If you or someone you know takes an antipsychotic, you might have heard the word prolactin tossed around. It’s a hormone that helps with milk production after pregnancy, but certain brain‑acting drugs can push its levels way up. High prolactin can cause breast swelling, unwanted milk, irregular periods, or even mood changes. Knowing the why and how can keep you from getting caught off guard.
Most antipsychotics block dopamine receptors in the brain. Dopamine normally tells the pituitary gland to keep prolactin low. When dopamine is blocked, the pituitary goes into overdrive and releases more prolactin. Drugs like risperidone, paliperidone, and haloperidol are strong dopamine blockers, so they are the usual suspects. Some newer meds, such as aripiprazole, act a bit differently and usually don’t raise prolactin much.
Common clues include breast tenderness, nipple discharge (even if you’re not pregnant or nursing), missed periods, and low libido. Men might notice reduced sexual drive or erectile problems. If any of these show up, don’t ignore them—talk to your doctor. A simple blood test can tell if your prolactin is high.
When labs confirm an elevation, your doctor has a few options. First, they might lower the dose of the current antipsychotic. If that works, you stay on the same pill but at a safer level. Second, they could switch you to a drug that’s less likely to raise prolactin, like aripiprazole or ziprasidone. Third, they might add a medication called a dopamine agonist (such as bromocriptine) to bring prolactin down, but this is less common because it can interfere with the antipsychotic’s effect.
While you’re sorting this out, lifestyle tweaks can help. Keep a regular sleep schedule, avoid excess alcohol, and stay active. These won’t fix the hormone problem on their own, but they reduce overall stress, which can make symptoms feel less intense.
Regular monitoring is key. If you’re on a high‑risk antipsychotic, ask your doctor to check prolactin levels every few months, especially when you start a new dose. Keeping a symptom diary can also give your doctor a clear picture of what’s happening.
Bottom line: antipsychotics can raise prolactin, but you have tools to catch it early and manage it. Talk openly with your prescriber, get the right tests, and don’t hesitate to explore alternative meds if side effects become a problem. Staying informed means you can keep your mental health treatment effective without unnecessary hormone hassles.
