Psychotropic Medication and the Endocrine System

133 Abstract: Background: Both bipolar disorder and schizophrenia are associated with imbalances affecting not only certain neurotransmitter pathways, but also the endocrine system, which is partly controlled by neurotransmitters. As a result, the psychotropic treatment used to treat these disorders can result in endocrine side effects. Method: We reviewed recent searches to determine the relevance of individual factors (genotype, sex, age, duration of the illness, compliance to treatment) and medication depending factors (specificity for binding on certain receptors, the dissociation constant from D2 receptors, the degree of penetration of the blood – brain barrier, the route of administration). Results and conclusions: Medication induced hyperprolactinemia has a negative impact on the compliance to the treatment. The long-term consequences of hyperprolactinemia can affect the cardio-vascular system the bone metabolism, and possibly, the cognitive status. Because both schizophrenia and bipolar disorder need continuous prophylactic treatment, some psychotropic medication may produce long-term side effects such as hypogonadodropic hypogonadism with its negative consequences on cognition, cardio-vascular system and bone metabolism. The authors discuss possible corrective strategies to be followed, from both a psychiatric and an endocrinologist point of view. There will be addressed also, the consequences of medication induced hypothyroidism with or without preexistent hormonal disturbances, which could be linked or not with the presence of the psychosis. The clinical picture of schizophrenia and bipolar disorder is heterogeneous, which makes their treatment to be complex. Because of its side effects, psychotropic medication should be individualized according to the present status and to the potential side effects on endocrine system, bone and energetic metabolism, cardio-vascular and cognitive status. Baseline endocrine and metabolic status should be assessed along with long-term side effects monitoring.