Schizophrenia usually affects more men than women, and women usually develop symptoms around five years later than men. Thus far, the treatment for both men and women has been the same.
During her psychiatric training, Jayashri Kulkami, MBBS, PhD, spoke with many schizophrenic women who kept telling her "It's my hormones, Doc." They also told her "No one takes any notice when I say it's to do with my hormones." Dr. Kulkami took notice and she and her colleagues have now completed a series of small studies which shows that estrogen can have a noticeable effect in reducing symptoms such as delusions, hallucinations, and disordered thinking. The findings were from a four-week study of 102 women of childbearing age with diagnosed schizophrenia.
Kulkami and her colleagues at Monash University in Melbourne, Australia used a patch containing estradiol, the most common form of estrogen, for half of the women. They continued to take the normal medications prescribed for their illness. The other half also had a patch, but it contained no active medication.
During the 28 days of the study, the symptoms and feelings of the study subjects were recorded on a weekly basis, and those on estrogen reported less negative changes in their condition.
More than a century ago it was recognized that there was a link between estrogen and mental illness, but it was only recently considered as a possible treatment. The exact affect of hormones on schizophrenia isn't understood, but the researchers said that it might have a swift effect on blood flow in the brain, or the way sugar is used as fuel for the brain. There is also the possibility that the way brain cells communicate with each other was affected. They said that there was a possibility that the hormone might have uses in other mental illnesses in women.
Estrogen has effects throughout the body, including promotion of hormone sensitive breast and cervical cancers. This means that continuing research using estrogen must be done with some caution. Kulkami's team is exploring the use of drugs called selective estrogen receptor modulators or SERMs. They want to see if these drugs exert the same antipsychotic effect as estrogen without the side effects.
The researchers did a brief study treating schizophrenic men with estrogen, and the therapy also seemed to reduce their acute symptoms. Though men do have some natural estrogen introducing too much would bring out effeminate characteristics. The researchers plan a larger study using SERMs in men. SERM trials on women are also planned. At present, Kulkami is focusing on a three-site study of estrogen patches in women of childbearing age with schizophrenia. This study is designed to ensure that the findings of the previous study were not a fluke.
Kulkami said she treats women with estrogen therapy but insures their continued health with Pap smears, breast exams, and blood pressure checks.
Other professionals warn that estrogen therapy appears useful, but much more work is needed before it can be considered safe and effective.
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