The Psychological Effects of Hyperprolactinaemia: Depression, Anxiety, and More

When your body makes too much prolactin, it doesn’t just mess with your periods or milk production. It can quietly steal your mood, your sleep, and your sense of self. Hyperprolactinaemia-high levels of the hormone prolactin-is often dismissed as a reproductive issue. But for many people, the real struggle isn’t infertility or irregular cycles. It’s the crushing fatigue, the unexplained sadness, and the constant worry that won’t go away-even when doctors say everything else is normal.

What Exactly Is Hyperprolactinaemia?

Prolactin is a hormone made by the pituitary gland, tucked at the base of your brain. Its main job is to trigger breast milk after childbirth. But it also talks to your brain, your ovaries, your testes, and your stress system. Normal levels are low in men and non-pregnant women-usually under 20 ng/mL. When levels climb above 25 ng/mL consistently, that’s hyperprolactinaemia.

It’s not rare. Studies show up to 1 in 5 women with unexplained infertility have high prolactin. Men are less likely to notice symptoms until they’re hit with low sex drive, breast tenderness, or erectile dysfunction. But the psychological side? That’s often overlooked.

Depression Isn’t Just ‘In Your Head’-It’s in Your Hormones

People with hyperprolactinaemia are two to three times more likely to be diagnosed with clinical depression than those with normal levels. Why? Prolactin interferes with serotonin and dopamine, the brain’s natural mood stabilizers. High prolactin doesn’t just make you feel sad-it dulls your ability to feel joy, even in things you used to love.

One 2023 study tracked 127 patients with prolactin levels over 40 ng/mL. Nearly 68% met the criteria for major depressive disorder. What stood out? Their depression didn’t improve with talk therapy alone. It lifted only after prolactin levels dropped-with medication like cabergoline or bromocriptine. That’s not coincidence. That’s biology.

Many patients describe it as a fog. Not just tired. Not just down. But emotionally numb. They cry for no reason. They stop calling friends. They lie in bed for hours, unable to get up-even though they know they should. It’s not laziness. It’s neurochemical disruption.

Anxiety Doesn’t Come From Stress-It Comes From Your Pituitary

High prolactin doesn’t just cause depression. It fuels anxiety too. People report panic attacks, racing thoughts, and a constant sense of dread. Even when life is calm, their body feels like it’s under threat.

Research shows prolactin activates the hypothalamic-pituitary-adrenal (HPA) axis-the system that controls your stress response. When prolactin is too high, your HPA axis stays stuck in overdrive. Your cortisol stays elevated. Your heart races. Your muscles tighten. You can’t relax, even when you’re asleep.

One woman in her early 30s, diagnosed after years of panic attacks and missed work, told her doctor: ‘I thought I was losing my mind. I checked my credit card statements to see if I was being robbed. I called my mom three times a day just to hear her voice. I didn’t know why I felt so unsafe.’ Her prolactin was 78 ng/mL. After three months of treatment, her panic attacks stopped. She didn’t need therapy. She just needed her hormone levels fixed.

Other Psychological Symptoms No One Talks About

Depression and anxiety are the big ones. But hyperprolactinaemia also shows up in subtler ways:

• Brain fog: Trouble remembering names, losing track of conversations, forgetting where you put your keys. This isn’t aging. It’s hormonal.
• Sleep disruption: Insomnia or waking up exhausted, even after 8 hours. Prolactin spikes at night-too much of it throws off your deep sleep cycles.
• Low motivation: You used to run marathons. Now you can’t even muster energy to walk the dog. Your dopamine is suppressed.
• Emotional volatility: Sudden anger, crying fits, feeling overwhelmed by small things. Your brain’s emotional regulators are out of sync.

These symptoms often get mislabeled as ‘stress,’ ‘burnout,’ or ‘mental weakness.’ But they’re physical. They’re measurable. And they’re treatable.

What Causes High Prolactin?

