Role of estradiol in puerperal psychosis

Rationale: Postpartum period has been considered a time of increased risk f or the development of psychiatric disorders with long-lasting adverse conse quences. Psychoses are the most severe of these illnesses and can be resist ant to psychiatric medication. Objective: We present two women with puerper al psychosis who had low serum estradiol, were refractory to neuroleptic me dication but responded successfully to estradiol treatment. Methods: Serum estradiol concentration was measured at baseline and during the treatment w ith sublingual 17-beta estradiol. Treatment effect was evaluated using Brie f Psychiatric Rating Scale. Results: Both patients had a low pretreatment e stradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms . Discontinuation of estradiol treatment resulted in a rebound of florid ps ychotic symptoms in both cases. Conclusions: Estradiol may have a causal re lation to postpartum psychosis and significance in the treatment of this il lness.