Khan Mohammad M
Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Zawia, P.O. Box 16418, Az-Zawiyah, Libya.
Int J Endocrinol. 2018 Oct 8;2018:9516592. doi: 10.1155/2018/9516592. eCollection 2018.
Accumulating data from various clinical trial studies suggests that adjuvant therapy with ovarian hormones (estrogens) could be effective in reducing cognitive deficit and psychopathological symptoms in women with psychiatric disorders. However, estrogen therapy poses serious limitations and health issues including feminization in men and increased risks of thromboembolism, hot flashes, breast hyperplasia, and endometrium hyperplasia when used for longer duration in older women (aged ≥ 60 years) or in women who have genetic predispositions. On the other hand, selective estrogen receptor modulators (SERMs), which may (or may not) carry some risks of hot flashes, thromboembolism, breast hyperplasia, and endometrial hyperplasia, are generally devoid of feminization effect. In clinical trial studies, adjuvant therapy with tamoxifen, a class of SERM, has been found to reduce the frequency of manic episodes in patients with bipolar disorder, whereas addition of raloxifene, a class of SERM, to regular doses of antipsychotic drugs has been found to reduce cognitive deficit and psychological symptoms in men and women with schizophrenia, including women with treatment refractory psychosis. These outcomes together with potent neurocognitive, neuroprotective, and cardiometabolic properties suggest that SERMs could be the potential targets for designing effective and safer therapies for psychiatric disorders.
来自各种临床试验研究的越来越多的数据表明，用卵巢激素（雌激素）进行辅助治疗可能有效减少患有精神疾病的女性的认知缺陷和精神病理症状。然而，雌激素疗法存在严重的局限性和健康问题，包括在老年女性（年龄≥60岁）或有遗传易感性的女性中长时间使用时男性女性化以及血栓栓塞、潮热、乳腺增生和子宫内膜增生风险增加。另一方面，选择性雌激素受体调节剂（SERM）虽然可能（或可能不）有潮热、血栓栓塞、乳腺增生和子宫内膜增生的一些风险，但通常没有女性化作用。在临床试验研究中，已发现一类SERM他莫昔芬的辅助治疗可降低双相情感障碍患者躁狂发作的频率，而在常规剂量的抗精神病药物中添加一类SERM雷洛昔芬已被发现可减少精神分裂症男性和女性（包括治疗难治性精神病的女性）的认知缺陷和心理症状。这些结果连同强大的神经认知、神经保护和心脏代谢特性表明，SERM可能是设计有效和更安全的精神疾病治疗方法的潜在靶点。
