Adjunctive estrogen patches significantly improve positive and negative symptoms of schizophrenia in premenopausal women, new research suggests.

The study, a randomized controlled trial, replicates previous research but also extends it. The beneficial effect of the patch was especially evident in women older than 38 years.  The new findings suggest that estrogen patches should be considered for premenopausal women with schizophrenia

In previous studies, use of the estradiol patch led to improvement in measures of positive symptoms and in scores on the general psychopathology subscale and total Positive and Negative Syndrome Scale (PANSS) in women. In the largest of these studies, a higher dose (200 μg) had greater effects than a lower dose (100 μg).  The study included 200 premenopausal women (mean age, 38 years) who lived in the Republic of Moldova, had schizophrenia or schizoaffective disorder, and were receiving antipsychotic medication.

Participants had to have a total PANSS score of 60 or greater. The mean baseline PANSS score was 82.8, and the mean PANSS positive subscale score at baseline was 19.6, reflecting severe symptomatology.  The primary outcome was change in the positive PANSS subscale score. Secondary outcomes included total PANSS score and changes in negative symptoms.

Positive symptoms of schizophrenia refer to such things as delusions and hallucinations, whereas negative symptoms include lack of initiative and poor social skills that may result in difficulty holding down a job or maintaining relationships. Symptoms on the PANSS are rated from 1 to 7, with 1 being normal.  Participants were randomly assigned to receive either an estradiol patch or a placebo patch. Investigators found that participants in both study groups experienced considerable improvement. At week 8, the mean PANSS positive subscale score was 14.4 in the placebo group and 13.4 in the estradiol group.

The estradiol group had a statistically significant improvement vs placebo in the PANSS positive subscale scores.  What’s really exciting about the data is that researchers found improvements in the positive but also the negative symptoms above and beyond the improvement with antipsychotics. Results for women aged 38 to 45 years were certainly clinically significant.