![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by angelrose on November 21, 2000, at 12:00:01
Hi,
I recently went to the Doctor and had a blood test to check my prolactin levels. The test came back normal.
The Doctor said that I did not need any medication unless it really bothered me.
I'm not too sure if I should at this point.
I also asked him if it caused weight gain and his reply was no.
So, I do not understand why I CANNOT lose weight, it has always been so easy for me to lose weight. I lost my pregnancy weight in 4 months and 2 years later after being back on AD's I cannot even lose 2LBS. What is the deal?Would love to hear your comments.
Thanks!
Posted by MarkinBoston on November 22, 2000, at 13:30:15
In reply to Does Galactorrhea cause weight gain?, posted by angelrose on November 21, 2000, at 12:00:01
Possibly only locally :-)
I did a google search and found this link:
http://www.postgradmed.com/issues/2000/06_00/whitman.htm
amongst several.So, galactorrhea can have numerous causes including AD meds, which sounds like the most likely one. Your meds might be decreasing dopamine levels and be the link between your two symptoms. Another common cause would be hypothyroidism.
Your doc did only the most basic screening test to cover his ass against malpractice and may not have the time or inclination to research the problem and subtle endocrine effects of your meds.
Don't be frightened by pituitary tumors in the cases from that link, its not likely. I had a $2,000 MRI scan to rule one out for my hypogonadism and I thought it was a complete waste of money for the HMO, while a cover your ass move for my primary and endo docs.
Posted by angelrose on November 22, 2000, at 16:10:45
In reply to Re: Does Galactorrhea cause weight gain?, posted by MarkinBoston on November 22, 2000, at 13:30:15
> Possibly only locally :-)
>
> I did a google search and found this link:
> http://www.postgradmed.com/issues/2000/06_00/whitman.htm
> amongst several.
>
> So, galactorrhea can have numerous causes including AD meds, which sounds like the most likely one. Your meds might be decreasing dopamine levels and be the link between your two symptoms. Another common cause would be hypothyroidism.
>
> Your doc did only the most basic screening test to cover his ass against malpractice and may not have the time or inclination to research the problem and subtle endocrine effects of your meds.
>
> Don't be frightened by pituitary tumors in the cases from that link, its not likely. I had a $2,000 MRI scan to rule one out for my hypogonadism and I thought it was a complete waste of money for the HMO, while a cover your ass move for my primary and endo docs.
Posted by SLS on November 22, 2000, at 19:50:27
In reply to Does Galactorrhea cause weight gain?, posted by angelrose on November 21, 2000, at 12:00:01
Hi Angelrose.
I don't think your difficulty losing weight while taking antidepressants (not specified) is due to elevated levels of prolactin. There are quite a few mechanisms by which the various psychotropic drugs can cause weight-gain and increase appetite. Some silly boy posted the results of his literature search in a previous thread. Perhaps it will answer your question.
http://www.dr-bob.org/babble/20001115/msgs/48889.html
FYI:
You may be confusing galactorrhea with hyperprolactinemia. One can have elevated levels of prolactin without having it produce galactorrhea. Galactorrhea is an excessive flow of milk from the breasts during lactation or spontaneous milk flow not associated with childbirth or the nursing of an infant.
Elevated levels of prolactin can contribute to weight gain.
The older neuroleptic antipsychotics (Haldol, Thorazine, Sulpiride, etc.) are the most notorious for substantially elevating prolactin levels due to their blockade of dopamine D2 receptors in the pituitary gland. Tricyclic and SSRI antidepressants can elevate prolactin also, the tricyclics perhaps more so. Hyperprolactinemia can be associated with weight gain. It upsets the endocrine balance and can lead to a reduction in the secretion of sex hormones. Decreased gonadal steroid secretion can cause weight-gain. Testosterone, which is also secreted by the adrenal glands in both men and women, promotes the burning of fat and increases metabolism. With lower levels of testosterone comes reduced metabolism and increased body weight. Decreased levels of estrogen may cause overeating and cravings. Prolactin can also reduce insulin sensitivity, leading to more blood sugar being stored as fat.
