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Psych meds and endocrine imbalance

September 25, 2009

I decided to turn this into a separate post, arising from the last one, Balance in a Bottle?.

Returning to something I mentioned earlier, neuroleptics have also gotten the most attention for disrupting your endocrine system, but SSRIs will also elevate cortisol and prolactin levels. SSRIs are also known to cause movement disorders (akathisia, tardive dyskinesia, tardive dystonia, etc.) like neuroleptics will, so I suspect that they’re creating similar biochemical imbalances in general. It definitely looks like they’re messing with the hypothalamic-pituitary-adrenal axis in similar ways, as a result of manipulating neurotransmitter levels. This can cause all sorts of endocrine problems. With a quick search, I found support for this idea here. Mess with serotonin, it affects dopamine. Upset the balance in one body system, you get a domino effect.

It’s hard to tell what set off my diabetes, since I was given an amazing variety of medications over the course of almost 15 years: SSRIs, anticonvulsant “mood stabilizers”, and four different antipsychotics (neuroleptics). Turns out, Depakote/valproate and other anticonvulsants will also cause metabolic syndrome with its associated insulin resistance. (It annoyed me that the best collection of research links I ran across was on why-low-carb-diets-work.com. This information is marginalized.) I gained 40 lbs. in a month, sleeping 20 hours a day and not eating much–among other things–during my brief stint on Depakote. Anything that raises cortisol levels will mess with your blood sugar regulation, as well. That includes SSRIs and antipsychotics; the newer atypical ones, such as Zyprexa and Abilify, may be pushed as “safer”, but they are not.

To throw in another anecdote, I was coerced into starting Prozac at 14. This was 1989, and they were pushing it very hard indeed, while the manufacturer was still successful at covering up most potential side effects. I got galactorrhea from elevated prolactin levels–still not connected to the medication, mind–and ended up diagnosed with a pituitary adenoma at 15. I also showed signs of Cushing’s Syndrome from the sky-high cortisol levels. Yep, galactorrhea, horrendous weight gain, and stretch marks are particularly welcome when you’re a 15-year-old girl.

The assumption was that it all this unrelated to anything else going on, and that the hyperprolactinemia and milk production were coming from a prolactin-secreting tumor. The cortisol mostly got lost in the shuffle, except when people snarked about the weight gain. Come to find out, not only can high prolactin levels trigger breast cancer (some neuroleptics must carry warnings now), some pituitary tumors seem to be prolactin mediated as well. Increased risk* and accelerated growth of pituitary adenomas have both been associated with elevated prolactin levels from meds.

In short, you can get a vicious cycle started in which the prolactin from the meds gives you a prolactin-mediated tumor which secretes more prolactin. One example is summed up nicely in this abstract: “[R]isperidone use was found to correspond with an increase in the size of a prolactinoma and prevented the return of serum prolactin level to baseline.” I only figured out about a month ago, looking into lasting effects from psych meds, that this is precisely what happened to me on Prozac. It grew much more quickly and larger than expected, and besides its starting pressing on one optic nerve (estimated blind in 6 months tops), I almost died. In fact, my heart stopped on the operating table when it was removed. (Bromocriptine did nothing but make me desperately sick, with a side dish of Prozac to keep the prolactin levels up!) Then I went through years of continuing symptoms, most of which got blamed on depression, and thus more meds to aggravate the situation. Prolactin levels stayed up, estrogen levels plummeted, and the hormonal uproar sent me into full-blown symptoms of menopause between the ages of 17 and 27. Throw in the emotional effects of high cortisol levels, and things can get really ugly.

As for lasting effects, I have no idea whether I’m infertile now that I’m having regular periods again. Doctors certainly used that specter to try to bully me into doing what they said, when I was 15 and future infertility was the least of my worries. It was more than a little creepy, even if the doctor in question was not talking at my newly-DDD breasts at the time (as a couple of them did). As an adult, they have frequently heard “pituitary adenoma” and immediately asked if I’m infertile. Nobody has offered to do any tests to find out, and I’m not about to stop using birth control to see what happens! It is probably a good thing that I don’t want kids, without better support.

My continuing high prolactin and cortisol levels, along with their symptoms, were specifically blamed on depression and stress. Come to find out, the real apathy and sluggishness I experienced, and which is reported by a lot of other pituitary patients, has nothing to do with depression. It does not help that they are blaming many endocrine disorders on the “mental illness” itself, as illustrated nicely by this morass, when they are not separating medicated from unmedicated patients. Incidentally, the same thing goes for most brain scan studies; what you are probably really seeing is the effects of medications on people’s brains. It’s hard to find people with schizophrenia or bipolar diagnoses who are not medicated.

Circa 1999, once I read that Zyprexa raises prolactin levels (had taken to reading monographs by then!), I asked the doctor if I should really be taking it since I already had hyperprolactinemia to the point of galactorrhea and amenorrhea when I started on it. The answer was about what you’d expect, unfortunately.

It took another 5+ years before I went off the medications, and my system started balancing itself out. Hopefully I’m regaining some bone density, which has never been checked at all.

