Role of estradiol in puerperal psychosis

Rationale: Postpartum period has been considered a time of increased risk for the development of psychiatric disorders with long-lasting adverse consequences. Psychoses are the most severe of these illnesses and can be resistant to psychiatric medication. Objective: We present two women with puerperal psychosis who had low serum estradiol, were refractory to neuroleptic medication but responded successfully to estradiol treatment. Methods: Serum estradiol concentration was measured at baseline and during the treatment with sublingual 17-β estradiol. Treatment effect was evaluated using Brief Psychiatric Rating Scale. Results: Both patients had a low pretreatment estradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms. Discontinuation of estradiol treatment resulted in a rebound of florid psychotic symptoms in both cases. Conclusions: Estradiol may have a causal relation to postpartum psychosis and significance in the treatment of this illness.