An underappreciated possible side effect of the SSRIs is mammoplasia; breast enlargement due to cell division. The exact reason of this is unclear. Effexor does not seem to do this.
I am really not too sure how estrogen and estrogen/androgen balance works in this context. Oh well...
- Scott
Posted by natg on November 23, 2000, at 13:06:00
In reply to Re: Does Galactorrhea cause weight gain? » angelrose, posted by SLS on November 22, 2000, at 19:50:27
Dear Scott:
Thanks for the valuable info.
I have to admit all this is quite confusing to me. I'm wondering if you have any suggestions.
I'm taking Prozac and Neurontin. I've had milk leakage for the last 8-9 months and breast enlargmeent. As I forementioned, my prolactin levels were normal.
I don't dare to give up the Prozac + Neurontin combo. as it is working BUT this side- effect is bothering me tremendously.
Do you know what meds. can treat this problem? should I go see another Doctor?
What would be your suggestion.Thanks, I REALLY appreciate your help.
Posted by natg on November 23, 2000, at 18:07:55
In reply to To Scott, posted by natg on November 23, 2000, at 13:06:00
> Dear Scott:
> I forgot to mention I'm also taking a low dose of Wellbutrin.
I got a little distracted writing the first post. The other thing I forgot to say is that my menses have been irregular.I used to take Risperdal but had to give that up because I thought this particular medication was the cause of the milk leakage.
I hope I have not confused you too much.
Regards,
nat
Posted by angelrose on November 23, 2000, at 18:10:01
In reply to Re: Does Galactorrhea cause weight gain? » angelrose, posted by SLS on November 22, 2000, at 19:50:27
> Hi Angelrose.
>
> I don't think your difficulty losing weight while taking antidepressants (not specified) is due to elevated levels of prolactin. There are quite a few mechanisms by which the various psychotropic drugs can cause weight-gain and increase appetite. Some silly boy posted the results of his literature search in a previous thread. Perhaps it will answer your question.
>
> http://www.dr-bob.org/babble/20001115/msgs/48889.html
>
>
>
> FYI:
>
> You may be confusing galactorrhea with hyperprolactinemia. One can have elevated levels of prolactin without having it produce galactorrhea. Galactorrhea is an excessive flow of milk from the breasts during lactation or spontaneous milk flow not associated with childbirth or the nursing of an infant.
>
> Elevated levels of prolactin can contribute to weight gain.
>
> The older neuroleptic antipsychotics (Haldol, Thorazine, Sulpiride, etc.) are the most notorious for substantially elevating prolactin levels due to their blockade of dopamine D2 receptors in the pituitary gland. Tricyclic and SSRI antidepressants can elevate prolactin also, the tricyclics perhaps more so. Hyperprolactinemia can be associated with weight gain. It upsets the endocrine balance and can lead to a reduction in the secretion of sex hormones. Decreased gonadal steroid secretion can cause weight-gain. Testosterone, which is also secreted by the adrenal glands in both men and women, promotes the burning of fat and increases metabolism. With lower levels of testosterone comes reduced metabolism and increased body weight. Decreased levels of estrogen may cause overeating and cravings. Prolactin can also reduce insulin sensitivity, leading to more blood sugar being stored as fat.
>
> An underappreciated possible side effect of the SSRIs is mammoplasia; breast enlargement due to cell division. The exact reason of this is unclear. Effexor does not seem to do this.
>
> I am really not too sure how estrogen and estrogen/androgen balance works in this context. Oh well...
>
>
> - Scott
Posted by shellie on November 23, 2000, at 18:51:20
In reply to Re: Does Galactorrhea cause weight gain? » angelrose, posted by SLS on November 22, 2000, at 19:50:27
Hi Scott, my friend
While scimming these posts, I just started to wonder about my weight gain on lamictal. Besides the weight gain, my breasts were somewhat enlarged and aching all the time. I had no sign of milk flow.
Could these symptoms have to do with increased levels of prolactin? Is there any way to control this, e.g., small amounts of testrosterone?
