Hyperprolactinemia and medications for bipolar disorder: Systematic review of a neglected issue in clinical practice

Pacchiarotti, Isabella; Murru, Andréa; Kotzalidis, Georgios D.; Bonnín, C.M.; Mazzarini, Lorenzo; Colom, Francesc; Vieta, Eduard

doi:10.1016/j.euroneuro.2015.04.007

Cited by 36 publications

(17 citation statements)

References 83 publications

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“…In fact, schizophrenia has an onset around adolescence and early adulthood, while anxiety disorders and depression have a later onset and a later initiation of treatment (12). The hormonal profile (gonadotropins, testosterone and TSH levels) was similar in the different groups; on the other hand, prolactin levels, a hormone related to sexual dysfunction, was significantly higher in the groups treated with atypical antipsychotics, alone or in combination, in line with literature (3,13). There are few reports on the use of sildenafil and tadalafil in patients treated with atypical antipsychotic or antidepressant drugs in monotherapy, and they showed variable efficacy (6, 14-15).…”

Section: Discussionsupporting

confidence: 73%

“…However, antipsychotics differ in their hyperprolactinemic effect; risperidone, olanzapine, ziprasidone, and amisulpride have all been associated with hyperprolactinemia, quetiapine, clozapine and aripiprazole with both hyperprolactinemia and its reversal, and lurasidone has shown no hyperprolactinemizing potential. Furthermore, combining antidepressants with antipsychotics was associated with increased prolactin level (3). There are several reports and studies dealing with the treatment of ED with PDE5-i in patients receiving psychotropic medication, mainly in patients who developed ED secondary to antidepressant or antipsychotic intake.…”

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confidence: 99%

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Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

Mazzilli

Angeletti

Olana

et al. 2018

Arch Ital Urol Androl

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Objectives: The aim of this study was to assess the prevalence of patients with Erectile Dysfunction (ED) receiving psychotropic drugs, the impact of these drugs on hormonal profile, and the efficacy of PDE5-i in these patients. Materials and methods: We recruited 1872 patients referring for ED to our Andrology Unit. Assessment included serum testosterone, gonadotropins, TSH, prolactin, and PSA, and the IIEF-5 questionnaire for ED diagnosis. Inclusion criteria were age 21-75 years and IIEF-5 total score ≤ 21; exclusion criteria included hypogonadism, diabetes mellitus, previous prostatectomy, other medication intake, and ED diagnosis prior to psychotropic drug treatment. Efficacy was rated with the IIEF-5 (remission: total score ≥ 22). Results: The prevalence of ED patients treated with psychotropic drugs since ≥ 3 months was 9.5% (178/1872), subdivided according to the drugs used into: Group A, 16 patients treated with atypical antipsychotics (9.0%); Group B, 55 patients with benzodiazepines (30.9%); Group C, 33 patients with antidepressant drugs (18.5%); and Group D, 74 patients with multiple psychotropic drugs (41.6%). Patients in Group A were significantly younger than other groups (p < 0.05). The hormonal profile presented only higher prolactin level in patients treated with antipsychotics, alone or in combination (p < 0.05). Overall, 146 patients received PDE5-i. Remission rate, after three months of treatment, was significantly higher in Group B compared to C and D groups (p < 0.05). Conclusions: A substantial portion of patients receiving psychotropic drugs show ED. Sexual performance in these patients benefits from PDE5-i. Age, effects of psychiatric disorders, psychotropic drugs, and PDE5-i treatment modality accounted for variability of response in this sample.

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Section: Discussionsupporting

confidence: 73%

mentioning

confidence: 99%

Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

Mazzilli

Angeletti

Olana

et al. 2018

Arch Ital Urol Androl

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“…Valproate may induce an increase of serum testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEAS) concentrations, while prolactin levels typically remain within normal limits 137 . The increase in androgen levels is associated with a higher incidence of menstrual disorders and polycystic ovarian syndrome in women treated with this drug 138,139 .…”

Section: Influence Of Treatment Of Bipolar Disorder On Sexualitymentioning

confidence: 99%

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

2018

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Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.

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“…Predictably, then, AA drugs with higher peripheral exposure have been associated with clinical hyperprolactinemia. Hyperprolactinemia can cause hypogonadism, as observed in patients with prolactin-secreting tumors [20]. However, not all patients treated with AA drugs present with hyperprolactinemia and hypogonadism, and there is little evidence supporting a direct link between AA-induced hyperprolactinemia, bone mass and fracture risk in the clinical literature.…”

Section: Introductionmentioning

confidence: 99%

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice

Motyl

Beauchemin

Barlow

et al. 2017

Bone

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Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia, bipolar disorder, and autism, and are prescribed off-label for other mental health issues. AA drugs are associated with severe metabolic side effects of obesity and type 2 diabetes. Cross-sectional and longitudinal data also show that risperidone causes bone loss and increases fracture risk in both men and women. There are several potential mechanisms of bone loss from RIS. One is hypogonadism due to hyperprolactinemia from dopamine receptor antagonism. However, many patients have normal prolactin levels; moreover we demonstrated that bone loss from RIS in mice can be blocked by inhibition of β-adrenergic receptor activation with propranolol, suggesting the sympathetic nervous system (SNS) plays a pathological role. Further, when, we treated ovariectomized (OVX) and sham operated mice daily for 8 weeks with RIS or vehicle we demonstrated that RIS causes significant trabecular bone loss in both sham operated and OVX mice. RIS directly suppressed osteoblast number in both sham and OVX mice, but increased osteoclast number and surface in OVX mice alone, potentially accounting for the augmented bone loss. Thus, hypogonadism alone cannot explain RIS induced bone loss. In the current study, we show that dopamine and RIS are present in the bone marrow compartment and that RIS can exert its effects directly on bone cells via dopamine receptors. Our findings of both direct and indirect effects of AA drugs on bone are relevant for current and future clinical and translational studies investigating the mechanism of skeletal changes from AA drugs.

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Hyperprolactinemia and medications for bipolar disorder: Systematic review of a neglected issue in clinical practice

Cited by 36 publications

References 83 publications

Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice

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