Increased Prolactin Concentrations in a Patient with Bipolar Disorder

Abstract

A 58-year-old woman in the depressive phase of bipolar disorder ( BPD)3 type 1 enrolled in a clinical study of the efficacy of a new form of electroconvulsive therapy (ECT) for her depression, because ECT has not been commonly used for the treatment for BPD or depression. BPD is any of several mood disorders characterized by alternating episodes of depression and mania or by episodes of depression alternating with mild nonpsychotic excitement. BPD type 1 is distinguished from type 2 according to the severity of increased mood symptoms (1). At study enrollment, the patient reported severe sadness, a lack of motivation, fatigue, general malaise, feelings of guilt, and an increased need for sleep, but she had no suicidal or homicidal thoughts. She had no history of galactorrhea. A physical examination revealed nothing outstanding except decreased tendon reflexes in the patellar and the achilles, and a small nodule on the closure site from a previous hysterectomy. A cranial computed axial tomography (CAT) scan was performed to assess for increased intracranial pressure before proceeding with ECT; no unusual findings were noted. Initial blood tests showed a serum sodium concentration of 135 mEq/L (135 mmol/L; reference interval, 135–145 mmol/L), a high triglyceride concentration [217 mg/dL (2.45 mmol/L); reference interval, <150 mg/dL (<1.69 mmol/L)], and a VLDL cholesterol concentration of 43 mg/dL [1.11 mmol/L; reference interval, <30 mg/dL (<0.78 mmol/L)]. The results of a urine drug screen for amphetamines, barbiturates, benzodiazepine, cannabinoids, cocaine, opiates, and phencyclidine were negative. As per the study protocol, a baseline blood sample was drawn 5 min before treatment, and at 5, 15, 30, 45 min after seizure termination. Prolactin (PRL) concentrations were assessed from these blood draws during the second and fourth treatments of the study by means of a 2-site sandwich immunochemiluminometric assay (Siemens ADVIA Centaur® System). These …