Posted by SLS on November 24, 2000, at 17:54:29
In reply to Re: Does Galactorrhea cause weight gain? » SLS, posted by shellie on November 23, 2000, at 18:51:20
Hi guys.
For NagG:Have you birthed children?
Your suspicion of Risperdal (risperidone) being the culprit was very logical. Of the newer atypical antipsychotics (Clozaril, Risperdal, Zyprexa, and Seroquel), Risperdal is the one that can cause an increase in the secretion of prolactin. It was a great guess.
I included below what seems to be the only investigation into antidepressant-induced breast-enlargement (mammoplasia, macromastia). This side effect is caused primarily by the SSRI class of antidepressants. Prozac is a member of this class. As far as I know, there is no explanation as to why Prozac does this. Prolactin does not seem to be involved. Also, those women who experienced mammoplasia also experienced the most weight gain (beyond the obvious). Effexor did not seem to produce mammoplasia that often. I would place a great deal of confidence in the results of this study. Jay Amsterdam is one of the best. If their observations regarding Effexor are valid, you might consider using it to replace Prozac. Both drugs affect serotonin in the same way. Of course, that does not guarantee that it will be effective, but it is a very good drug. Actually, it is possible that using another member of the SSRI class will not produce the same effect in you as does Prozac. I don't know what I would do in your place. I guess I would want to find another drug that worked that would not cause macromastia and galactorrhea, especially if I thought I would have to take it for the rest of my life - or at least for a very long time.
The word that sticks in my mind is "unacceptable". I don't think this side effect is acceptable unless there are no better options. The more desirable option would be to treat the macromastia and continue to take Prozac. Right now, I really don't know how to go about this. My best guess is that bromocryptine (Parlodel) would be ideal. Bromocryptine should help with both your depression and your macromastia/galactorrhea at the same time. Tamoxefin is sometimes used.
I can understand any fears you might have about stopping Prozac. You might feel terrible right away. I would also be afraid that, if after having tried a lot of different drugs that didn't work, Prozac wouldn't work when I go back to it. Well, if you weren't worried about this possibility before, you are now. That's good. I I feel that this is a valid consideration when reaching a decision. I really can't give you much of an idea as to how often this happens, except to say that it is the exception rather than the rule. I am sure there are ways to minimize this risk to near zero.
Two thoughts:
1. If you do not respond to a given drug within three weeks, return to Prozac immediately. In this way, you are almost assured of recapturing your response to it. Perhaps you can try a different medication every three or four months in this fashion.
2. Remain on Prozac and add one of the alternative drugs to it. I can only guess as to what the safest way to go about this. You will need to get much more feedback from others regarding this strategy. I would like to hear something from Sunnely. Combining Prozac with Effexor or another SSRI carries a very small risk of developing something called the "serotonin-syndrome". This involves nervousness, confusion, incoherency, involuntary muscle movements, muscle tension and contraction, sweating, nausea, diarrhea, high blood pressure, shivering, and fever. It can be life threatening. Again, I just want to provide you with some information so that your decision is an informed one. If it were me, this wouldn't stop me from trying such a combination, especially if I knew what symptoms to screen for.I guess the most sensible thing to do is to start with a very low dosage of the new drug and work up gradually while at the same time reducing your dosage of Prozac. I don't know whether or not there is a liquid preparation of Prozac. I have never heard of one. Prozac stays in the body for a long time, so reducing the dosage will involve skipping days. I think you should begin to reduce your dosage of Prozac before adding any others. Maybe you can work your way down to 20mg every three days before beginning the new drug. Again, this is just my throwing ideas around without giving them much thought.
I think I wrote too much here. Sorry. If it were me, I would try adding bromocryptine first. If your side effects can't be adequately treated, I would try another drug in the safest way possible while not endangering your responsivity to Prozac. I'd give Effexor a try first.
For Shellie:Sorry to have to disappoint you, my friend. My initial response to Zyprexa lasted for only a few days. Man, I thought I hit a homerun. I did so many things and thought so many thoughts and felt so many feelings. Having a sex-drive is pretty cool. I forgot what a skirt-chaser I can be. Here I am, not feeling better for even three days, not knowing whether it will last even one more hour, ready to slip some gorgeous young woman at a restaurant my phone number. I had written it down on a post-it my mother had in her pocket-book. Unfortunately, after a half-hour of mutual flirting, she ruined it by talking.
I am like a dog that begins running in mid-air as you lower him to the ground. As soon as he touches the ground, he's gone. Nothing but dust.
I think I'm in the same situation with Zyprexa as is Anita with Risperdal. I was doing better at the lower dosage I started at. I decided to skip my dose last night and I am feeling a bit better today. I'm not sure what I'm going to do at this point. I haven't decided whether I should give the reduced dosage of Zyprexa some more time or to switch over to Risperdal immediately. My doctor gave me prescriptions for both drugs and wanted me to switch if my first choice was inadequate. I see him in 12 days, and I want to make sure I go in to see him with enough information to be able to compare Risperdal to Zyprexa. Perhaps I owe a turkey for a burst of serotonin that is making me feel better today. :-)
Shellie, that your mood plummetted upon starting pindolol, and I believe it did, may be a clue as to what you need. What SSRIs have you tried, at what dosages, and for how long. Effexor? With which drugs have you added lithium to, and at what dosages.
Regarding your side effects with Lamictal, I'll want to give that more thought. Taken from the abstract I included below, it may not insignificant that you describe breast enlargement and tenderness and your greater-than-average weight gain. If you do decide to go back to Lamictal along with your MAOI, I would add bromocryptine and/or amphetamine. I think you'll kill two birds with one stone. I would also consider adding low-dosages of lithium (300-600mg) in there. If all of that crap ends up unlocking the door to the rest of your life, be sure to tell me. Hopefully, I'll be following right behind you taking the same combination.
I have come to two conclusions:
1. Life sucks.
2. Life is great.I'm hanging around for #2. I can't wait!!!
Love,
Scott
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1: J Affect Disord 1997 Nov;46(2):151-6 Related Articles, Books, LinkOut
Breast enlargement during chronic antidepressant therapy.Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M
Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Recent reports of mammoplasia during selective serotonin re-uptake inhibitor (SSRI) therapy suggested that this side effect may be more common than previously reported. We examined 59 women receiving > or = 2 months treatment with an SSRI or venlafaxine for changes in breast size in relation to menopausal status, weight gain and duration of drug therapy. Serum prolactin, estradiol and beta-hCG were also measured before and during treatment in a subgroup of patients. Twenty-three out of 59 patients (39%) reported some degree of mammoplasia. Significantly more SSRI vs. venlafaxine patients reported mammoplasia (p < 0.01). Eighty-four percent with mammoplasia had weight gain vs. 30% without mammoplasia (p < 0.001). The rate of mammoplasia was unrelated to age, menopausal status or duration of treatment. Serum prolactin increased during treatment in the paroxetine subgroup (p < 0.03). In conclusion, antidepressant-induced mammoplasia may be more common than previously expected.
PMID: 9479619, UI: 98140246
poster:SLS
thread:49179
URL: http://www.dr-bob.org/babble/20001115/msgs/49359.html