Galactorrhea - side effect of risperidone in combination with depakine chrono in a patient with bipolar disorder

Risperidone, as all atypical antipsychotics, can cause hyperprolactinemia which can in turn lead to galactorrhea. Mood stabilizers, one of which is valproic acid and its derivate "Depakine Chrono", are rarely linked with symptomatic hyperprolactinemia and do not alter prolactin concentrations. This case is based around a patient suffering from a bipolar disorder that has been psychiatrically treated in an outpatient clinic during four years. Bipolar disorder treatment was started with carbamazepine, but later it was discontinued due to adverse events and extreme increase of liver transaminases. Treatment was continued with introduction of lithium, but the patient stated that she could not tolerate it. Subsequently, her endocrinologist advised for lithium discontinuation due to very severe osteoporosis. At the beginning of 2009, lithium was discontinued and Depakine Chrono was introduced. Due to patient's psychotic decompensation it was necessary to introduce risperidone into treatment and soon afterwards her psychotic symptoms settled. After several months of treatment her mood lowered, she began to feel sedated, psychomotorically retarded and that lead to dose lowering of Depakine Chrono and risperidone, at which point galactorrhea as a serious adverse event occurred. Occurrence of galactorrhea at lower risperidone doses in this case might be partially explained by recent studies that showed that lower doses of risperidone can also improve psychic state, but could also cause adverse events. Although galactorrhea, as a direct consequence of hyperprolactinemia caused by risperidone has mainly been researched with higher doses of this atypical antipsychotic, we have to keep in mind that lower doses could also cause serious adverse events.