Not all cases are the same. The cause changes how you treat it-and how fast your mood improves.

• Prolactinoma: A benign tumor on the pituitary gland. It’s the most common cause. Tumors under 1 cm (microadenomas) often respond well to medication. Larger ones may need surgery.
• Medications: Antidepressants (especially SSRIs), antipsychotics, blood pressure drugs like verapamil, and even some stomach meds (like metoclopramide) can raise prolactin.
• Thyroid problems: Underactive thyroid (hypothyroidism) triggers the pituitary to overproduce prolactin as a side effect.
• Chronic stress: Long-term stress can nudge prolactin up, especially if you’re already sensitive.
• Physical irritation: Chest wall injuries, shingles on the chest, or even tight bras can stimulate prolactin release.

If you’re on antidepressants and suddenly feel worse-emotionally flat, anxious, or weepy-ask your doctor to check your prolactin. It might not be the medication failing. It might be the medication causing the problem.

How to Test and Diagnose It

There’s no single symptom that screams ‘hyperprolactinaemia.’ But if you have three or more of these, get tested:

• Unexplained depression or anxiety that doesn’t respond to therapy or meds
• Irregular periods or no periods (in women)
• Low sex drive or erectile dysfunction (in men)
• Breast milk when not pregnant or nursing
• Headaches or vision changes (signs of a pituitary tumor)

The test is simple: a blood draw in the morning, before eating, after 10 minutes of rest. Stress and exercise can spike prolactin temporarily, so timing matters. If your level is over 25 ng/mL, your doctor should repeat it. If it stays high, they’ll likely order an MRI to check for a tumor.

Treatment That Fixes More Than Just Hormones

The good news? Most cases of hyperprolactinaemia respond quickly to treatment.

Cabergoline is the first-line drug. It’s taken twice a week. In studies, it lowers prolactin by 70-90% within weeks. And mood improves fast. One patient reported feeling ‘like herself again’ after just 10 days. Her depression scores dropped by 60% in six weeks.

Bromocriptine is older and has more side effects-nausea, dizziness, low blood pressure. But it works too.

If a tumor is found, medication still comes first. Surgery is only needed if the tumor is pressing on your optic nerve or doesn’t shrink with drugs.

And if your high prolactin is from a medication? Sometimes switching drugs fixes everything. For example, switching from an SSRI like sertraline to bupropion (which doesn’t raise prolactin) can lift depression without losing the benefits of treatment.

What Happens If You Ignore It?

Leaving hyperprolactinaemia untreated doesn’t just mean ongoing sadness. Over time, high prolactin can:

• Lower bone density, increasing fracture risk
• Reduce estrogen or testosterone, leading to long-term sexual dysfunction
• Worsen anxiety into panic disorder or agoraphobia
• Trigger or deepen depression to the point of suicidal thoughts

It’s not a ‘minor’ hormonal quirk. It’s a systemic issue with mental health consequences that can last for years if missed.

When to See a Doctor-Right Now

If you’ve been struggling with:

• Depression that won’t lift, even with therapy and meds
• Anxiety that feels physical-heart racing, chest tightness, dizziness
• Unexplained fatigue, brain fog, or loss of libido
• Any breast discharge, missed periods, or erectile issues

-ask for a prolactin blood test. Don’t wait. Don’t assume it’s ‘just stress.’

Many people spend years going from therapist to therapist, trying new antidepressants, doing yoga, meditating, journaling-while their hormone levels keep poisoning their mood. Fix the hormone, and sometimes, the mind heals on its own.

What to Ask Your Doctor

Bring this list to your appointment:

• ‘Can my prolactin level be checked?’
• ‘Could any of my medications be raising it?’
• ‘If it’s high, what’s the next step-an MRI?’
• ‘If it’s a tumor, is it small enough to treat with pills?’
• ‘How long until I might feel better if we treat this?’

Doctors aren’t always trained to connect mood symptoms with prolactin. But if you ask clearly, you’ll get answers.