Role of estradiol in puerperal psychosis

Psychopharmacology (Berl). 1999 Nov;147(1):108-10. doi: 10.1007/s002130051149.


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-beta 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.

Publication types

  • Case Reports

MeSH terms

  • Administration, Sublingual
  • Adult
  • Depression, Postpartum / drug therapy*
  • Depression, Postpartum / psychology
  • Estradiol / administration & dosage
  • Estradiol / blood
  • Estradiol / physiology*
  • Estradiol / therapeutic use*
  • Estrogens / deficiency
  • Female
  • Humans
  • Progesterone / blood
  • Psychiatric Status Rating Scales
  • Radioimmunoassay


  • Estrogens
  • Progesterone
  • Estradiol