55b8541c7a807314f253c98de7f496ea 292085.pdf 2f02b939643f9fda9b49ac68daa8bafadff5a408 292085.pdf 2d86921ae77c951dc9a97f5c27803e94ca1c2515adb06aced9052b1d383cff55 292085.pdf Title: The Effect of Menopause on Antipsychotic Response Subject: Background: It has been hypothesized that, whenever estrogen levels decline, psychosis symptoms in women increase. At menopause, this can happen in two main ways: (a) the loss of estrogen (mainly estradiol) can directly affect central neurotransmission, leading to increase in schizophrenia-related symptoms, and (b) the loss of estrogen can decrease the synthesis of enzymes that metabolize antipsychotic drugs, thus weakening their efficacy. Aims and Methods: The aim of this narrative review was to investigate the second possibility by searching PubMed and ClinicalTrials.gov for studies over the last two decades that investigated the metabolism of antipsychotics and their efficacy before and after menopause in women or that studied systemic and local estrogen level effects on the pharmacokinetics and pharmacodynamics of individual antipsychotic drugs. Results: The evidence suggests that symptom level in women with schizophrenia rises after menopause for many reasons beyond hormones but, importantly, there is an estrogen-dependent loss of efficacy related to antipsychotic treatment. Conclusion: Effective clinical intervention is challenging; nevertheless, several promising routes forward are suggested. Keywords: antipsychotics; drug metabolism; menopause; schizophrenia Author: Alexandre González-Rodríguez, José A. Monreal and Mary V. Seeman Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Oct 24 10:49:32 2022 CEST ModDate: Mon Oct 24 10:54:55 2022 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 637867 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IOJCNK+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 SXQPWE+VnURWPalladioL Type 1 Custom yes yes no 15 0 KTIDZB+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 BFGOUD+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 JNRIGM+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 QDCWHF+EURM10 Type 1 Builtin yes yes no 32 0 SLUQMQ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 86 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 90 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 94 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 98 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-16 03:11:39 CEST RepresentationInformation: 292085.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-15 12:29:48 CEST Size: 637867 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 496 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Children: Item: Title: Differences in Short and Long Outcomes in Women with Schizophrenia Destination: subsection.1.1 Item: Title: Why Estrogen Is Important Destination: subsection.1.2 Item: Title: The Perimenopause Destination: subsection.1.3 Item: Title: Estrogen, Dopamine, and Schizophrenia Destination: subsection.1.4 Item: Title: Estrogen and Antipsychotic Efficacy Destination: subsection.1.5 Item: Title: Estrogen after Menopause Destination: subsection.1.6 Item: Title: Symptom Exacerbation after Menopause Due to Stress Destination: subsection.1.7 Item: Title: Aims Destination: subsection.1.8 Item: Title: Methods Destination: section.2 Item: Title: Pharmacokinetics of Antipsychotics Destination: section.3 Children: Item: Title: Absorption of Antipsychotics Destination: subsection.3.1 Item: Title: Antipsychotic Drug Metabolism Destination: subsection.3.2 Item: Title: Antipsychotic Drug Distribution Effect of Adipose Tissue Changes Post Menopause Destination: subsection.3.3 Item: Title: Elimination of Antipsychotics in Men and Women Destination: subsection.3.4 Item: Title: Genes and Antipsychotic Response Destination: subsection.3.5 Item: Title: Pharmacodynamics of Antipsychotics Destination: subsection.3.6 Item: Title: Changes in Postmenopausal Clinical Response to Antipsychotics Destination: subsection.3.7 Item: Title: Discussion and Future Directions Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: The Effect of Menopause on Antipsychotic Response Author: Alexandre González-Rodríguez, José A. Monreal and Mary V. Seeman Subject: Background: It has been hypothesized that, whenever estrogen levels decline, psychosis symptoms in women increase. At menopause, this can happen in two main ways: (a) the loss of estrogen (mainly estradiol) can directly affect central neurotransmission, leading to increase in schizophrenia-related symptoms, and (b) the loss of estrogen can decrease the synthesis of enzymes that metabolize antipsychotic drugs, thus weakening their efficacy. Aims and Methods: The aim of this narrative review was to investigate the second possibility by searching PubMed and ClinicalTrials.gov for studies over the last two decades that investigated the metabolism of antipsychotics and their efficacy before and after menopause in women or that studied systemic and local estrogen level effects on the pharmacokinetics and pharmacodynamics of individual antipsychotic drugs. Results: The evidence suggests that symptom level in women with schizophrenia rises after menopause for many reasons beyond hormones but, importantly, there is an estrogen-dependent loss of efficacy related to antipsychotic treatment. Conclusion: Effective clinical intervention is challenging; nevertheless, several promising routes forward are suggested. 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Annotation: Subtype: Link Rect: 453, 215, 490, 226 Annotation: Subtype: Link Rect: 59, 193, 96, 203 Annotation: Subtype: Link Rect: 342, 169, 380, 180 Annotation: Subtype: Link Rect: 175, 135, 212, 146 Annotation: Subtype: Link Rect: 218, 135, 254, 146 Annotation: Subtype: Link Rect: 327, 112, 365, 123 Annotation: Subtype: Link Rect: 371, 112, 407, 123 Annotation: Subtype: Link Rect: 131, 90, 168, 100 Annotation: Subtype: Link Rect: 175, 90, 211, 100 Checksum: 51417882 Type: CRC32 Checksum: 55b8541c7a807314f253c98de7f496ea Type: MD5 Checksum: 2f02b939643f9fda9b49ac68daa8bafadff5a408 Type: SHA-1 Checksum: 2d86921ae77c951dc9a97f5c27803e94ca1c2515adb06aced9052b1d383cff55 Type: SHA-256