Psychotropic Medications That Cause Lactation

Mechanism and Clinical Impact

Galactorrhea (lactation) can occur in both women and men due to antipsychotic use, particularly with typical antipsychotics and risperidone, as reported by the American Academy of Child and Adolescent Psychiatry 2
Amenorrhea/oligomenorrhea and anovulation in women, and decreased libido, erectile dysfunction, and gynecomastia in men can be caused by antipsychotics, according to the American Academy of Child and Adolescent Psychiatry and Praxis Medical Insights 3, 1

The American Academy of Child and Adolescent Psychiatry suggests that certain psychotropics, such as carbamazepine and benzodiazepines, rarely cause symptomatic hyperprolactinemia or produce no clinically important prolactin changes 2

Before concluding medication is the cause of hyperprolactinemia, it is essential to exclude other potential causes, including prolactinomas, primary hypothyroidism, chronic kidney disease, severe liver disease, macroprolactinemia, pituitary stalk compression, and stress, as recommended by Praxis Medical Insights 3, 1, 5

The American Academy of Child and Adolescent Psychiatry and Praxis Medical Insights warn against assuming mild elevation is benign, as even asymptomatic hyperprolactinemia can cause long-term bone density loss through hypogonadism, and recommend checking for "hook effect" with large pituitary masses, which can produce falsely low readings in ~5% of macroprolactinomas 3, 5