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Pharmacy World & Science

, Volume 30, Issue 5, pp 613–616 | Cite as

Osteoporosis after combined use of a neuroleptic and antidepressants

  • Gert LaekemanEmail author
  • Lieven Zwaenepoel
  • Johan Reyntens
  • Marc de Vos
  • Minne Casteels
Case Report

Abstract

Bone mineral density may be negatively influenced by hyperprolactinemia, which can be caused by atypic neuroleptics and antidepressants. Case description The present paper reports about a spontaneous rib fracture in a female patient (age 52) taking neuroleptics (mainly risperidone), antidepressants (mainly sertraline), and anxiolytics (mainly lorazepam). At the time of the fracture a severe osteoporosis and a strongly enhanced plasma prolactin level (117 ng/ml; normal values: 3–24 ng/ml) were detected. The latter one normalized 2 months after abandoning sertraline and risperidone. After this normalization, the patient did not report further accidents up to now. Discussion Enhancement of plasma prolactin levels is linked to the mechanism of action of risperidone. Mammoplasia and increased plasma prolactin can occur during SSRI (Selective Serotonin Reuptake Inhibitors) or trazodone administration. The role of anxiolytics is less clear. The causal relationship between osteoporosis and long-term use of neuroleptics and antidepressants was assessed using probability scores, more particularly the Naranjo probability scale and the Bradford-Hill criteria of causality. A score of 6/13 (probable) was obtained with the Naranjo scale, whereas all 9 Bradford-Hill criteria were fulfilled. Conclusion Although this case could not be fully explored, attention should be paid to bone mineral density loss in depressed patients taking a combined therapy of atypic antipsychotics and antidepressants.

Keywords

Antipsychotics Antidepressants Osteoporosis BMD Prolactin Rib fracture 

Notes

Funding

No special funding was obtained for this contribution.

Conflict of interest

None to declare.

References

  1. 1.
    Goodnick PJ, Chaudry T, Artadi J, Arcey S. Women’s issues in mood disorders. Expert Opin Pharmacother. 2000;1:903–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Halbreich U, Rojansky N, Palter S, Hreshchyshyn M, Kreeger J, Bakhai Y, et al. Decrease bone mineral density in medicated psychiatric patients. Psychosomatic Med. 1995;57:485–91.Google Scholar
  3. 3.
    Fric M, Laux G. Plasma prolactin level and incidence of adverse endocrinologic effects during therapy with atypical neuroleptics. Psychiatr Praxis. 2003;30(Suppl. 2):S97–101.Google Scholar
  4. 4.
    Love RC, Nelson MW. Pharmacology and clinical experience with risperdone. Expert Opin Pharmacother. 2000;1:1441–1453.PubMedCrossRefGoogle Scholar
  5. 5.
    Baxter K. Stockley’s drug interactions. Pharmaceutical Press: London; 2008. p. 766–767.Google Scholar
  6. 6.
    Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M. Breast enlargement during chronic antidepressant therapy. J Affect Disord 1997;46:151–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Morrison J, Remick RA, Leung M, Wrixon KJ, Bebb RA. Galactorrhea induced by paroxetine. Can J Psychiatry. 2001;46:88–9.PubMedGoogle Scholar
  8. 8.
    Otani K, Yasui N, Kaneko S, Ishida M, Ohkubo T, Osanai T, et al. Trazodone treatment increases plasma prolactin concentrations in depressed patients. Int Clin Psychopharmacol. 1995;10(2):115–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Copinschi G, Van Onderbergen A, L’Hermite-Baleriaux M, Szyper M, Caufriez A, Bosson D, et al. Effects of the short-acting benzodiazepine triazolam, taken at bedtime, on circadian and sleep-related hormonal profiles in normal men. Sleep. 1990;13:232–44.PubMedGoogle Scholar
  10. 10.
    Kopecek M, Bares M, Horacek J, Mohr P. Low-dose risperidone augmentation of antidepressants or anxiolytics is associated with hyperprolactinemia. Neuro Endocrinol. Lett. 2006;27(6):803–6.Google Scholar
  11. 11.
    Scordo MG, Spina E, Facciolà G, Avenoso A, Johansson I, Dahl ML. Cytochrome P450 2D6 genotype and steady state plasma levels of risperidone and 9-hydroxyrisperidone. Psychopharmacology. 1999;147(3):300–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Wang L, Zhang AP, Fang C, Du J, Gu JF, Qin SY, et al. Serum prolactin levels, plasma risperidone levels, polymorphism of cytochrome P450 2D6 and clinical response in patients with schizophrenia. J Psychopharmacol. 2007;21(8):837–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Eskandari F, Martinez PE, Torvik S, Phillips TM, Sternberg E, Mistry S, et al. Low bone mass in premenopausal women with depression. Arch Intern Med. 2007;167:2329–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Bilici M, Cakirbay H, Guler M, Tosun M, Ulgen M, Tan U. Classical and atypical neuroleptics, and bone mineral density, in patients with schizophrenia. Int J Neurosci. 2002;112:817–28.PubMedCrossRefGoogle Scholar
  15. 15.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.PubMedGoogle Scholar
  16. 16.
    Shakir SAW, Layton D. Causal application in pharmacovigilance and pharmacoepidemiology. Drug Saf. 2002;25 467–471.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Gert Laekeman
    • 1
    Email author
  • Lieven Zwaenepoel
    • 2
  • Johan Reyntens
    • 3
  • Marc de Vos
    • 4
  • Minne Casteels
    • 5
  1. 1.Research Centre of Pharmaceutical Care and Pharmacoeconomics, Faculty of Pharmaceutical SciencesKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.BergBelgium
  3. 3.Psychiatric Hospital St.-JanEekloBelgium
  4. 4.Psychiatric HospitalZelzateBelgium
  5. 5.Laboratory of Pharmacology, Faculty of MedicineKatholieke Universiteit LeuvenLeuvenBelgium

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