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Antidepressant-induced hyperprolactinaemia

incidence, mechanisms and management

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Abstract

Prolactin, a polypeptide hormone, is responsible, amongst other things, for milk production during lactation and breast enlargement during pregnancy. Numerous drugs can affect prolactin levels. Most commonly, conventional antipsychotics are associated with hyperprolactinaemia but there have also been reports of antidepressants causing hyperprolactinaemia. This review sets out to establish the incidence of antidepressant-induced hyperprolactinaemia, its possible mechanism and to determine appropriate remedial actions. Nearly all antidepressants are reported to be associated with hyperprolactinaemia. Incidence rates were not clearly established and symptoms were very rare. The mechanism by which antidepressants may cause hyperprolactinaemia is not fully understood, though several theories have been postulated, such as serotonin stimulation of GABAergic neurons and indirect modulation of prolactin release by serotonin. Patients taking antidepressants presenting to their clinician with symptoms potentially related to hyperprolactinaemia, such as galactorrhoea, should have their plasma prolactin level measured and their antidepressant changed if an increased prolactin level is confirmed. Routine monitoring of prolactin levels is otherwise not appropriate.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Prof. Taylor has received consultancy fees, research funding and honoraria from Servier, Lundbeck, Eli Lilly and Wyeth. Miss Coker has no conflicts of interest that are directly relevant to the content of this review.

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  1. Pharmacy Department, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK

    Flora Coker &  David Taylor

  2. Divison of Pharmaceutical Sciences, King’s College, London, UK

    David Taylor

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  1. Flora Coker
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  2. David Taylor
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Correspondence to David Taylor.

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Coker, F., Taylor, D. Antidepressant-induced hyperprolactinaemia. CNS Drugs 24, 563–574 (2010). https://doi.org/10.2165/11533140-000000000-00000

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