Association between oestradiol and puerperal psychosis

Objective: Postpartum psychiatric disorders with long-lasting adverse seque lae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present tw o consecutive cases with puerperal psychosis who were refractory to convent ional treatment methods but responded successfully to oestrogen therapy. Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradio l sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. Results: In both cases the baseline oestradiol concentration was low (28 an d 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with t he decline in psychotic symptoms. Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.