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zyprexa + cabergoline??

Posted by nf39x on October 3, 2003, at 1:31:18

First post here, so be gentle.

Back in January '02 I went on Zyprexa after going to a shrink because I was essentially staying up all night, sleeping all day, miserable, irrelevant to the human race, etc etc. I was mistrustful of SSRIs since Zoloft didn't do jack for me years before (other than get me high), and I said that mood instability and inappropriately large mood reactions to small stimuli were a problem for me. She gave me some Zyprexa samples, told me to start at 2.5mg per day and work up as needed until effects were felt, checking at every 5mg increment. I went home, looked it up, thought she was nuts (do I need a serotonin/dopamine ANTAGONIST?!) and tried it anyway. I was also buying xanax off the street because I had no health insurance, blah blah blah, apparently she was satisfied that I was not a drug-seeking addict because she gave me a scrip for it at the level I'd been using (.25mg mornings, as-needed afterwards, rarely ever more than .5mg in any one day), so I continued with that for anxiety.

I never got above 2.5mg/day with the Zyprexa. It was like a night and day difference. It was NOT a miracle in a pill, but it was amazing. I won't go into the long and short of it, but because of that stuff I'm back in school and all kinds of other things. Sure I gained 35 lbs (20 of which I needed) and when left to myself would sleep 12 hours a day, but it was a small price to pay. For those of you scoffing at 2.5mg/day being able to do that, well, let's just say I've determined over the years that I have a VERY odd brain and leave it at that. :-P

Anyway. This spring my left breast swelled up a bit and got tender with two palpable lumps in it (I'm male). I freaked, thinking I had breast cancer due to a family history, but the docs prodded at it and looked things up and found, hmm, Zyprexa can cause hyperprolactinemia.. that's probably not it since you're on such a small dose, but let's try taking you off it just to be sure.

Sure enough, the boob calmed down within two days and the mass started to shrink. Tenderness was gone.

Unfortunately, the two months I spent off Zyprexa were unbelievably hellish. Getting overstimulated by anything was enough to bring up the danger that I would vomit, I was having bona fide withdrawal symptoms the whole time, mainly the first three weeks.. waking up with tremor, nausea, noise and light sensitivity.. it was horrible. My xanax usage skyrocketed to compensate, and I have some theories on why I had such a strong withdrawal form Zyprexa, but anyway... at the end of the summer I was to return to school at a major university to get my undergrad degree. This involved moving and tons of stressful things. A few days after getting out here, I said the hell with it and went back on Zyprexa at 1.25mg/day.

It took 48 hours for symptoms to subside. I could brush my teeth again without throwing up, and all sorts of other lovely things. The thing is, 1.25mg/day just returns me to the level of functioning I had at say 16 years old. (That sounds bad, but in my case it's good.) 2.5mg/day brought order and stability to my moods and my mind. I was resistant to the little negatives in life that otherwise hijack my mood and my thoughts and take me down. My thinking was much more ordered and I could get things done, though I still usually took my own sweet time about it. Now at 1.25mg/day... not so much. I'm better than with none, but I still have enough issues that my schoolwok is already suffering just a month in.

Worse yet, my breast is a little swollen again, though there is no tenderness. I felt one of the little lumps again (they disappeared completely after I went off the Zyprexa) once, they tended to wax and wane before and I haven't felt it again, but it's definitely feeling the effects even at 1.25mg/day.

I found something on the net today about Cabergoline, which apparently acts as a prolactin blocker. It's actually a dopamine agonist, which would seem to contradict Zyprexa (a dopamine antagonist among other things). But, Cabergoline is selective for D2 receptors, and Zyprexa for D4. I can't seem to find the data on HOW selective Cabergoline is for D2 vs. D4, though.

I guess my questions are, how selective is it (in other words, how likely is it that it would just defeat Zyprexa's action), and has anybody used this combination to prevent hyperprolactinemia with Zyprexa, or think this is a good or bad idea?

I haven't been confirmed with hyperprolactinemia since I still didn't have health insurance and it's an expensive test. My insurance kicks in in a few days, though, so I may get it tested. If cabergoline would work, I would LOVE to go back up to 2.5mg/day of Zyprexa and have my peace of mind back.

Incidentally, while surfing around today I found the description of "atypical depression". It fits my weird issues much better than any other description I've read to date, and I've read quite a few. Mood reactivity is half the reason I went on the xanax, and I had some hypersomnia and BIG TIME rejection sensitivity, along with "comorbid" (what a word) anxiety disorders before going on the Zyprexa. Just thought I'd throw that in for information's sake.. I'm not saying Zyprexa is or isn't an appropriate treatment for atypical depression (the warning signs of which are now returning in me at 1.25mg/day), because I am an extremely odd case.


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