Positive treatment effect of estradiol in postpartum psychosis: A pilot study

Background: Postpartum illnesses with psychiatric symptoms and serious adve rse sequelae are highly prevalent during the childbearing years. Despite mu ltiple medical contacts, these illnesses often remain unidentified and untr eated. To study the association between estradiol and puerperal psychosis, we measured serum concentration of estradiol and performed an open-label tr ial of physiologic 17 beta-estradiol in women with this disorder. Method: Ten women with ICD-10 psychosis with postpartum onset consecutively recruited from a psychiatric duty unit were studied. Serum estradiol conce ntration was measured at baseline and weekly during sublingual 17 beta-estr adiol treatment for 6 weeks. The treatment effect was evaluated by a clinic ian-rated psychiatric symptom scale (the Brief Psychiatric Rating Scale [BP RS]). Results: The baseline serum estradiol levels (mean = 49.5 pmol/L; range, 13 -90 pmol/L) were even lower than the threshold value of gonadal failure, an d the patients exhibited high scores on the psychiatric symptom scale (mean BPRS total score = 78.3; range, 65-87). During the first week of 17 beta-e stradiol treatment, psychiatric symptoms diminished significantly (BPRS sco re decreased to a mean of 18.8, p < .001). Until the end of the second week of treatment, serum estradiol concentrations rose to near the values norma lly found during the follicular phase, and the patients became almost free of psychiatric symptoms. Conclusion: The reversal of psychiatric symptoms in all patients by treatin g documented estradiol deficiency suggests that estradiol plays a role in t he pathophysiology and may have a role in the treatment of this condition. There was a rebound of psychotic symptoms in the 1 patient who discontinued estradiol treatment. Given the small number of patients, this area deserve s further study.