No sex difference in antipsychotic efficacy, but prolactin rises more in women

The edition in brief

An individual-participant data meta-analysis of 18 fixed-dose trials (7,062 adults with acute schizophrenia; haloperidol, olanzapine, paliperidone, risperidone or placebo) found no sex difference in antipsychotic efficacy on overall symptoms (difference in SMD 0.04, 95% CI −0.09 to 0.18), with dose-response curves plateauing at 3–5 mg risperidone equivalents in both sexes. Prolactin rose considerably more in women (difference in SMD 0.83, high credibility), and antipsychotics reduced all-cause dropout more in women. Dosing should not differ by sex, but prolactin-related effects deserve closer attention in women. A US difference-in-differences study of 62 million enrollee-years found that state legalisation of online sports betting was associated with small rises in antidepressant and anxiolytic prescribing and outpatient depression and anxiety diagnoses, without change in substance use treatment. In the Avon cohort of 3,499 children, each additional positive childhood experience was associated with 11% lower adjusted odds of psychiatric disorder at 24 (OR 0.89), mainly depression. The FDA recorded a supplement to Aurobindo's generic risperidone application, an administrative action rather than a new safety or efficacy finding. The pearl covers asking about prolactin-related symptoms in people on antipsychotics.