>
A lot of this is over my head,but I'd love to take lamictal again without the weight gain and breast pain.On the third day of taking pindolol (only 1/8 of a 25mg pill), I plummeted. Coincidence maybe, but somehow I don't believe so. Anyway, I think probably no more drug trials until after xmas.
How are you doing on your last combo? You were in a pretty good place when last we communicated.
Happy Thanksgiving.
until later, shellie
Posted by SLS on November 24, 2000, at 17:54:29
In reply to Re: Does Galactorrhea cause weight gain? » SLS, posted by shellie on November 23, 2000, at 18:51:20
Hi guys.
For NagG:Have you birthed children?
Your suspicion of Risperdal (risperidone) being the culprit was very logical. Of the newer atypical antipsychotics (Clozaril, Risperdal, Zyprexa, and Seroquel), Risperdal is the one that can cause an increase in the secretion of prolactin. It was a great guess.
I included below what seems to be the only investigation into antidepressant-induced breast-enlargement (mammoplasia, macromastia). This side effect is caused primarily by the SSRI class of antidepressants. Prozac is a member of this class. As far as I know, there is no explanation as to why Prozac does this. Prolactin does not seem to be involved. Also, those women who experienced mammoplasia also experienced the most weight gain (beyond the obvious). Effexor did not seem to produce mammoplasia that often. I would place a great deal of confidence in the results of this study. Jay Amsterdam is one of the best. If their observations regarding Effexor are valid, you might consider using it to replace Prozac. Both drugs affect serotonin in the same way. Of course, that does not guarantee that it will be effective, but it is a very good drug. Actually, it is possible that using another member of the SSRI class will not produce the same effect in you as does Prozac. I don't know what I would do in your place. I guess I would want to find another drug that worked that would not cause macromastia and galactorrhea, especially if I thought I would have to take it for the rest of my life - or at least for a very long time.
The word that sticks in my mind is "unacceptable". I don't think this side effect is acceptable unless there are no better options. The more desirable option would be to treat the macromastia and continue to take Prozac. Right now, I really don't know how to go about this. My best guess is that bromocryptine (Parlodel) would be ideal. Bromocryptine should help with both your depression and your macromastia/galactorrhea at the same time. Tamoxefin is sometimes used.
I can understand any fears you might have about stopping Prozac. You might feel terrible right away. I would also be afraid that, if after having tried a lot of different drugs that didn't work, Prozac wouldn't work when I go back to it. Well, if you weren't worried about this possibility before, you are now. That's good. I I feel that this is a valid consideration when reaching a decision. I really can't give you much of an idea as to how often this happens, except to say that it is the exception rather than the rule. I am sure there are ways to minimize this risk to near zero.
Two thoughts:
1. If you do not respond to a given drug within three weeks, return to Prozac immediately. In this way, you are almost assured of recapturing your response to it. Perhaps you can try a different medication every three or four months in this fashion.
2. Remain on Prozac and add one of the alternative drugs to it. I can only guess as to what the safest way to go about this. You will need to get much more feedback from others regarding this strategy. I would like to hear something from Sunnely. Combining Prozac with Effexor or another SSRI carries a very small risk of developing something called the "serotonin-syndrome". This involves nervousness, confusion, incoherency, involuntary muscle movements, muscle tension and contraction, sweating, nausea, diarrhea, high blood pressure, shivering, and fever. It can be life threatening. Again, I just want to provide you with some information so that your decision is an informed one. If it were me, this wouldn't stop me from trying such a combination, especially if I knew what symptoms to screen for.I guess the most sensible thing to do is to start with a very low dosage of the new drug and work up gradually while at the same time reducing your dosage of Prozac. I don't know whether or not there is a liquid preparation of Prozac. I have never heard of one. Prozac stays in the body for a long time, so reducing the dosage will involve skipping days. I think you should begin to reduce your dosage of Prozac before adding any others. Maybe you can work your way down to 20mg every three days before beginning the new drug. Again, this is just my throwing ideas around without giving them much thought.
