Editorial: Sex and the Suffering Brain - A Call for Sex-Stratified Analyses in Psychiatric Research

Barth, Cláudia; Blokland, Gabriëlla A.M.; Riecher‐Rössler, Anita

doi:10.3389/fpsyt.2022.849009

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Our findings also suggest several promising strategies for future drug trials: Comparing the effectiveness of different antipsychotics in postmenopausal women with schizophrenia Recruiting pre- and post- menopausal women in trials of antipsychotic drugs. Stratifying by hormonal status when analyzing results of antipsychotic trials [ 118 ] Comparing D2/D3 occupancy in pre- and post-menopausal women and matched age men in patients being treated for schizophrenia Comparing antipsychotic side effects in pre- and post- menopausal women and men with schizophrenia [ 119 , 120 ]. Studying the effect on antipsychotic requirements of adrenopause in postmenopausal women and men with schizophrenia Studying the effect of sex hormones on the blood–brain barrier for antipsychotic medications [ 121 ] Studying the effect of phytoestrogens [ 122 ] in the diet and xenoestrogens [ 123 ] in the environment on symptoms and antipsychotic requirements in postmenopausal women and men with schizophrenia.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

The Effect of Menopause on Antipsychotic Response

2022

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Background: It has been hypothesized that, whenever estrogen levels decline, psychosis symptoms in women increase. At menopause, this can happen in two main ways: (a) the loss of estrogen (mainly estradiol) can directly affect central neurotransmission, leading to increase in schizophrenia-related symptoms, and (b) the loss of estrogen can decrease the synthesis of enzymes that metabolize antipsychotic drugs, thus weakening their efficacy. Aims and Methods: The aim of this narrative review was to investigate the second possibility by searching PubMed and ClinicalTrials.gov for studies over the last two decades that investigated the metabolism of antipsychotics and their efficacy before and after menopause in women or that studied systemic and local estrogen level effects on the pharmacokinetics and pharmacodynamics of individual antipsychotic drugs. Results: The evidence suggests that symptom level in women with schizophrenia rises after menopause for many reasons beyond hormones but, importantly, there is an estrogen-dependent loss of efficacy related to antipsychotic treatment. Conclusion: Effective clinical intervention is challenging; nevertheless, several promising routes forward are suggested.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

The Effect of Menopause on Antipsychotic Response

2022

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“…Therefore, future trials on LAI-APs should compare the effectiveness not only between men and women, but also between pre- and postmenopausal women, 33 stratifying by hormonal status when analyzing the results. 107 This information should be used in a shared-decision process, involving the patients and their families/partners, to facilitate LAI-APs’ use in a manner that is constructive to the clinician–patient relationship and successful treatment. 49 Until such information is attainable for tailoring treatment decisions, the patient’s sex is valuable immediately available information on which to personalize treatments, 108 and sex-specific drug selection and dose determination has the potential to reduce the overall adverse effects of treatments in clinical practice, 108 namely with LAI-APs.…”

Section: Final Considerationsmentioning

confidence: 99%

Long-acting antipsychotic treatments: focus on women with schizophrenia

Brissos,

Balanzá-Martínez

2024

Therapeutic Advances in Psychopharmacology

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Effective management of schizophrenia (SZ) requires long-term treatment with antipsychotics (APs) to prevent clinical relapse, attain remission and improve patients’ personal and social functioning, and quality of life. Although APs remain the cornerstone treatment for patients with SZ, despite their potential benefits, long-acting injectable APs (LAI-APs) remain underused, most notably in women with SZ. The efficacy and tolerability of APs differ significantly between men and women, and some of these differences are more noticeable depending on the patient’s age and the stage of the disorder. Although sex differences may influence treatment outcomes in SZ, their pertinence has been insufficiently addressed, especially regarding the use of LAI-APs. Some biological and social experiences, such as pregnancy, lactation, contraception and menopause, are specific to women, but these remain under-researched issues. Implications of this disorder in parenting are also of special pertinence regarding women; therefore, taking sex differences into account when treating SZ patients is now recommended, and improving personalized approaches has been proposed as a priority in the management of psychosis. In this narrative, critical review, we address some aspects specific to sex and their implications for the clinical management of women with SZ, with a special focus on the potential role of LAI-AP treatments.

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