Clinical Report: Fluctuations in Serum Ferritin Levels and Antipsychotic Discontinuation

Overview

This study investigates the predictive value of serum ferritin fluctuations below 30 ng/mL for antipsychotic treatment discontinuation in children with tic disorders. High fluctuations were associated with significantly higher discontinuation rates.

Background

Tic disorders are prevalent neurodevelopmental conditions affecting children, often leading to significant functional impairment. Iron plays a critical role in dopamine synthesis, and lower serum ferritin levels have been linked to tic manifestations. Understanding the relationship between ferritin fluctuations and treatment outcomes may help identify high-risk patients.

Data Highlights

Key Findings

• High-fluctuation patients had a discontinuation rate of 60.3% compared to 24.0% in low-fluctuation patients (P < 0.001).
• High ferritin fluctuation predicted a >2-fold risk of treatment discontinuation (HR = 2.24, P < 0.001).
• Typical antipsychotics showed a stronger association with discontinuation risk (HR = 4.12) compared to atypical agents (HR = 1.87).
• Baseline ferritin levels <30 ng/mL alone were not predictive of discontinuation (HR = 1.18, P = 0.42).
• High fluctuation was associated with a slower rate of tic symptom improvement (P = 0.002).

Clinical Implications

Monitoring serum ferritin levels in pediatric patients receiving antipsychotics for tic disorders may help identify those at higher risk for treatment discontinuation.

Conclusion

Dynamic fluctuations in serum ferritin below 30 ng/mL are significant predictors of antipsychotic treatment discontinuation in children with tic disorders.

Related Resources & Content

1. Frontiers in Pediatrics, 2026 -- Clinical Significance of Serum Brain-Derived Neurotrophic Factor and Serotonin Levels in Children with Tic Disorders
2. Frontiers in Psychiatry, 2026 -- Circulating microRNA molecular signatures converge with erythroid phenotypes and iron homeostasis in pediatric tic disorders
3. JAMA Network Open, 2023 -- Ferritin Reference Curves and Optimal Curves in Preadolescent Children
4. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders | Neurology, 2019
5. Frontiers in Pediatrics — Serum Ferritin as an Adjunctive Marker of Dengue Severity in the Pediatric Emergency Department
6. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders | Neurology
7. Safety of aripiprazole for tics in children and adolescents: A systematic review and meta-analysis - PMC
8. Serum Ferritin Levels Are Lower in Children With Tic Disorders Compared with Children Without Tics: A Cross-Sectional Study - Matan Avrahami, Ran Barzilay, Miki HarGil, Abraham Weizman, Nathan Watemberg, 2017