A four week randomised control trial of adjunctive medroxyprogesterone and tamoxifen in women with mania

Jayashri Kulkarni; Michael Berk; Wei Wang; Ling Mu; Elizabeth Scarr; Tamsyn E Van Rheenen; Roisin Worsley; Caroline Gurvich; Emorfia Gavrilidis; Anthony de Castella; Paul Fitzgerald; Susan R Davis

doi:10.1016/j.psyneuen.2014.02.004

A four week randomised control trial of adjunctive medroxyprogesterone and tamoxifen in women with mania

Psychoneuroendocrinology. 2014 May:43:52-61. doi: 10.1016/j.psyneuen.2014.02.004. Epub 2014 Feb 14.

Affiliations

¹ Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia. Electronic address: jayashri.kulkarni@monash.edu.
² IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Ryrie Street, Geelong, Victoria 3220, Australia.
³ Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia.
⁴ The Florey Institute of Neuroscience and Mental Health Victoria, Parkville, Victoria 3052, Australia.
⁵ Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia; Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia.
⁶ Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia.

PMID: 24703170
DOI: 10.1016/j.psyneuen.2014.02.004

Abstract

Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone.

Keywords: Bipolar disorder; Mania; Medroxyprogesterone acetate; Schizoaffective disorder; Tamoxifen; Treatment.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bipolar Disorder / drug therapy*
Bipolar Disorder / psychology
Double-Blind Method
Estrogen Antagonists / adverse effects
Estrogen Antagonists / therapeutic use*
Female
Gonadal Steroid Hormones / blood
Humans
Medroxyprogesterone / adverse effects
Medroxyprogesterone / therapeutic use*
Middle Aged
Protein Kinase C / antagonists & inhibitors
Selective Estrogen Receptor Modulators / adverse effects
Selective Estrogen Receptor Modulators / therapeutic use*
Tamoxifen / adverse effects
Tamoxifen / therapeutic use*
Treatment Outcome

Substances

Estrogen Antagonists
Gonadal Steroid Hormones
Selective Estrogen Receptor Modulators
Tamoxifen
Protein Kinase C
Medroxyprogesterone