I think I wrote too much here. Sorry. If it were me, I would try adding bromocryptine first. If your side effects can't be adequately treated, I would try another drug in the safest way possible while not endangering your responsivity to Prozac. I'd give Effexor a try first.
For Shellie:Sorry to have to disappoint you, my friend. My initial response to Zyprexa lasted for only a few days. Man, I thought I hit a homerun. I did so many things and thought so many thoughts and felt so many feelings. Having a sex-drive is pretty cool. I forgot what a skirt-chaser I can be. Here I am, not feeling better for even three days, not knowing whether it will last even one more hour, ready to slip some gorgeous young woman at a restaurant my phone number. I had written it down on a post-it my mother had in her pocket-book. Unfortunately, after a half-hour of mutual flirting, she ruined it by talking.
I am like a dog that begins running in mid-air as you lower him to the ground. As soon as he touches the ground, he's gone. Nothing but dust.
I think I'm in the same situation with Zyprexa as is Anita with Risperdal. I was doing better at the lower dosage I started at. I decided to skip my dose last night and I am feeling a bit better today. I'm not sure what I'm going to do at this point. I haven't decided whether I should give the reduced dosage of Zyprexa some more time or to switch over to Risperdal immediately. My doctor gave me prescriptions for both drugs and wanted me to switch if my first choice was inadequate. I see him in 12 days, and I want to make sure I go in to see him with enough information to be able to compare Risperdal to Zyprexa. Perhaps I owe a turkey for a burst of serotonin that is making me feel better today. :-)
Shellie, that your mood plummetted upon starting pindolol, and I believe it did, may be a clue as to what you need. What SSRIs have you tried, at what dosages, and for how long. Effexor? With which drugs have you added lithium to, and at what dosages.
Regarding your side effects with Lamictal, I'll want to give that more thought. Taken from the abstract I included below, it may not insignificant that you describe breast enlargement and tenderness and your greater-than-average weight gain. If you do decide to go back to Lamictal along with your MAOI, I would add bromocryptine and/or amphetamine. I think you'll kill two birds with one stone. I would also consider adding low-dosages of lithium (300-600mg) in there. If all of that crap ends up unlocking the door to the rest of your life, be sure to tell me. Hopefully, I'll be following right behind you taking the same combination.
I have come to two conclusions:
1. Life sucks.
2. Life is great.I'm hanging around for #2. I can't wait!!!
Love,
Scott
-------------------------------------------------------
1: J Affect Disord 1997 Nov;46(2):151-6 Related Articles, Books, LinkOut
Breast enlargement during chronic antidepressant therapy.Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M
Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Recent reports of mammoplasia during selective serotonin re-uptake inhibitor (SSRI) therapy suggested that this side effect may be more common than previously reported. We examined 59 women receiving > or = 2 months treatment with an SSRI or venlafaxine for changes in breast size in relation to menopausal status, weight gain and duration of drug therapy. Serum prolactin, estradiol and beta-hCG were also measured before and during treatment in a subgroup of patients. Twenty-three out of 59 patients (39%) reported some degree of mammoplasia. Significantly more SSRI vs. venlafaxine patients reported mammoplasia (p < 0.01). Eighty-four percent with mammoplasia had weight gain vs. 30% without mammoplasia (p < 0.001). The rate of mammoplasia was unrelated to age, menopausal status or duration of treatment. Serum prolactin increased during treatment in the paroxetine subgroup (p < 0.03). In conclusion, antidepressant-induced mammoplasia may be more common than previously expected.
PMID: 9479619, UI: 98140246
Posted by shellie on November 25, 2000, at 12:03:45
In reply to Re: Does Galactorrhea cause weight gain?, posted by SLS on November 24, 2000, at 17:54:29
Hey Scott. This thing about the antipsychotics pooping out after a few days is very strange--I wonder how your pdoc will explain if, if he is able to. It does give you a lot in common with Anita
(better than being alone).I'm wondering if you've ever added thyroid to your cocktail. Some years ago my hair started falling out-went to endocrinologist-test negative, hair still getting thinner. Went to vitamin, natural, MD, had me take my temperature every morning-was very low; put me on thyroid (armour natural t3 & t$). Hair stopped falling out in very short time. No difference noted in depression (which was pretty much under control at that time). Two weeks ago doubled thyroid and don't know if it is effecting depression, but definitely giving me more energy.
