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Cited by 31Schizophrenia research and treatmentNeurotransmitter Receptor Influence on BehaviorPsychopathy, Forensic Psychiatry, Sexual Offending

Antipsychotic-Related Prolactin Levels and Sexual Dysfunction in Mentally Ill Youth: A 3-Month Cohort Study

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Koch, Marie T., Carlson, Harold E., Kazimi, Milad M., Correll, Christoph U.·2023·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2023.03.007PMC PMC10502189
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Abstract

Objective Although these agents are used frequently, prospective data comparing serotonin/dopamine antagonists/partial agonists (SDAs) in youth regarding prolactin levels and sexual adverse effects (SeAEs) are scarce.Method Youth aged 4 to 17 years, SDA-naive (≤1 week exposure) or SDA-free for ≥4 weeks were followed for ≤12 weeks on clinician's-choice aripiprazole, olanzapine, quetiapine, or risperidone. Serum prolactin levels, SDA plasma levels, and rating scale-based SeAEs were assessed monthly.Results Altogether, 396 youth (aged 14.0 ± 3.1 years, male participants = 55.1%, mood spectrum disorders = 56.3%, schizophrenia spectrum disorders = 24.0%, aggressive-behavior disorders = 19.7%; SDA-naive = 77.8%) were followed for 10.6 ± 3.5 weeks. Peak prolactin levels/any hyperprolactinemia/triple-upper-limit-of-normal-prolactin level were highest with risperidone (median = 56.1 ng/mL/incidence = 93.5%/44.5%), followed by olanzapine (median = 31.4 ng/mL/incidence = 42.7/76.4%/7.3%), quetiapine (median = 19.5 ng/mL/incidence = 39.7%/2.5%) and aripiprazole (median = 7.1 ng/mL/incidence = 5.8%/0.0%) (all p < .0001), with peak levels at 4 to 5 weeks for risperidone and olanzapine. Altogether, 26.8% had ≥1 newly incident SeAEs (risperidone = 29.4%, quetiapine = 29.0%, olanzapine = 25.5%, aripiprazole = 22.1%, p = .59). The most common SeAEs were menstrual disturbance = 28.0% (risperidone = 35.4%, olanzapine = 26.7%, quetiapine = 24.4% aripiprazole = 23.9%, p = .58), decreased erections = 14.8% (olanzapine = 18.5%, risperidone = 16.1%, quetiapine = 13.6%, aripiprazole = 10.8%, p = .91) and decreased libido = 8.6% (risperidone = 12.5%, olanzapine = 11.9%, quetiapine = 7.9%, aripiprazole = 2.4%, p = .082), with the least frequent being gynecomastia = 7.8% (quetiapine = 9.7%, risperidone = 9.2%, aripiprazole = 7.8%, olanzapine = 2.6%, p = 0.61), galactorrhea = 6.7% (risperidone = 18.8%, quetiapine = 2.4%, olanzapine = 0.0%, aripiprazole = 0.0%, p = .0008), and mastalgia = 5.8% (olanzapine = 7.3%, risperidone = 6.4%, aripiprazole = 5.7%, quetiapine = 3.9%, p = .84). Postpubertal status and female sex were significantly associated with prolactin levels and SeAEs. Serum prolactin levels were rarely associated with SeAEs (16.7% of all analyzed associations), except for the relationship between severe hyperprolactinemia and decreased libido (p = .013) and erectile dysfunction (p = .037) at week 4, and with galactorrhea at week 4 (p = .0040), week 12 (p = .013), and last visit (p < .001).Conclusion Risperidone, followed by olanzapine, was associated with the largest prolactin elevations, with little prolactin-elevating effects of quetiapine and, especially, aripiprazole. Except for risperidone-related galactorrhea, SeAEs did not differ significantly across SDAs, and only galactorrhea, decreased libido, and erectile dysfunction were associated with prolactin levels. In youth, SeAEs are not sensitive markers for significantly elevated prolactin levels.

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Authors
Koch, M. T., Carlson, H. E., Kazimi, M. M., & Correll, C. U.
Affiliations
  • Charité – Universitätsmedizin Berlin (DE)
  • Stony Brook University (US)
  • Northwell Health (US)
Corresponding author
Correll, Christoph U.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2023-09
Volume
62
Issue
9
Pages
1021-1050
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2023.03.007
PMC
PMC10502189
OpenAlex
W4324135531
Cited by
31
References
51
Citations by year
2026: 4 · 2025: 10 · 2024: 15 · 2023: 2
FWCI
6.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Berlin Institute of Health
  • National Institute of Mental Health (P30MH090590)
  • National Center for Research Resources (M01RR018535)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
antipsychotic adverse effects, prolactin, hyperprolactinemia, sexual adverse effects, youth mental illness, aripiprazole, olanzapine, quetiapine, risperidone, menstrual irregularity, sexual dysfunction, schizophrenia spectrum disorders, mood disorders, antipsychotic-naive patients
MeSH terms
Aripiprazole, Quetiapine Fumarate, Olanzapine, Adolescent, Amenorrhea, Benzodiazepines, Female, Galactorrhea, Humans, Hyperprolactinemia, Erectile Dysfunction, Male, Pregnancy, Prolactin, Prospective Studies, Antipsychotic Agents, Cohort Studies, Risperidone, Persons with Psychiatric Disorders, Mentally Ill Persons

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