This thesis of Bodyl Brand challenges if we are doing enough when we treat women with schizophrenia- spectrum disorders (SSD) as if they were equal to men, by investigating the impact of sex and sex hormones on the disorder. While the widespread effects of the female sex hormone estrogen in SSD have been well-established, they have not been translated into current treatment strategies.
In women, certain antipsychotics lower estrogen levels, which can affect physical and mental health. Both sex and sex hormones influence the efficacy of antipsychotics in the brain, and the way they are broken down in the body. Current guidelines fail to consider these sex-specific effects, leaving women more susceptible to adverse events. Menopause adds another layer of complexity, being associated with reduced treatment tolerability and effectiveness. The latter was demonstrated in a cohort study showing that women are more vulnerable to be hospitalized for psychosis after reaching menopausal age, suggesting that current antipsychotic treatment options may be insufficient for postmenopausal women.
The second part of this thesis conveys a more positive message. Results from a clinical trial demonstrate that addition of the estrogen-like compound raloxifene significantly improves outcomes in women only. This clinical evidence for estrogen’s protective effects was then translated into real-world settings by another cohort study, revealing that estrogen-based menopausal hormone therapy reduces the risk of relapse to psychosis. Overall, this thesis highlights the importance of sex-specific treatment approaches for SSD, showing how estrogen’s protective effects can be harnessed to improve outcomes for female patients.
