Q. Dear Anna,

My teenage daughter has been taking risperdal since October of last year. Along with her other meds (effexor and lithium, just recently added geodon) has finally acheived stability. Well, it seems that she hasn't had a period for about three months. After telling her pdoc about this, along with my concerns about weight gain, the doc got it out of her that she has been lactating, also. The doc is decreasing the risperdal and slowly upping the geodon and has ordered some labs, one of which is for prolactin level. I read with the script insert that lactation and cessation of menstruation is a possible side effect. But it doesn't seem to be a common one. I also saw this same advisory with the geodon insert info. If she stops the risperdal, how long for these side effects to cease? Is it just as likely that these s.e. will occurr with the geodon? I understand that weight gain is not as much a concern with geodon. She was on it once before but the dr that prescribed it imm ediately wrote for a high dose:160 mg. to which she showed twitching and had sporadic rapid eye movements. Her present pdoc stopped geodon and wrote for risperdal at that point. The current strategy is to more slowly add geodon and phase out the risperdal. Do all ap's cause the same side effects (i.e. wt gain and increased prolactin levels) in certain people? My concern is that my daughter really needs an ap. Through partial noncompliance (reducing risperdal) she once had bad consequences. What are "safer" alternatives in the ap dept? I also noticed that in much of the drug literature, the side effect of weight gain is listed as less common in Risperdal. But I have also read on different message boards from people's personal experiences, quite the opposite. Thanks for your help.

Jeanne

A. Dear Jeanne,

You seem to already know the answers to your own questions. I really can't offer any more information than what you have already. Medications affect every person differently, based on individual body chemistry, weight, other medications taken, diet, and dose. Lactation is not a very common side effect, but it is one that happens to some people. The fact that one antipsychotic caused your daughter to lactate does not mean another will, but I would have to say the risk is increased. Be certain to find out her prolactin levels when the results are in.

Antipsychotics cause weight gain in most people who take them, but each medication will affect each person differently. I really have no way to predict how your daughter will do on a specific medication. There are other alternatives, including seroquel and zyprexa, but they generally cause increased weight also.

Since your daughter is taking lithium I will assume her diagnosis is bipolar disorder. Has your doctor considered the addition of another mood stabilizer instead of an antipsychotic?

I am sorry I could not be of more help.

Anna