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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by angelrose on November 1, 2000, at 0:18:07
Hi,
I know it is common for some antipsychotics to cause milk leakage from a woman's breast. I have been experiencing this problem since I started Paxil (about a year ago) but now it is getting increasingly worse since I have been on Prozac.
Could it be related to the AD's or maybe something else is wrong with me? (I'm not pregnant by the way)Anybody have any answers or suggestions.
Thanks.
Posted by AndrewB on November 1, 2000, at 1:42:50
In reply to AD's and Galactorrhea?, posted by angelrose on November 1, 2000, at 0:18:07
ADs can raise prolactin levels and thus cause galactorrhea.
The dopaminergic agonists bromocriptine and pramipexole are both able to lower prolactin levels and thus ameliorate the galctorrhea.
Pramipexole has the added benefit of often improving mood yet further when combined with an SSRI.
I suggest you consult an experienced psychopharmocologist about adding on one of these meds to treat your problem.
AndrewB
Posted by Noa on November 1, 2000, at 16:10:15
In reply to AD's and Galactorrhea?, posted by angelrose on November 1, 2000, at 0:18:07
Yes, I have heard that this is possible--something about elevated prolactin levels caused by serotonin increases (I had the impression when I heard this, tho, that it isn't that simple, but more like what they call a "cascade" effect of hormone changes).
Posted by Sunnely on November 1, 2000, at 19:49:03
In reply to AD's and Galactorrhea?, posted by angelrose on November 1, 2000, at 0:18:07
> Hi,
> I know it is common for some antipsychotics to cause milk leakage from a woman's breast. I have been experiencing this problem since I started Paxil (about a year ago) but now it is getting increasingly worse since I have been on Prozac.
> Could it be related to the AD's or maybe something else is wrong with me? (I'm not pregnant by the way)
>
> Anybody have any answers or suggestions.
> Thanks.
Hi Angelrose,Yes, SSRIs such as Prozac and Paxil can cause galactorrhea (breast milk discharge). This is most likely related to its serotonin-boosting action further causing an elevation in the level of hormone called "prolactin." This condition is called "hyperprolactinemia." Elevation of prolactin levels enables milk secretion, and this is a normal physiological effect during pregnancy and postpartum (after birth). At the same time, prolactin suppresses ovulation and depresses libido, making it less likely that a newborn baby will face a competing sibling in the near future. Although serotonin regulates release of prolactin, its release is actually under complex neurophysiological control, and several neurotransmitters regulate its release including dopamine, serotonin, gamma-aminobutyric acid (GABA), acetylcholine, and endorphins.
Although serotonin causes the release of prolactin, it is usually counterbalanced by the inhibitory effects of dopamine. It is therefore uncommon for drugs that enhance serotonin neurotransmission to lead to clinically meaningful elevations of prolactin. However, this can still happen, as in your case. FYI, serotonin is a neuromodulator (influences the action) of dopamine. Increased serotonin supply leads to decrease dopamine action. Dopamine is a "PIF" (prolactin-inhibiting factor) i.e., it inhibits the release of prolactin. Blocking the action of dopamine via increased serotonin supply decreases the inhibiting effect of dopamine on prolactin, leading to the release of prolactin or "hyperprolactinemia." GABA and endogenous opioids also enhance the release of prolactin by inhibiting dopamine release.
Untreated hyperprolactinemia can cause hormonal and sexual disturbances such as galactorrhea (breast milk discharge; rare in men), amenorrhea (absence of menses), gynecomastia (breast enlargement in men), loss of libido (both in men and women), infertility, and impotence. Prolonged hyperprolactinemia also predisposis one to osteoporosis (brittle bones).
FYI, aside from the antipsychotics and the antidepressants, other drugs that can cause hyperprolactinemia include opiates, anesthetics, oral contraceptives, reserpine (Serpalan), methyldopa (Aldomet), metoclopramide (Reglan), and sulpiride. Benzodiazepines and lithium may also cause moderate elevations of prolactin levels but rarely clinical symptoms. Medical conditions that can cause hyperprolactinemia include pituitary tumor (prolactinoma), hypoglycemia (low blood sugar), kidney failure, liver failure, and thyroid dysfunctions.
Elevations of prolactin levels also occur in certain physiologic-behavioral conditions including: 1. sleep (peaks between 4 am & 6 am, followed by decline soon after awakening; lowest levels reached 1-3 hours later; increases in prolactin level rarely exceeds 30); 2. exercise; 3. pregnancy; 4. nursing; 5. estrogens; 6. stress (stress-induced increases in prolactin have been implicated in cases of infertility when a medical/physical condition cannot be demonstrated).
Even if one is taking an antipsychotic or antidepressant drug, elevations in prolactin levels should be medically investigated to rule out the possibility of a more serious condition (e.g. pituitary tumor). However, prolactin elevations due to antipsychotics or antidepressants rarely exceed 200. If the elevation is marked or symptomatic, CT (computerized tomography) and MRI (magnetic resonance imaging) are fairly accurate tests in detecting pituiatary tumors. Other laboratory tests such as thyroid function is also important.
You should discuss this problem with your physician or prescriber. Your physician/prescriber may refer you to an endocrinologist for further evaluation. At least, you should have a prolactin level and a thyroid function to determine where they're at. CT or MRI may need to be done, too.