When I briefly went back on Paxil last year, trying to keep myself in some kind of shape to look after my mom when she was dying, my hormones went absolutely crazy again. Enter amenorrhea, galactorrhea and almost complete lack of blood sugar control. Not surprisingly, I blamed it all on stress at the time, but know better now.

Since I pieced things together, I’ve been trying not to get overwhelmed by anger and despair. I have avoided writing about it because it gets me really worked up. Not only at the my own experience, but mostly at the idea of how many other people out there are getting sick from these meds. Having the connection completely dismissed just adds a layer of dog crap to this already revolting cake.

Edit: Looking at search terms which have brought people here, I think I neglected one link. There may be a more direct relationship between prolactin and cortisol levels–especially since so many meds will cause both–but there is at least one connection:

In 1989 a study was undertaken to determine whether excessive insulin could cause prolactin levels to become excessive. The study concluded that insulin may have a role in the regulation of prolactin synthesis and release in humans.

Another study shows that: “Weight reduction, with accompanying decrease in plasma insulin levels, leads to a normalization of prolactin responses in most circumstances.” This is presumably without medications directly raising the levels–and doing multiple things to your system that will make you gain weight–in the first place. (The author who collected these studies also points out that elevated prolactin levels on their own will make you gain weight.) Since high cortisol levels will give you insulin resistance, making more insulin circulate in your body, that right there can cause high prolactin levels. So, yeah, that’s another way it all fits together.
_________
* More on how this works, in PDF format. In short: mess with dopamine, you mess with prolactin.

4 Comments leave one →
  1. September 27, 2009 12:02 am

    Interesting, thought-provoking series of posts, Urocyon!

    Your experience with Depakote sounds a lot like what I’m experiencing with Zoloft now.

    It’s nowhere near as bad — I sleep 12 hours a day instead of 20, and am not having any of those other problems you mentioned, like Cushing’s syndrome, pituitary adenoma and galactorrhea — but I certainly relate to what you say about feeling dead tired and zombified all the time.

    Before I took the pills, though, the depression was equally incapacitating, with the added bonuses of crying all the time and obsessing about killing myself. But you are right — though it’s taken that hellishness away, the medication really doesn’t leave me with much in terms of physical or mental resources to put towards bettering my life.

    That’s also quite a shocker that the extreme tiredness isn’t a part of depression itself! Everything I’d heard said otherwise.

    I’ll have to read more about that.

    • urocyon permalink
      October 12, 2009 1:41 pm

      Sorry for the late reply! I’ve been having some verbal retrieval problems.

      Yeah, it’s a difficult situation. Weighing the beneficial effects against the not-so-desirable effects is the best anybody can do, and it does sound like not having suicidal thoughts is a huge factor in favor of taking the Zoloft! Sorry you’re feeling like a zombie.😦 Zoloft mostly made me agitated and anxious, but everybody’s chemistry is different.

      Glad you haven’t noticed any weird endocrine effects. Besides just being prone to less common side effects (again, biochemical variations, part ethnic), I strongly suspect that I experienced so much endocrine disruption because I was put on the meds at an age when my hormones were naturally in flux, and well before my body had reached any kind of adult equilibrium. I’m sure it’s been harder for my system to find a healthy hormonal balance, having been thrown out of whack at a vulnerable point. That’s one of the reasons it really disturbs me how many more kids are getting these drugs these days, even before puberty, not to mention during the adolescent hormonal storms–when they’re naturally prone to mood swings, etc. Most of the doctors prescribing them are minimally aware of the potential for endocrine effects, and don’t really know what to look for if something serious does happen.

      Not to mention that, IME, not that many endocrinologists even look at things from the viewpoint that all these things are interconnected, and it doesn’t even occur to them that levels of one substance in the body will affect the levels of other substances, and other body systems, ad infinitum. (I’d imagine that good pattern recognition skills help there–it helped this layman put things together!) That is more than a little scary. Especially since this is once a person has had their symptoms recognized as endocrine and been sent to a specialist, which is not always likely.

      Unfortunately, the tiredness and lack of energy seem to come from both the depression itself and from meds. Not many people I’ve known have had their energy levels improve on antidepressants, unless they got agitated. No wonder they don’t like to mention this, since lack of energy is one of the most debilitating things about depression.😐

  2. February 6, 2013 7:18 pm

    “Psych meds and endocrine imbalance Urocyon’s Meanderings” was indeed a truly awesome blog, . Continue creating and I’ll
    try to keep following! Many thanks ,Jaime

  3. Beth permalink
    September 3, 2015 1:35 am

    I found your blog to be interesting reading. I am having endocrine symptoms from Zoloft and Remeron. I am soon to be 40 so I agree with your stance about antidepressants and fluctuating hormones. The only thing I can’t find is what treatment is recommended for secondary hypothyroidism and/or pituitary issues. The GP wants the Remeron changed but I thought it was supposed to be neutral. I must stay on the medication or I am in a state of SI. So do we treat the depression or the endocrine symptoms?

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