Estrogene Effects in Psychiatric Disorders

A number of studies, mostly focusing on estrogen replacement therapy in women, have reported beneficial actions of these hormones on various neurobiological and neuropathological parameters in health and disease. Recent research has focused on gender differences and there is increasing evidence that estrogens exert protective effects in schizophrenia. Hormonal fluctuations or lack of estrogen may increase the risk of depression among vulnerable women. Treatment of depression with estrogen may stabilize and restore disrupted homeostasis – as during post-partum, premenstrual, or perimenopausal conditions – and act as a psychomodulator to offset vulnerability to dysphoric mood when estrogen levels are significantly decreased, as in the case of postmenopausal women. Studies on the effect of estrogens on Alzheimer’s Disease are still rather controversial, they do, however, facilitate the hypothesis that estrogens may have a modifying effect on the onset and course of AD, at least in subgroups of patients.

The study of the effects of gonadal hormones in the brain focussed mainly on reproductive actions for a long time. Meanwhile, however, it is well known that gonadal hormones, in particular estrogens, also have neuroprotective and psychoprotective properties. They modulate many brain functions such as cognitive functions, pain regulation, motor coordination, and epilepsy, as well as affective and psychotic disorders, to name just a few. In fact, during the past few years we have experienced a major change in our understanding of the endocrinologic aspects of psychiatric disorders. Endocrinologic irregularities in psychiatric patients are no longer viewed as pure epiphenomena but rather discussed as part of the pathomechanism of the disorders.

How exactly estrogens affect various disorders is a fascinating and intriguing aspect of this emerging field of non-reproductive brain actions of gonadal hormones. Among the estrogens, especially estradiol appears to play an important and multimodal role in the brain. Which of estradiol’s many membrane, intracellular, and genomic actions matters most in psychiatric disorders, remains to be discovered.

The aim of this volume is to summarize the role estrogens play in major psychiatric disorders, such as schizophrenia, depression, and dementia, and to provide a state-of-the-art overview of current knowledge, but also of questions that are still open. It is intended to be a resource for clinicians and readers who are interested in contemporary research developments in this field.

Doody Review Services

Reviewer:Raj Tummala, MD(Wyeth Pharmaceuticals)
Description:This is a comprehensive overview of the role of estrogens in the pathophysiology of psychiatric disorders. Special focus is on the effects of estrogen in schizophrenia, affective, and cognitive disorders.
Purpose:The purpose is to present an overview of the latest thinking on the effects of nonreproductive functions of gonadal hormones on psychiatric illness.
Audience:This review is meant for students, researchers, clinicians, psychiatrists, and gynecologists as well as anyone interested in women's health. The book is very well written and is a worthwhile contribution to the field.
Features:It is thought that there is a correlation between endocrine abnormalities and psychiatric disorders. The differences in epidemiology of psychiatric disorders between men and women strongly point to role of gonadal hormones in their etiology. These endocrine abnormalities are no longer viewed just as occurrences but as a part of the pathophysiology of psychiatric disorders. The book is divided into three sections that cover the effects of estrogen on schizophrenia, affective disorders, and cognitive disorders. These three clinical sections are prefaced by a well-written chapter on the basic mechanisms of estrogen on various cellular processes including the modulation of neurotransmitters. Information is supplemented with high quality illustrations, graphs, tables, and recent references. The section on schizophrenia pays special attention to gender differences and estrogen replacement treatment. Clinical information is supported by clinical estrogen trials that show the levels of estradiol during the various phases of the menstrual cycle in women with schizophrenia. The hypoestrogenism secondary to antipsychotics is also addressed. The role of estrogen in depression in women is discussed with an emphasis on premenstrual, perinatal, and perimenopausal implications both from a clinical and research perspective. There has been some recent evidence that estrogen replacement might affect the onset and progression of dementia. The authors address this issue with recent clinical trial information.
Assessment:This is a comprehensive review of the latest information on the effects of estrogen on psychiatric disorders. I would highly recommend it to anyone involved in women's health initiatives and mental health.