How hormones impact effectiveness of medication

In a recent paper, MHP scientists from King’s College London have contributed to the work of untangling the impact hormones and age has on the effectiveness of antipsychotic drugs in women.

What does this study show? 

Hormones and getting older are things that everyone experiences, and they affect our lives in many significant ways. A new way hormones and ageing may affect people with SMI has been reported in a recent paper. Researchers, including MHP members at King’s College London, have found a link between hormonal changes involved in menopause and more severe symptoms related to psychosis.

How do hormones affect metabolism?

Hormones have many different functions, one of them being in the metabolism or breakdown of drugs. Hormones can speed up or slow down this process. As a result, the amount and frequency a drug may be prescribed for depends on relative hormone levels [1].

Sex hormones such as oestrogen have neuroprotective effects, and they impact how drugs are broken down. Because of this, large changes in hormone levels can have significant effects on how a medicine works. In fact, this effect goes both ways and medications can alter how hormones are sensed by the body as well. In the case of antipsychotic medications, these reduce the body’s sensitivity to oestrogen.

How was this research done? 

In this study, researchers decided to take another look at data collected in a 2017 study called the ‘IMPaCT Randomised Clinical Trial’. In the IMPaCT study, researchers were interested in how effective patient-tailored therapy would be compared to standard treatment. Results from before, 12 months after, and 15 months after treatment were recorded. 

From this original study, researchers specifically focused on linking mental health status to age and medication use. A total of 174 female-sex participants aged 18-60 were included in this study. All had a formal diagnosis of psychotic disorder and were using medication to manage their symptoms, and information about gender was not reported. This group was further divided by age, with 65 women under the age of 40 and 109 above the age of 40. Because this age was used as an approximation for peri/menopausal status, participants on hormone replacement therapy were not included. 

By analysing the data in this way, researchers were better able to see how anti-psychosis medication and peri/menopause, both linked to reduced oestrogen levels, leads to more severe symptoms of psychosis.