This newsletter covers the topic of medication side effects that create breast growth in men and breast enlargement and lactation in women. If you’re loved one is on an antipsychotic, this is a must read.
A letter from a worried parent…
💬 Hi Julie! Hope you don’t mind me messaging again. You helped a lot with the suggestion to talk with the doctor about adding Lamictal to my daughter’s medication regimen. I had no idea that Effexor was the reason she was so irritated. Her prescriber is a GP and I gave her Take Charge of Bipolar Disorder. She’s very compassionate, but I feel I know more about bipolar than she does. At your suggestion, we’re finally on a waiting list for a psychiatrist. The wait is over six months.
Julie. She, the doc didn’t know that Effexor can cause agitated mania even if my daughter takes risperidone! But, she listened and now has the info from your book.
I worked with her to come up with a plan to decrease the Effexor very, very slowly. I will say coming off the Effexor was not fun for my daughter, but she made it thought. I’m wondering if you could answer another question for me. I can then take the info to her doctor. Risperidone is working so well for my kid. It changed her life Julie, but there’s a big problem. Her last blood test came back with high prolactin levels and Julie, her breasts are growing and she started lactating! I can’t imagine that this is good for her body. I’m wondering if there is another antipsychotic that is similar to the benefits of risperidone that doesn’t elevate prolactin? She tried Seroquel, but it didn’t work well for her. Thank you for any information or suggestions you have!
Marisol
I have two answers. One is for the free newsletter and the next is for the $1.99 FIT System guide from Julie A. Fast
The guide includes a full explanation along with a script for talking to the loved and a script for talking to the doctor.
Before I answer Marisol’s questions, here is background information on the antipsychotics discussed in this document.
Antipsychotics are referred to as
Hello Marisol,
These are side effects that can happen with some antipsychotics. This is a well known side effect for risperidone. My answer is a bit technical, but I believe that understanding what is happening in the body is important for making medication decisions
Hyperprolactinemia and Gynecomastia and
The high level of prolactin in called Hyperprolactinemia.
Hyperprolactinemia is a medication-induced hormonal change caused by the elevated prolactin.
This elevated prolactin is caused by dopamine D2 blockade in the tuberoinfundibular pathway created by the Invega. Antipsychotics work on dopamine! But as my coauthor Dr. John Preston said, “Julie, there’s no way to harpoon a drug straight to the problem in the brain. It goes through the whole body as well. This is what creates so many side effects.”
Don’t worry, you don’t have to memorize this!
The breast growth is called Gynecomastia.
Recap: Prolactin is a hormone. When antipsychotics raise prolactin levels, the resulting hormonal imbalance can lead to gynecomastia in men (the growth of breasts) and an increase in breast growth in women. This is a big tricky, so I will explain it clearly. The term gynecomastia refers to abnormal proliferation of glandular breast tissue in a male, but it also applies to women if the growth is a side effect of a medication for example. What happens in women is biologically the same process, but it is not given a distinct, widely used diagnostic label because women already have breast tissue.
Image what it’s like to be a guy and you finally take a med that can help and you start to grow breasts! This has to be addressed immediately in men. The breast growth in women can be problematic, but the lactation is always upsetting.
Gynecomastia = growth of male breast tissue driven by prolactin elevation plus estrogen–testosterone imbalance. Galactorrhea = milk or nipple discharge. It is prolactin-driven and can occur with or without gynecomastia.
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Let’s first clear up which antipsychotics have this side effect:
called gynecomastia or breast enlargement. Some men grow breasts as well. Gynecomastia (breast enlargement) is a side effect of neuroleptic antipsychotic drugs, related to prolactin elevation caused by dopamine D2 receptor blockade in the tuberoinfundibular pathway.(Richelson, 1996).
A deeper dive into the topic shows that gynecomastia is a downstream effect of chronic hyperprolactinemia, mediated through altered estrogen–testosterone balance, not prolactin alone.
In other words, some antipsychotic medications can disrupt normal hormone balance, and that disruption can cause breast tissue growth called gynecomastia.
Not all antipsychotics carry the same risk. Typical antipsychotics and certain second-generation agents (e.g., risperidone, paliperidone) have a much higher prolactin liability than others (e.g., aripiprazole, quetiapine, clozapine).
Antipsychotics tend to work in the same way- but there are enough differences that you may be able to find one that isn’t as intense in terms of the lactating.
Here is a link that shares what is happening.
I suggest searching online for the most effective antipsychotic that has LESS prolactin effects. Side effects are the main reason meds are problematic for those of us with bipolar. It’s not that the meds are ineffective. These meds can be incredibly effective. Do the research and find the list of antipsychotics that are not as problematic with prolactin. Then discuss those meds with the doc. This is a trade off. It sounds like the meds are really helping, but I agree that lactating consistently is a sign something is off. Let me know if you have any further questions. This is a common question for me, so I will do a post on the topic! You can figure this out. Julie
The Side Effect Trade Off
I teach a very specific plan in Take Charge of Bipolar Disorder. I want people with bipolar disorder and/or a psychotic disorder to manage the majority of their symptoms through lifestyle and behavioral changes. This means less medications and less side effects.
As you might know, I can’t take any medications for bipolar or my psychotic disorder. from 1995-1998, I tried over 20 medications that made me incredibly ill physically. I’m not against medications for brain illnesses. Many people need them. I need them! But I can’t tolerate them. My symptoms are daily and intense. I can use lithium in small amounts.
Is what I do possible for your loved one? Absolutely. They will likely tolerate medications a bit better than I can, but overall, I want everyone to use the management plan in Take Charge of Bipolar Disorder. It’s a family plan that works.
As you know from earlier newsletters, I never suggest that you give my books to a loved one. They can find my books on their own. My work with you is separate. Once you learn how to manage these illnesses with as few medications as possible, you can make changes in your life that can then help your loved one.
The more symptoms those of us with bipolar can manage without meds, the more we can get out in the world as a healthy and whole person. I will never say this is easy. It’s not. But being able to reduce medications that increase breast size and cause lactation seems like a good plan to me!
Here is one example on how you can make the changes from Take Charge in your own life to help a loved one. If you live in the same home and especially if you’re letting someone live with you, make it clear that the house sleeps on the same schedule. This means sleeping at night and getting up and getting out of the house during the day. I can’t stress enough how much this can positively impact the bipolar brain.
For a more detailed explanation and a plan for how to talk to your loved one’s doctor, click on the link below to purchase my Medication Side effect guide for caregivers: Breast Growth and Lactation
Sell this for $1.99 on Etsy and through my website.
Question or lead in to bulleted list:
There are symptoms of anxiety or psychosis when a person is not manic or depressed.
There are persistent memory and/or executive functioning symptoms that are consistent over time even when a person is not in a mood swing.
Cannabis use creates a secondary psychotic disorder.
A possible neurological diagnosis such as autism or a traumatic brain injury impacts their behavior.
There has been childhood trauma that affects the person’s behavior.
Remember:
You get to decide what works for you in your own home. You get to decide what you need from a loved one who lives with a brain illness. You have the ability to create a life that works for you.
Thank you,
Julie