Raloxifene Hydrochloride / Q000008:administration & dosage*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D020845:Selective Estrogen Receptor Modulators / Q000008:administration & dosage*; D013629:Tamoxifen / Q000008:administration & dosage*
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride; D004958:Estradiol