Abstract
Prolactin elevations occur in people treated with antipsychotic medications and are often much higher in women than in men. Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss. These side effects increase risk of antipsychotic nonadherence and suicide and pose significant problems in the long term management of women with schizophrenia. In this manuscript, we review the literature on prolactin; its physiology, plasma levels, side effects and strategies for treatment. We also present the rationale and protocol for an ongoing clinical trial to treat symptomatic hyperprolactinemia in premenopausal women with schizophrenia. More attention and focus are needed to address these significant side effects and help the field better personalize the treatment of women with schizophrenia.
Highlights
Hyperprolactinemia and related consequences are known side effects of several first and second generation antipsychotics
We review the physiology and treatment of elevated prolactin secondary to antipsychotic medications and present the rationale and protocol for an ongoing clinical trial that addresses this issue in women
We have identified what we think to be the most effective strategy for managing these effects in women and are running an NIMH funded R01 double blind, placebo controlled randomized clinical trial to address high prolactin levels with associated symptoms in women with schizophrenia, the DAAMSEL study (Dopamine Partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated Prolactin) It is a 4 year study with a target enrollment of 50 women with schizophrenia treated with risperidone, paliperidone or first generation antipsychotics (FGAs) and with elevated prolactin and sexual side effects at baseline
Summary
Hyperprolactinemia and related consequences are known side effects of several first and second generation antipsychotics. We have identified what we think to be the most effective strategy for managing these effects in women and are running an NIMH funded R01 double blind, placebo controlled randomized clinical trial to address high prolactin levels with associated symptoms in women with schizophrenia, the DAAMSEL study (Dopamine Partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated Prolactin) It is a 4 year study with a target enrollment of 50 women with schizophrenia treated with risperidone, paliperidone or FGAs and with elevated prolactin and sexual side effects (menstrual abnormalities or galactorrhea) at baseline. While there were no statistically significant decreases in clinical psychiatric symptoms, aripiprazole was found to improve prolactin elevations (in both men and women), with the authors suggesting this deserves further study as a treatment. Clinicians in the field have published recently on the importance of recognition and treatment and that we can possibly halt or potentially even reverse associated bone loss [134]
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