Estrogens in Tardive Dyskinesia in Male Psychiatric Patients

Abstract

The beneficial effect of estrogens on L-dopa-induced dyskinesias and on tardive dyskinesia has recently been reported. In this open pilot study, conjugated estrogens (CE) were administered to 20 male chronic psychiatric patients (age range: 29-63). All except 1 were still on neuroleptic medication and 8 of them were still receiving an antiparkinsonian agent. Patients were divided into 4 equal groups. Groups I and II (< 51 years old) received daily CE at different doses (1.25 or 2.50 mg) for a period of 6 weeks. Groups III and IV (> 52 years old) were treated identically. A significant decrease (p < 0.006) in intensity or disappearance of one type of dyskinesia was observed in each group (4 of 5 patients). No definite trend was noted in neuroleptic-induced parkinsonism, or apparent change in the mental condition of the patients. The functioning of the extrapyramidal system reveals itself therefore, increasingly complex if this antidopaminergic action of estrogens is added. Indeed, it had been hypothesized lately that in addition to dopamine and acetylcholine, substances like GABA and enkephalin could also be involved in its regulation. The relationship between dopamine and estrogens is interesting as the presence of catechol estrogens, compounds that might play an important role in neuroendocrine regulation, has been demonstrated in some areas of rat brain. Finally, with respect to hormones, the reported prompt and transitory rise in serum prolactin level after electroconvulsive therapy (ECT) may reflect a possible involvement of endorphins, at least in part, in the therapeutic effect of ECT. The possible influence of this form of treatment on extrapyramidal symptoms in relation with this is briefly discussed.

Extrapyramidal symptoms and oestrogen

“…It has been observed that women suffer more Parkinsonism, akathasia and tardive dyskinesia than men (1,12). Villeneuve et al (13) investigated the effect of oestradiol treatment on extrapyramidal symptoms in males and found a slight reduction in the intensity of dyskinetic movements, but the expected increase in Parkinsonism was not supported by their results. In their discussion they went on to report a single case of a menopausal woman suffering from tardive dyskinesia.…”

Oestrogen and Nigrostriatal Dopaminergic Neurodegeneration: Animal Models and Clinical Reports of Parkinson's Disease

“…In 1978, Villeneuve et al reported that 16 of 20 female patients with dyskinesias showed an improvement in the dyskinesias when treated with oestrogen 56 . A significant decrease in the intensity of neuroleptic‐induced dyskinesias in male psychiatric patients placed on conjugated equine oestrogen was also observed 57 . It has also been shown that administration of exogenous oestrogens affects the onset or severity of l ‐DOPA‐induced dyskinesias.…”

Drugs with Estrogen-like Potency and Brain Activity Potential Therapeutic Application for the CNS

“…After menopause, women require larger doses of neuroleptics and are more at risk to develop more and more severe forms of dyskinesias [41]. Some clinical studies in women with tardive dyskinesia have shown beneficial effects of estradiol [42][43][44][45] whereas other This review will survey the effects of estrogens on mental and neurodegenerative diseases. More specifically we will focus on schizophrenia, depression as well as AD and PD because of their high prevalence and the documented effects of steroids in these diseases.…”