The best way to determine if the problem is due to the meds is to stop the meds. Stopping the meds should resolve this problem. However, this puts you at risk for depressive relapse and even withdrawal symptoms. Sometimes lowering the dose alleviates the problem. Adding a dopamine agonist such as bromocriptine (Parlodel) or amantadine (Symmetrel) also helps. Both drugs, however, have their own inherent side effects including causing confusion and psychotic symptoms. If indeed the problem is due to medication, and is persistent, a (gradual) switch to another antidepressant (one without serotonin effect such as Wellbutrin or reboxetine), is probably your next best alternative.
Posted by angelrose on November 2, 2000, at 10:10:52
In reply to Re: AD's and Galactorrhea? » angelrose, posted by Sunnely on November 1, 2000, at 19:49:03
Hi,
Thanks for all the detailed information re. galactorrhea. I did not realize the seriousness of this condition.
Now that I think about it,this problem did not manifest itself until I got back on AD's 6 months after I gave birth. It's been 2 years since I had a baby and I did not breast- feed for a very long time (a month).
The other thing that crossed my mind is that I did not realize this ( that I was experiencing milk leakage) until I had a misscarriage about 7 months ago.Anyway, thanks for listening and for your helpful info. and suggestions. I pray it is not too serious.
>
>
> Hi Angelrose,
>
> Yes, SSRIs such as Prozac and Paxil can cause galactorrhea (breast milk discharge). This is most likely related to its serotonin-boosting action further causing an elevation in the level of hormone called "prolactin." This condition is called "hyperprolactinemia." Elevation of prolactin levels enables milk secretion, and this is a normal physiological effect during pregnancy and postpartum (after birth). At the same time, prolactin suppresses ovulation and depresses libido, making it less likely that a newborn baby will face a competing sibling in the near future. Although serotonin regulates release of prolactin, its release is actually under complex neurophysiological control, and several neurotransmitters regulate its release including dopamine, serotonin, gamma-aminobutyric acid (GABA), acetylcholine, and endorphins.
>
> Although serotonin causes the release of prolactin, it is usually counterbalanced by the inhibitory effects of dopamine. It is therefore uncommon for drugs that enhance serotonin neurotransmission to lead to clinically meaningful elevations of prolactin. However, this can still happen, as in your case. FYI, serotonin is a neuromodulator (influences the action) of dopamine. Increased serotonin supply leads to decrease dopamine action. Dopamine is a "PIF" (prolactin-inhibiting factor) i.e., it inhibits the release of prolactin. Blocking the action of dopamine via increased serotonin supply decreases the inhibiting effect of dopamine on prolactin, leading to the release of prolactin or "hyperprolactinemia." GABA and endogenous opioids also enhance the release of prolactin by inhibiting dopamine release.
>
> Untreated hyperprolactinemia can cause hormonal and sexual disturbances such as galactorrhea (breast milk discharge; rare in men), amenorrhea (absence of menses), gynecomastia (breast enlargement in men), loss of libido (both in men and women), infertility, and impotence. Prolonged hyperprolactinemia also predisposis one to osteoporosis (brittle bones).
>
> FYI, aside from the antipsychotics and the antidepressants, other drugs that can cause hyperprolactinemia include opiates, anesthetics, oral contraceptives, reserpine (Serpalan), methyldopa (Aldomet), metoclopramide (Reglan), and sulpiride. Benzodiazepines and lithium may also cause moderate elevations of prolactin levels but rarely clinical symptoms. Medical conditions that can cause hyperprolactinemia include pituitary tumor (prolactinoma), hypoglycemia (low blood sugar), kidney failure, liver failure, and thyroid dysfunctions.
>
> Elevations of prolactin levels also occur in certain physiologic-behavioral conditions including: 1. sleep (peaks between 4 am & 6 am, followed by decline soon after awakening; lowest levels reached 1-3 hours later; increases in prolactin level rarely exceeds 30); 2. exercise; 3. pregnancy; 4. nursing; 5. estrogens; 6. stress (stress-induced increases in prolactin have been implicated in cases of infertility when a medical/physical condition cannot be demonstrated).
>
> Even if one is taking an antipsychotic or antidepressant drug, elevations in prolactin levels should be medically investigated to rule out the possibility of a more serious condition (e.g. pituitary tumor). However, prolactin elevations due to antipsychotics or antidepressants rarely exceed 200. If the elevation is marked or symptomatic, CT (computerized tomography) and MRI (magnetic resonance imaging) are fairly accurate tests in detecting pituiatary tumors. Other laboratory tests such as thyroid function is also important.
>
> You should discuss this problem with your physician or prescriber. Your physician/prescriber may refer you to an endocrinologist for further evaluation. At least, you should have a prolactin level and a thyroid function to determine where they're at. CT or MRI may need to be done, too.
>
> The best way to determine if the problem is due to the meds is to stop the meds. Stopping the meds should resolve this problem. However, this puts you at risk for depressive relapse and even withdrawal symptoms. Sometimes lowering the dose alleviates the problem. Adding a dopamine agonist such as bromocriptine (Parlodel) or amantadine (Symmetrel) also helps. Both drugs, however, have their own inherent side effects including causing confusion and psychotic symptoms. If indeed the problem is due to medication, and is persistent, a (gradual) switch to another antidepressant (one without serotonin effect such as Wellbutrin or reboxetine), is probably your next best alternative.
Posted by noa on November 2, 2000, at 10:28:58
In reply to Re: AD's and Galactorrhea? » Sunnely, posted by angelrose on November 2, 2000, at 10:10:52
yes, thanks for the explanation.
There is a brief discussion of this at Dr. Bob's psychopharm tips:
go to the link at the very top of this page called "tips". then, do a search using the word hyperprolactinemia (you can also put in SSRI). Sorry, I tried to copy and paste the url but it didn't work for some reason.
This is the end of the thread.
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