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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Sliabh6 on June 6, 2001, at 22:28:51
Hi, I've been taking 225 Effexor, 60 Celexa, and 1.5 risperdal for about 7 years. Up till last Nov I was doing pretty well with it, then I started getting so exhausted I couldn't even drive. I quit taking the risperdal, but it didn't help. Now I have full blown breast milk, no, I havn't had a kid in 6 years. My Prolactin is low, less than 60 and my OBGYN has written me off to mt GP. MY shrink says if I was taking the risperdal I would have an elevated Prolactin level and possibly the milk problem. But doesn't know why I've got it now. Any ideas?
Posted by SalArmy4me on June 7, 2001, at 0:32:21
In reply to Anyone got this problem?, posted by Sliabh6 on June 6, 2001, at 22:28:51
It sounds like you have galactorrhea, which can't be remedied by Risperdal alone. Get a new doctor and look into Bromocriptine.
Posted by Sunnely on June 7, 2001, at 1:00:05
In reply to Anyone got this problem?, posted by Sliabh6 on June 6, 2001, at 22:28:51
Hi Sliabh6,
Risperdal, Celexa, and even Effexor are capable of raising the prolactin level. (Actually, the normal value for prolactin level is less than 18.5 ng/ml.)
Secreted by the anterior pituitary, the hormone prolactin has obvious advantages for species survival. Elevated blood levels of prolactin after birth enables milk secretion. 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. The secretion of prolactin is under complex neuropyhsiological control, and several neurotransmitters regulate its release, including dopamine, serotonin, gamma-aminobutyric acid (GABA), acetylcholine, and endorphins.
Antipsychotic drugs (especially the older ones) that block dopamine receptors often cause elevated prolactin (hyperprolactinemia) resulting in stoppage of menses, secretion of breast milk, and decreased libido. SSRIs too, have been shown to increase prolactin, possibly via a decrease in dopamine neurotransmission. GABA and endogenous opioids enhance the release of prolactin by inhibiting dopamine release. Of course, high prolactin levels (usually above 200 ng/ml) sometimes result from a pituitary tumor. And believe it or not, the following physiologic factors can also cause hyperprolactinemia: 1. sleep (peaks between 4 am and 6 am, followed by a decline soon after awakening; lowest levels reached 1-3 hours later; rarely exceeds 30 ng/ml); 2. exercise, and 3. stress (stress-induced increases in prolactin have been implicated in cases of infertility when a medical condition cannot be demonstrated).
Among the three drugs that you take, Risperdal is the one more commonly reported to elevate prolactin levels. This is due to its dopamine receptor blocking effect (D2 receptor). However, if indeed prolactin level elevation is due to Risperdal, it generally return to normal once it is discontinued. Since you have already discontinued this drug, I assume in November, I highly doubt it is still the culprit. Celexa, being an SSRI (the most selective) and Effexor, also with an SRI effect, are probably contributing to the prolactin level elevations via serotonin's negative effect on dopamine.
If possible, consider lowering the dose of Celexa (first) as this may alleviate the problem. If this is not possible, the addition of a dopamine agonist such as bromocriptine (Parlodel) or amantadine (Symmetrel) may be helpful.
BTW, has your thyroid functions been checked? With such a prolactin level, I highly doubt you will need to undergo head CT or MRI to rule out a pituitary tumor. Won't be surprised, however, if your doctor suggests this especially if prolactin level remains elevated.
+++++++++++++++++++++++++++++
> Hi, I've been taking 225 Effexor, 60 Celexa, and 1.5 risperdal for about 7 years. Up till last Nov I was doing pretty well with it, then I started getting so exhausted I couldn't even drive. I quit taking the risperdal, but it didn't help. Now I have full blown breast milk, no, I havn't had a kid in 6 years. My Prolactin is low, less than 60 and my OBGYN has written me off to mt GP. MY shrink says if I was taking the risperdal I would have an elevated Prolactin level and possibly the milk problem. But doesn't know why I've got it now. Any ideas?
Posted by Sliabh6 on June 8, 2001, at 7:09:48
In reply to Re: Anyone got this problem? » Sliabh6, posted by Sunnely on June 7, 2001, at 1:00:05
>Thanks for your input. Yeah, my thyroid was checked at the same time. I see another Dr. next week so here goes the merry go round again.
