Effect of lithium on prolactin responses to thyrotropin releasing hormone in patients with manic state

The plasma thyrotropin (TSH) and prolactin (PRL) responses to thyrotropin releasing hormone (TRH) were studied before and during lithium treatment for 3-4 weeks in 6 patients with manic states and 8 control subjects. The plasma TSH responses to TRH were not different between the two groups before lithium treatment. Lithium administration did not alter non-stimulated secretion of TSH in any groups, but resulted in exaggerated responses of plasma TSH to TRH in both groups. No difference between two groups was observed in plasma TSH responses to TRH. The basal plasma PRL concentration did not differ between the two groups and was not affected by lithium administration to either group. The plasma PRL responses to TRH in female subjects were greater than those in male subjects. In females, the plasma PRL responses to TRH in manic patients were significantly higher than those in control subjects before the treatment. Lithium administration caused enhanced responses to TRH in patients when compared to pretreatment levels, but not in control subjects. Although the small number of male subjects limits conclusions, pretreatment plasma PRL responses to TRH in male manic patients were apparently greater than those in control subjects. However, lithium administration appeared not to affect the responses of plasma PRL to TRH in manic patients when compared to pretreatment levels. The augmented responses of plasma PRL to TRH in patients with manic states suggest the existence of some abnormality in the hypothalamo-pituitary axis. Thus, the effect of the anti-manic agent on PRL secretion in manic patients may suggest the mechanism by which the drug affects manic symptoms.