Intended for healthcare professionals

Rapid response to:


Hyperprolactinaemia caused by antipsychotic drugs

BMJ 2002; 324 doi: (Published 02 February 2002) Cite this as: BMJ 2002;324:250

Rapid Response:

Physical complications of mental illness

The physical complications of mental illness, both primary and
iatrogenic, tend to be poorly recognised and treated. The article by Weick
and Haddad discusses hyperprolactinaemia caused by antipsychotic
medication. (1). The tendency to focus on extra-pyramidal side effects is
presumably due to the subjective awareness of these unpleasant side
effects by patients. Relatively ‘silent’ side effects such as endocrine
disturbance are not so obvious, and tend not to get the same attention.

As well as antipsychotics, other psychotropic medicines such as
SSRIs(with the exception of sertraline), can cause hyperprolactinaemia.(2)
In depressive disorders stress-system mediated hypercortisolism
contributes to osteoporosis. (3)(4)(5) Depression must be considered as a
risk factor for osteoporosis, as well as cardiovascular disease.

Many patients suffering from schizophrenia, bipolar affective
disorder or depressive illness are on long-term medication, and often
combinations of antipsychotic and antidepressant medications. It is
important to consider that underlying biological processes acting on the
hypothalamo-pituitary-adrenal axis may be compounded, and sequelae such as
osteoporosis accelerated, by pharmacotherapy.

Increased awareness of the physical pathologies associated with
mental illness is essential if optimal care is to be provided.

Dr Sally Winning

Staff Grade Psychiatrist

Royal Cornhill Hospital,
Aberdeen AB25 2ZH

1 Wiek A, Haddad P. Hyperprolactinaemia caused by antipsychotic
drugs. BMJ 2002; 324: 250-252

2 Goodnick et al. Women’s issues in mood disorders. Expert Opinion on
Pharmacotherapy 2000; 1(5): 903-916

3 Deuschle et al. Effects of major depression, aging and gender upon
calculated diurnal free plasma cortisol concentrations: a re-evaluation
study. Stress 1998; 2 (4): 281-287

4 Gold PW, Chrousos GP. The endocrinology of melancholic and atypical
depression: relation to neurocircuitry and somatic consequences.
Proceedings of the Association of American Physicians 1999 Jan – Feb;
111(1): 22-34

5 Schweiger et al. Low lumbar density in patients with major
depression. American Journal of Psychiatry 1994; 151(11): 1691-1693

Competing interests: No competing interests

05 February 2002
Sally A Winning
Staff Grade Psychiatrist
Royal Cornhill Hospital Aberdeen AB25 2ZH