Sent by pdoc to get thyroid tests (waiting until after Christmas).Tried effexor once, couldn't keep it down; luvox (slept for a month) and serzone (no improvement). Also wellbutrin and prozac for 1 month- 6 weeks each (no improvement). (All quite a few years ago).
All other combinations were with nardil.
Have not been able to tolerate any of the amphetimines (tried adderall, ritalin, dexadrine). Could tolerate adrafinil, but didn't see any real improvement and had hypertensive reaction with nardil.
Can't tolerate tricyclics or new or old antipsycholtics (haven't tried zyeprexa because of weight).
No help with nardil and buspar; depression increassed with depakote and nardil and neuotin and nardil. My body seems not to be able to tolerate most medications.Anyway, I am very reluctant to give up nardil; I used to consider it my best friend in the world; now, although it is not giving me the relief it once did, I am most comfortable with it as my starting point.
Apparently primrose is good for galactorrhea, but I guess it wouldn't do anything for the weight gain. I wish I could take adderall or ritalin.
BTW, if what you told me about yourself is true (a couple posts ago when referring to intellect and humor), and I have no reason to believe it is not--I will be afraid to write to you when you find your right medication combo. Of course, then you will probably not have the need to write. I will send you pictures!
Until later, shellie
Posted by SLS on November 25, 2000, at 19:16:54
In reply to Re: Does Galactorrhea cause weight gain? » SLS, posted by shellie on November 25, 2000, at 12:03:45
> Hey Scott. This thing about the antipsychotics pooping out after a few days is very strange--I wonder how your pdoc will explain if, if he is able to. It does give you a lot in common with Anita
> (better than being alone).It is. I just wish we could all be together in Paradise - the paradise that can be life without mental illness.
> I'm wondering if you've ever added thyroid to your cocktail. Some years ago my hair started falling out-went to endocrinologist-test negative, hair still getting thinner. Went to vitamin, natural, MD, had me take my temperature every morning-was very low; put me on thyroid (armour natural t3 & t$). Hair stopped falling out in very short time. No difference noted in depression (which was pretty much under control at that time). Two weeks ago doubled thyroid and don't know if it is effecting depression, but definitely giving me more energy.
Thanks for reminding me about thyroid. I will be sure to add it to my list and tell my doctor about it. I once tried T4 Synthroid in addition to a high-dosage Parnate + desipramine combination. I liked how I felt on it. However, I gave up the Synthroid when we abandoned the core regime. T3 Cytomel makes me feel MUCH more depressed.
> Sent by pdoc to get thyroid tests (waiting until after Christmas).
FRIG the tests. Titrate the thyroid for optimal antidepressant effect. When treating TRD depression, thyroid is used as a drug to augment antidepressant therapy, and not as a hormonal supplement. You don't worry about blood-tests and normal ranges. You just use it.
After reading some of what you have written (I'll need to take some time to get through it thoroughly), I can't help but to be excited for you at the proposition of you trying Mirapex (pramipexole). Mirapex will give you a completely different type of dopamine enhancing effect as compared to the stimulants you have had trouble with in the past.
I also like the idea of adding low-dosages of either Zyprexa or Risperdal for you. I know you were unhappy with what you experienced the first day after taking Risperdal. I may have asked this before, and if I have, please forgive me, but what EXACTLY did you experience. Describe it in as much detail as possible. How much did you take? Even 1mg could have been too much. Risperdal usually doesn't produce much weight gain. You might also take a look at Seroquel.
When you say that you couldn't speak, is it because you literally could not form words and vocalize them no matter how hard you tried, or did you just feel mute and have difficulty getting words out fluently and without clear pronunciation?
> Anyway, I am very reluctant to give up nardil;
I would feel reluctant to recommend that you do. If your doctor recommends it, that's another story.
