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Changes in the Level of Prolactin in the Blood of Patients with Panic Disorder with Monotherapy with Paroxetine, Clomipramine and Combined Therapy with Paroxetine with Periciazine

T.A. Pavlova 1, L.N. Gorobets 2, I.V. Dorovskih 1, E.R. Madzhanova 1

1 FSCI “1586 military clinical hospital’ of the Ministry of Defence of the Russian Federation, Podolsk, Russian Federation
2 Moscow Institute of Psychiatry – branch of FGBU “SMRCPN named by V.P. Serbsky» Ministry of Health of the Russian Federation, Moscow, Russian Federation

Summary

Actuality. A small number of studies proving an increase in the level of prolactin in patients with panic disorder (PD) necessitates further study of its dynamics in this disease. Increasingly common in the scientific literature reports on the development of hyperprolactinemia (HP) against the background of taking antidepressants dictate the need to study changes in the level of prolactin in the treatment of antidepressants of different groups.
Aim of the study. The aim of the study was to assess the dynamics of prolactin levels in patients with PD during monotherapy with clomipramine or paroxetine in comparison with combined therapy with paroxetine and periciazine (comparative open randomized study).
Materials and methods. In 45 patients with PD in the course of monotherapy clomipramine and paroxetine investigated dynamics of level of prolactin. The group of comparison was made by 20 patients receiving the combined therapy paroxetine and periciazine. Hormonal indicators defined prior to therapy, in 6 weeks of therapy.
Results. The background level of prolactin exceeded the upper limit of the reference interval in 50,09% of patients in group 1 receiving clomipramine (785,5 ± 312,1 mME/l), in 47,83 % of patients in group 2 receiving paroxetine (821,4 ± 469,3 mME/l) and in 40 % of patients in group 3 (851,1 ± 366,4 mME/l). After 6 weeks from the start of therapy in group 1, the level of prolactin slightly increased (821,9 ± 391,3 mME/l), but exceeded the norm in 50 % of patients, as before the start of therapy. In group 2, prolactin levels decreased slightly (808,0 ± 624,2 mME/l) and exceeded the upper limit of normal in 39,13 % of patients. In the comparison group, the percentage of patients with values of prolactin levels above normal increased (1571,5 ± 834,1 mME/l) to 75 % of cases. Manifestations of galactorrhea after 6 weeks were not observed in group 1, were observed in 4,35 % of patients in group 2 and 65% of patients in group 3. Menstrual delay by 6 weeks of therapy was observed in a small number of patients of group 1 (5,8 %) and group 2 (6,67 %) and a significantly higher percentage (26 %) of patients from group 3; oligomenorrhea was observed in 26,6 % of patients in group 2 and 26,3 % of patients in group 3.
Conclusion. On average, 50 % of the examined patients with PD showed an increase in the background level of prolactin above the reference values, which may indicate both the role of increasing the level of prolactin in the development of the anxiety reaction, and be a consequence of stress-induced secretion of prolactin. Therapy with clomipramine and paroxetine after 6 weeks from the start of treatment did not lead to a significant increase in the level of prolactin and the development of severe drug HP, however, there were rare clinical manifestations of HP – galactorrhea, oligomenorrhea and menstruation delay. Combined therapy with paroxetine and periciazine compared with monotherapy with clomipramine and paroxetine led to a significant increase in prolactin levels and more frequent development of symptoms of HP. The study found no differences in the effectiveness of therapy in the groups, and the augmentation with antipsychotics led only to a short-term relief of anxiety, but at the same time to the development of HP.

Contact: Pavlova Tatyana Alekseevna, pava-6@yandex.ru

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