Posted by T.T. on June 8, 2001, at 9:39:40
In reply to Re: Anyone got this problem?, posted by Sliabh6 on June 8, 2001, at 7:09:48
Been there and done that. I was actually DC'd from Effexor at one time due to the lactation problem. However, my doctor and I ran out of things to try and went back to the Effexor. I did experience the lactation problem, but it discontinued. Unfortunately, I then experienced some of the worst side effects from any AD I've ever taken....memory loss (two-day duration), night sweats, nightmares.....TT
> >Thanks for your input. Yeah, my thyroid was checked at the same time. I see another Dr. next week so here goes the merry go round again.
Posted by medeena k on June 9, 2001, at 21:45:38
In reply to Re: Anyone got this problem?, posted by T.T. on June 8, 2001, at 9:39:40
> Been there and done that. I was actually DC'd from Effexor at one time due to the lactation problem. However, my doctor and I ran out of things to try and went back to the Effexor. I did experience the lactation problem, but it discontinued. Unfortunately, I then experienced some of the worst side effects from any AD I've ever taken....memory loss (two-day duration), night sweats, nightmares.....TT
>
> > >Thanks for your input. Yeah, my thyroid was checked at the same time. I see another Dr. next week so here goes the merry go round again.
you mentioned "MEMORY LOSS"...... for a period of 2-days? total memory loss? was this from the effexor? how many mgs of effexor...... and is this combined with any other type of medication?
please reply! thanx a mil!
Posted by T.T. on June 10, 2001, at 16:25:02
In reply to Re: Anyone got this problem? » T.T., posted by medeena k on June 9, 2001, at 21:45:38
Total memory loss, although what I thought was a dream turned out to be reality. I thought I was dreaming that I had hand-cuffs on, but in reality, I was arrested. I thought I dreamed breaking out my living room window, but woke up to find it was broken. Now, I'm trying to DC this antidepressant and ended up in the emergency room due to myoclonus (uncontrollable muscle twitching), night sweats and vivid dreams--so vivid, I wake myself up screaming.
Yes, as with a lot of people on this antidepressant, my anxiety was not controlled, so I was taking Klonpin 1 mg twice a day. The last thing I remember before the blackout was taking my Effexor 150 mg and my Klonpin 1 mg (as usual). Everything else is either completely gone or turned out to not be a dream after all. I sure wish it was a dream. I'm facing hitting two cars, getting a DUI and wreckless driving, broken window, jail, fines and possible prison. In my heart, I know it is the Effexor, but no one wants to listen to that. I hope someone will so this side effect will get more attention than it has in the past. It is a side effect, rare but a side effect nonetheless. T.T.
> Been there and done that. I was actually DC'd from Effexor at one time due to the lactation problem. However, my doctor and I ran out of things to try and went back to the Effexor. I did experience the lactation problem, but it discontinued. Unfortunately, I then experienced some of the worst side effects from any AD I've ever taken....memory loss (two-day duration), night sweats, nightmares.....TT
> >
> > > >Thanks for your input. Yeah, my thyroid was checked at the same time. I see another Dr. next week so here goes the merry go round again.
>
>
> you mentioned "MEMORY LOSS"...... for a period of 2-days? total memory loss? was this from the effexor? how many mgs of effexor...... and is this combined with any other type of medication?
> please reply! thanx a mil!
Posted by Kaysey on June 12, 2001, at 17:06:36
In reply to Re: Anyone got this problem?, posted by T.T. on June 10, 2001, at 16:25:02
> Total memory loss, although what I thought was a dream turned out to be reality. I thought I was dreaming that I had hand-cuffs on, but in reality, I was arrested. I thought I dreamed breaking out my living room window, but woke up to find it was broken. Now, I'm trying to DC this antidepressant and ended up in the emergency room due to myoclonus (uncontrollable muscle twitching), night sweats and vivid dreams--so vivid, I wake myself up screaming.