> I used to consider it my best friend in the world; now, although it is not giving me the relief it once did, I am most comfortable with it as my starting point.
It probably is your best starting point. If you are going to give it up, it would be for another MAOI like Parnate or Marplan. Just for the heck of it, post a question regarding adding Eldepryl (selegiline), a selective MAO-B inhibitor, to Nardil. AndrewB or Adam would be the best sources of information. If you don't, I will. I am going to ask my doctor at my next visit to switch me from Parnate to Nardil. Nardil has been one of my best friends too. I really like the idea of Nardil + Zyprexa.
SERZONE: What was your experience with this drug?
> BTW, if what you told me about yourself is true (a couple posts ago when referring to intellect and humor), and I have no reason to believe it is not--I will be afraid to write to you when you find your right medication combo.
The more of my talents I recover, the more invisible I like to make them. I remain very, very accessible and am quite humble. It is only during such protracted periods of poor function that I feel it somehow emotionally necessary to look for affirmation.
> Of course, then you will probably not have the need to write.
This is a very estute and honest anticipation. It's sort of like when you say to an aquaintenance who is moving away, "We'll stay in touch", and although it is a sincere sentiment at the time, you never do. I don't know how I will feel when I awaken from my nightmare and become part of the world. One way or the other.
> I will send you pictures!
I can't wait!
Love,
As always,
ScottMirapex.
Posted by natg on November 26, 2000, at 11:42:33
In reply to Re: Does Galactorrhea cause weight gain?, posted by SLS on November 24, 2000, at 17:54:29
Dear Scott:
How do you know so much?
I wish my Psychiatrist and GP was as informed as you are! WOW!I have decided to get off the Prozac and see what happens. Effexor may be my next choice.
I have another question for you: Risperdal was perhaps the best medication I have tried thus far. I think that for the first time in my life I felt alive and " normal".
I quit taking it after 8 weeks because of the same problem. Also, it sort of pooped out on me. Having said that, I think if I had lowered my dose, I might have recaptured the initial effect.
Do you think the other anti- psychotics you mentioned might be a better alternative? I have tried Zyprexa but the weight gain was pretty bad.My other concern is that I would like to have children in the next 5-7 years, do you think that gallactorhea would in anyway affect my fertility? ( To answer your question, I have birthed a child)
Maybe, these are difficult questions. I really appreciate your time and your valuable knowledge.
Thanks a lot!One more thing, would Amantadine be comparable to Bromocriptine?
Best of health to you,
Nat
>
>
> For NagG:
>
> Have you birthed children?
>
> Your suspicion of Risperdal (risperidone) being the culprit was very logical. Of the newer atypical antipsychotics (Clozaril, Risperdal, Zyprexa, and Seroquel), Risperdal is the one that can cause an increase in the secretion of prolactin. It was a great guess.
>
> I included below what seems to be the only investigation into antidepressant-induced breast-enlargement (mammoplasia, macromastia). This side effect is caused primarily by the SSRI class of antidepressants. Prozac is a member of this class. As far as I know, there is no explanation as to why Prozac does this. Prolactin does not seem to be involved. Also, those women who experienced mammoplasia also experienced the most weight gain (beyond the obvious). Effexor did not seem to produce mammoplasia that often. I would place a great deal of confidence in the results of this study. Jay Amsterdam is one of the best. If their observations regarding Effexor are valid, you might consider using it to replace Prozac. Both drugs affect serotonin in the same way. Of course, that does not guarantee that it will be effective, but it is a very good drug. Actually, it is possible that using another member of the SSRI class will not produce the same effect in you as does Prozac. I don't know what I would do in your place. I guess I would want to find another drug that worked that would not cause macromastia and galactorrhea, especially if I thought I would have to take it for the rest of my life - or at least for a very long time.
>
> The word that sticks in my mind is "unacceptable". I don't think this side effect is acceptable unless there are no better options. The more desirable option would be to treat the macromastia and continue to take Prozac. Right now, I really don't know how to go about this. My best guess is that bromocryptine (Parlodel) would be ideal. Bromocryptine should help with both your depression and your macromastia/galactorrhea at the same time. Tamoxefin is sometimes used.
