The association between hormones and antipsychotic use: a focus onpostpartum and menopausal women

摘要

During the postpartum and menopausal periods of women’s lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogensand selective estrogen-receptor modulators, mainly raloxifene, in addition toantipsychotics. Some symptoms appear to respond better than others. No oxytocinstudy has specifically targeted postmenopausal women. Because of feedbackmechanisms, there is a theoretical danger of therapy with exogenous hormonesinterfering with endogenous secretion and disturbing the balance amonginter-related hormones. When used with antipsychotics, hormones may also affectthe metabolism and, hence, the brain level of specific antipsychotics. Thismakes treatment with antipsychotics plus hormones complicated. Dose, timing androute of intervention may all prove critical to efficacy. While much remainsunknown, this literature review indicates that, within standard dose ranges, thecombination of hormones and antipsychotics for postnatal and menopausal womensuffering severe mental distress can be beneficial, and is safe.