Estrogen–progesterone combination for treatment‐refractory post‐partum mania

Huang, Ming‐Chyi; Wang, Ying-Bing; Chan, Chia-Hsiang

doi:10.1111/j.1440-1819.2007.01782.x

Cited by 15 publications

(14 citation statements)

References 7 publications

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“…A role for neurosteroids in bipolar disorder is also consistent with the observation that a number of anticonvulsants (including valproate, lamotrigine and carbamazepine) are effective in bipolar disorder [82,83], an effect that could be partially due to action on neurosteroids. Therefore endogenous neuroactive steroids with anticonvulsant properties may play a role in the pathogenesis of bipolar disorders.…”

Section: Introductionsupporting

confidence: 78%

GABAergic neuroactive steroids: a new frontier in bipolar disorders?

2012

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Neurosteroids are synthesized in the brain and modulate brain excitability. There is increasing evidence of their sedative, anesthetic and antiseizure properties, as well as their influence on mood. Currently neurosteroids are classified as pregnane neurosteroids (allopregnanolone and allotetrahydrodeoxycorticosterone), androstane neurosteroids (androstanediol and etiocholanone) or sulfated neurosteroids (pregnenolone sulfate and dehydroepiandrosterone sulfate). Both preclinical and clinical findings indicate that progesterone derivative neurosteroids such as allopregnanolone and allotetrahydrodeoxycorticosterone play a role in mood disorders. Clozapine and olanzapine, which were shown to be effective in stabilizing bipolar disorder, elevate pregnenolone levels in rat hippocampus, cerebral cortex, and serum. In lithium-treated mice, the blood levels of allopregnanolone and pregnenolone were elevated compared to control levels. Women diagnosed with bipolar disorder typically show symptomatic exacerbation in relation to the menstrual cycle, and show vulnerability to the onset or recurrence of mood disorders immediately after giving birth, when the levels of neurosteroid derivatives of progesterone drop. Whereas in women who had recovered from bipolar disorder, the plasma concentration of allopregnanolone was elevated compared to either healthy controls or women with major depressive disorder during the premenstrual period. During depressive episodes, blood level of allopregnanolone is low. Treatment with fluoxetine tends to stabilize the levels of neurosteroids in depression. These findings converge to suggest that these steroids have significant mood-stabilizing effect. This hypothesis is consistent with the observation that a number of anticonvulsants are effective therapies for bipolar disorder, a finding also consistent with the antiseizure properties of neurosteroids. Further exploration of action of neuroactive steroids is likely to open new frontiers in the investigation of the etiology and treatment of mood disorders, particularly bipolar disorders.

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Section: Introductionsupporting

confidence: 78%

GABAergic neuroactive steroids: a new frontier in bipolar disorders?

2012

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“…In another case report, this time involving a [34]. The patient remained in remission after the withdrawal of HRT 2 months after treatment initiation [34].…”

Section: Hormone Replacement Therapy In Women Withmentioning

confidence: 92%

“…Chouinard et al reported on 2 case reports of women in their 50s with treatment-resistant bipolar disorder, mainly consisting of depressive/mixed symptoms, who responded to a combination of estrogen and progesterone, while estrogen alone induced mania in one of these women [33]. In another case report, this time involving a [34]. The patient remained in remission after the withdrawal of HRT 2 months after treatment initiation [34].…”

Section: Hormone Replacement Therapy In Women Withmentioning

confidence: 99%

Hormonal Treatments for Bipolar Disorder: A Review of the Literature

Low¹

2012

JBBS

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Hormonal therapies may play a role in the treatment of bipolar disorder. Preliminary evidence suggests that: 1) tamoxifen has anti-manic properties; 2) hormone replacement therapy represents a good augmentation strategy in treatment-resistant peri-menopausal depression; and 3) certain oral contraceptives could prevent menstrual exacerbations of affective symptoms. Potential neurobiological mechanisms of the anti-manic effects of tamoxifen include the inhibition of protein kinase C in addition its anti-estrogenic effects. Estrogen is a serotonergic and adrenergic agonist as well as an agent promoting neurogenesis in the hippocampus through glutamatergic synaptic formation, which may be the basis of its antidepressant activity. Progesterone appears to decrease serotonergic and adrenergic tone and activity, while increasing GABAA receptor activation through its active metabolite allopregnanolone, which may be the basis of its anxiolytic, sedative, and potentially anti-manic properties. Although there is consistency between the evidence for clinical efficacy and neurobiological mechanisms of hormonal treatments, the current state of knowledge relies on studies with several methodological limitations. On the other hand, benefits of hormonal treatment include protection from osteoporosis and several gynecological cancers, as well as safe contraception in a population at-risk for unplanned pregnancy. Nonetheless, hormonal treatments should be reserved for treatment-resistant bipolar depression or mania, or when contra-indications to other psychotropic medications are present. Institution of regular monitoring for medical complications and drug-drug interactions are essential to minimize risks and maximize benefits

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“…Hormon replasmanının tedavide faydalı olduğunu gösteren vaka serileri mevcuttur. Ancak hormonal faktörlerin postpartum psikoz tedavisindeki yerini anlamamız açısından daha fazla çalışmaya ihtiyaç vardır (25). Postpartum psikoz belirtileri uygun tedavi ile yaklaşık 2 ayda tamamen düzelmektedir.…”

Section: öNlemeunclassified

Postpartum psychosis

Çim¹

2017

Van Med J

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Estrogen–progesterone combination for treatment‐refractory post‐partum mania

Cited by 15 publications

References 7 publications

GABAergic neuroactive steroids: a new frontier in bipolar disorders?

GABAergic neuroactive steroids: a new frontier in bipolar disorders?

Hormonal Treatments for Bipolar Disorder: A Review of the Literature

Postpartum psychosis

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