>
> Yes, as with a lot of people on this antidepressant, my anxiety was not controlled, so I was taking Klonpin 1 mg twice a day. The last thing I remember before the blackout was taking my Effexor 150 mg and my Klonpin 1 mg (as usual). Everything else is either completely gone or turned out to not be a dream after all. I sure wish it was a dream. I'm facing hitting two cars, getting a DUI and wreckless driving, broken window, jail, fines and possible prison. In my heart, I know it is the Effexor, but no one wants to listen to that. I hope someone will so this side effect will get more attention than it has in the past. It is a side effect, rare but a side effect nonetheless. T.T.
>
> > Been there and done that. I was actually DC'd from Effexor at one time due to the lactation problem. However, my doctor and I ran out of things to try and went back to the Effexor. I did experience the lactation problem, but it discontinued. Unfortunately, I then experienced some of the worst side effects from any AD I've ever taken....memory loss (two-day duration), night sweats, nightmares.....TT
> > >
> > > > >Thanks for your input. Yeah, my thyroid was checked at the same time. I see another Dr. next week so here goes the merry go round again.
> >
> >
> > you mentioned "MEMORY LOSS"...... for a period of 2-days? total memory loss? was this from the effexor? how many mgs of effexor...... and is this combined with any other type of medication?
> > please reply! thanx a mil!A couple of days after these messages posted I developed the same problem with lactation (only a small amount of discharge and only on the right side). It is enough to concern me though; and had I not been a part of this message board, I would have probably gone to the ER! I have been taking Effexor since the last of April. I have been at 225mg for two weeks. As I have mentioned in other posts, my OCPs and the Effexor, don't seem to get along. In fact, I had just started this cycle of pills when the lactation began. I take Ortho-Cyclen (the mono-phasic, not the tri-phasic tri-cyclen). I need both meds (or at least I need hormone pills and an anti-depressant/anti-GAD). I am also under a great deal of stress (trying to finish a medical research dissertation before my major professor retires in a couple of months). Does anyone have any suggesstions? Can I expect this to subside (as other effexor side effects have done)?
Thanks
Posted by SalArmy4me on June 13, 2001, at 8:35:50
In reply to Re: Anyone got this problem? Now I do!, posted by Kaysey on June 12, 2001, at 17:06:36
I wanna just take this time to point out a bad interaction between some mood stabilizers and Birth Control pills:
There is some evidence that suggests that Topiramate has an effect on the reproductive system, more specifically on the efficacy of orally-contraception pills (OCPs): "However, many anticonvulsant medications can induce an increase in hepatic microsomal enzymes, which can produce increased pill metabolism: "The result has been a decrease in the pill’s contraceptive efficacy resulting in an estimated 3.1 pregnancies per 100 women years of use. These medications include carbamazepine, topiramate, and tiagabine. A number of anticonvulsants do not cause such interference, including valproic acid and lamotrigine."
Greydanus, Donald E. MD et al. Contraception in the Adolescent: An Update. Pediatrics. 107(3):562-573, March 2001.
Posted by Kaysey on June 13, 2001, at 19:04:48
In reply to Re: Anyone got this problem? Now I do!, posted by SalArmy4me on June 13, 2001, at 8:35:50
> I wanna just take this time to point out a bad interaction between some mood stabilizers and Birth Control pills:
>
> There is some evidence that suggests that Topiramate has an effect on the reproductive system, more specifically on the efficacy of orally-contraception pills (OCPs): "However, many anticonvulsant medications can induce an increase in hepatic microsomal enzymes, which can produce increased pill metabolism: "The result has been a decrease in the pill’s contraceptive efficacy resulting in an estimated 3.1 pregnancies per 100 women years of use. These medications include carbamazepine, topiramate, and tiagabine. A number of anticonvulsants do not cause such interference, including valproic acid and lamotrigine."
> Greydanus, Donald E. MD et al. Contraception in the Adolescent: An Update. Pediatrics. 107(3):562-573, March 2001.Thanks for the ref. I was aware that some anti-convulsants had that impact. I also read at least one other post that indicated that someone had this problem also with effexor. Is there any evidence on this and/or suggestions? As I said, though this might be 'minor' inconvenience, my major concern stems from the fact that it (effexor and/or the combination of meds) could have such an unusual influence on my body.
I appreciate the assistance.
Kaysey
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