Sophie M Heringa1, Marieke J H Begemann2, Angelique J Goverde3, Iris E C Sommer4. 1. University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: s.m.heringa@umcutrecht.nl. 2. University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: m.j.h.begemann@umcutrecht.nl. 3. University Medical Center Utrecht, Department of Reproductive Medicine and Gynecology, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: a.j.goverde@umcutrecht.nl. 4. University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: i.sommer@umcutrecht.nl.
Abstract
INTRODUCTION: Sex differences in incidence, onset and course of schizophrenia suggest sex hormones play a protective role in the pathophysiology. Such a role is also proposed for oxytocin, another important regulator of reproduction function. Evidence on the efficacy of sex hormones and oxytocin in the treatment of schizophrenia is summarized. METHODS: Double-blind, placebo-controlled, randomized studies were included, examining augmentation with estrogens, selective estrogen receptor modulators (SERMs), testosterone, dehydroepiandrosterone (DHEA), pregnenolone, and oxytocin. Outcome measures were total symptom severity, positive and negative symptom subscores, and cognition. In meta-analyses, combined weighted effect sizes (Hedges' g) per hormone were calculated. RESULTS: Twenty-four studies were included, examining 1149 patients. Significant effects were found for estrogen action (k=10), regarding total symptoms (Hedges' g=0.63, p=0.001), positive (Hedges' g=0.42, p<0.001), and negative symptoms (Hedges' g=0.35, p=0.001). Subgroup analyses yielded significant results for estrogens in premenopausal women (k=6) for total, positive, and negative symptoms, and for the SERM raloxifene in postmenopausal women (k=3) for total and negative, but not positive symptoms. Testosterone augmentation in males (k=1) was beneficial only for negative symptoms (Hedges' g=0.82, p=0.027). No overall effects were found for DHEA (k=4), pregnenolone (k=4), and oxytocin (k=6). Results for cognition (k=12) were too diverse for meta-analyses, and inspection of these data showed no consistent benefit. CONCLUSIONS: Estrogens and SERMs could be effective augmentation strategies in the treatment of women with schizophrenia, although potential side effects, partially associated with longer duration use, should be taken into account. Future trials are needed to study long-term effects and effects on cognition.
INTRODUCTION: Sex differences in incidence, onset and course of schizophrenia suggest sex hormones play a protective role in the pathophysiology. Such a role is also proposed for oxytocin, another important regulator of reproduction function. Evidence on the efficacy of sex hormones and oxytocin in the treatment of schizophrenia is summarized. METHODS: Double-blind, placebo-controlled, randomized studies were included, examining augmentation with estrogens, selective estrogen receptor modulators (SERMs), testosterone, dehydroepiandrosterone (DHEA), pregnenolone, and oxytocin. Outcome measures were total symptom severity, positive and negative symptom subscores, and cognition. In meta-analyses, combined weighted effect sizes (Hedges' g) per hormone were calculated. RESULTS: Twenty-four studies were included, examining 1149 patients. Significant effects were found for estrogen action (k=10), regarding total symptoms (Hedges' g=0.63, p=0.001), positive (Hedges' g=0.42, p<0.001), and negative symptoms (Hedges' g=0.35, p=0.001). Subgroup analyses yielded significant results for estrogens in premenopausal women (k=6) for total, positive, and negative symptoms, and for the SERM raloxifene in postmenopausal women (k=3) for total and negative, but not positive symptoms. Testosterone augmentation in males (k=1) was beneficial only for negative symptoms (Hedges' g=0.82, p=0.027). No overall effects were found for DHEA (k=4), pregnenolone (k=4), and oxytocin (k=6). Results for cognition (k=12) were too diverse for meta-analyses, and inspection of these data showed no consistent benefit. CONCLUSIONS: Estrogens and SERMs could be effective augmentation strategies in the treatment of women with schizophrenia, although potential side effects, partially associated with longer duration use, should be taken into account. Future trials are needed to study long-term effects and effects on cognition.
Authors: Mark Weiser; Linda Levi; Daisy Zamora; Anat Biegon; John Paul SanGiovanni; Michael Davidson; Shimon Burshtein; Ilan Gonen; Paull Radu; Kristina Slobozean Pavalache; Igor Nastas; Rina Hemi; Timothy Ryan; John M Davis Journal: JAMA Psychiatry Date: 2019-10-01 Impact factor: 21.596
Authors: L Kobylinska; A M Panaitescu; G Gabreanu; C G Anghel; I Mihailescu; F Rad; C Nedelcu; I Mocanu; C Constantin; S V Badescu; I Dobrescu; M Neagu; O I Geicu; L Zagrean; A M Zagrean Journal: Acta Endocrinol (Buchar) Date: 2019 Jan-Mar Impact factor: 0.877