The Use of Progesterone in the Treatment of Postpartum Psychosis

Schmidt, Harry J.

doi:10.1001/jama.1943.02840030028007

Cited by 23 publications

(6 citation statements)

References 10 publications

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“…The concept of premenstrual mood worsening has been a focus of investigation for decades, with many, 52 – 54 , 57 , 58 , 68 but not all, 7 , 55 , 56 , 156 studies finding some evidence of symptom exacerbation (i.e., mood worsening) in this phase. Indeed, women have been treated with hormonal therapy for improving premenstrual symptoms, 51 , 202 with some success. Ongoing work seeks to better characterize the nature, timing, and mechanisms of changes in depression across the menstrual cycle to help develop and evaluate additional therapies.…”

Section: Resultsmentioning

confidence: 99%

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

Handy

Greenfield

Yonkers

et al. 2022

Harv Rev Psychiatry

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Learning objective After participating in this activity, learners should be better able to: • Discuss and outline the general and overlapping effects of the menstrual cycle on women’s mental health Abstract A growing body of research demonstrates menstrual cycle–dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women’s mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

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Section: Resultsmentioning

confidence: 99%

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

Handy

Greenfield

Yonkers

et al. 2022

Harv Rev Psychiatry

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“…More than 50 years ago, it was suggested in a single case-report that administration of progesterone might prevent the relapse of postpartum psychosis related to the recurrence of the menstrual cycle (Schmidt 1943). Although extrapolations to a putative clinical relevance have to be made with caution in view of the limited usefulness of animal models for the understanding of psychosis and the use of male animals in this study, our data on PPI are compatible with the idea that a sharp drop in progesterone concentrations may contribute to the development and course of psychotic symptoms and that an administration of progesterone as an additive therapy to neuroleptic drugs might be beneÞcial in psychotic disturbances.…”

Section: Discussionmentioning

confidence: 99%

Assessment of neuroleptic-like properties of progesterone

et al. 1999

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There is considerable evidence from epidemiological studies that the onset of psychiatric disorders may be related to changes in the secretion of gonadal hormones. For example, the postpartum period appears to be a vulnerable phase for the occurrence of psychiatric disturbances such as dysphoric mood and even severe psychotic disturbances. It has been suggested that a sudden drop in progesterone concentrations may contribute to the development of such disorders. Because the administration of this steroid might be of therapeutic value in psychiatric disturbances, we investigated the behavioral properties of progesterone in the rat to assess putative neuroleptic-like properties of this steroid. Progesterone administration dose-dependently increased the EEG activity during wakefulness in the 10- to 30-Hz frequency bands and decreased locomotor activity. While no anxiolytic activity could be detected in the plus maze, the highest dose of progesterone (90 mg/kg) exerted an inhibitory effect on the conditioned avoidance response. In contrast to haloperidol (0.5 mg/kg), progesterone neither produced catalepsy nor antagonized amphetamine-induced stereotypy. However, both progesterone (10, 30 and 90 mg/kg) and haloperidol (0.1 mg/kg) effectively restored the disruption of the prepulse inhibition (PPI) of the acoustic startle response (ASR) that was evoked by apomorphine (2 mg/kg). In contrast, allopregnanolone (10 mg/kg), one of the main metabolites of progesterone, did not significantly antagonize the effect of apomorphine on the PPI. This behavioral profile of progesterone is compatible with the sedative properties of its metabolite allopregnanolone via the GABAA receptor, but also with the possibility that progesterone itself shares some properties with atypical antipsychotics, which may be relevant for the development and treatment of psychotic disturbances.

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“…We mention obstetric disease {Weebers, 1893; Paffenbarger et al, 1966;Baker, 1967;Sievers and Grumbrecht, 1972;McNeil and Kay, 1973;Sameroff and Zax, 1973), vitamin deficiencies {de Smit and de Waart, 1962), hormonal changes {Karnosh and Hope, 1937;Billig and Bradley, 1946;Schmidt, 1943;Blumberg and Billig, 1942;Bower and Altschule, 1956;Tucker, 1962;Kane and Keeler, 1965;Swanson et al, 1974;Danowski et al, 1953 and many others), neurological disease (Posthumus Meyes and Sikkel, 1962;Gruñes, 1973;Hanson and Brown, 1973;Huhn and Drenk, 1973), infectious disease (Heidema, 1932;Harris, 1936;Bhattacharya and Uyas, 1969;Swift, 1972), abnormal loss of blood, over-tiredness, thrombosis, etc. The various authors suggested as many thera peutic measures as corresponded to their etiological concept or the com plicating disease {Ebie, 1972;Tucker, 1962;Ballache et al, 1958;Schmidt, 1943).…”

Section: Specificitymentioning

confidence: 99%

Clinical Treatment of <i>post partum</i> Delirium with Perfenazine and Lithium Carbonate

Silbermann¹,

F²,

Jong³

1975

Psychopathology

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Despite the development of psychopharmaceutical therapy, post partum delirium was difficult to treat. The patients remained psychotic for long periods and the course was of the disease capricious due to the many relapses. A comparative study of two groups, one consisting of 6 patients and the other of 13, all with a typical post partum delirium was carried out. The symptomatic treatment of this syndrome with a combination of perfenazine and lithium carbonate produced relatively favorable results in our clinic. For the time being, at any rate, it seems to be the medication of choice.

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The Use of Progesterone in the Treatment of Postpartum Psychosis

Cited by 23 publications

References 10 publications

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

Assessment of neuroleptic-like properties of progesterone

Clinical Treatment of <i>post partum</i> Delirium with Perfenazine and Lithium Carbonate

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