>
> I can understand any fears you might have about stopping Prozac. You might feel terrible right away. I would also be afraid that, if after having tried a lot of different drugs that didn't work, Prozac wouldn't work when I go back to it. Well, if you weren't worried about this possibility before, you are now. That's good. I I feel that this is a valid consideration when reaching a decision. I really can't give you much of an idea as to how often this happens, except to say that it is the exception rather than the rule. I am sure there are ways to minimize this risk to near zero.
>
> Two thoughts:
>
> 1. If you do not respond to a given drug within three weeks, return to Prozac immediately. In this way, you are almost assured of recapturing your response to it. Perhaps you can try a different medication every three or four months in this fashion.
>
>
> 2. Remain on Prozac and add one of the alternative drugs to it. I can only guess as to what the safest way to go about this. You will need to get much more feedback from others regarding this strategy. I would like to hear something from Sunnely. Combining Prozac with Effexor or another SSRI carries a very small risk of developing something called the "serotonin-syndrome". This involves nervousness, confusion, incoherency, involuntary muscle movements, muscle tension and contraction, sweating, nausea, diarrhea, high blood pressure, shivering, and fever. It can be life threatening. Again, I just want to provide you with some information so that your decision is an informed one. If it were me, this wouldn't stop me from trying such a combination, especially if I knew what symptoms to screen for.
>
> I guess the most sensible thing to do is to start with a very low dosage of the new drug and work up gradually while at the same time reducing your dosage of Prozac. I don't know whether or not there is a liquid preparation of Prozac. I have never heard of one. Prozac stays in the body for a long time, so reducing the dosage will involve skipping days. I think you should begin to reduce your dosage of Prozac before adding any others. Maybe you can work your way down to 20mg every three days before beginning the new drug. Again, this is just my throwing ideas around without giving them much thought.
>
> I think I wrote too much here. Sorry. If it were me, I would try adding bromocryptine first. If your side effects can't be adequately treated, I would try another drug in the safest way possible while not endangering your responsivity to Prozac. I'd give Effexor a try first.
>
>
>
> For Shellie:
>
> Sorry to have to disappoint you, my friend. My initial response to Zyprexa lasted for only a few days. Man, I thought I hit a homerun. I did so many things and thought so many thoughts and felt so many feelings. Having a sex-drive is pretty cool. I forgot what a skirt-chaser I can be. Here I am, not feeling better for even three days, not knowing whether it will last even one more hour, ready to slip some gorgeous young woman at a restaurant my phone number. I had written it down on a post-it my mother had in her pocket-book. Unfortunately, after a half-hour of mutual flirting, she ruined it by talking.
>
> I am like a dog that begins running in mid-air as you lower him to the ground. As soon as he touches the ground, he's gone. Nothing but dust.
>
> I think I'm in the same situation with Zyprexa as is Anita with Risperdal. I was doing better at the lower dosage I started at. I decided to skip my dose last night and I am feeling a bit better today. I'm not sure what I'm going to do at this point. I haven't decided whether I should give the reduced dosage of Zyprexa some more time or to switch over to Risperdal immediately. My doctor gave me prescriptions for both drugs and wanted me to switch if my first choice was inadequate. I see him in 12 days, and I want to make sure I go in to see him with enough information to be able to compare Risperdal to Zyprexa. Perhaps I owe a turkey for a burst of serotonin that is making me feel better today. :-)
>
> Shellie, that your mood plummetted upon starting pindolol, and I believe it did, may be a clue as to what you need. What SSRIs have you tried, at what dosages, and for how long. Effexor? With which drugs have you added lithium to, and at what dosages.
>
> Regarding your side effects with Lamictal, I'll want to give that more thought. Taken from the abstract I included below, it may not insignificant that you describe breast enlargement and tenderness and your greater-than-average weight gain. If you do decide to go back to Lamictal along with your MAOI, I would add bromocryptine and/or amphetamine. I think you'll kill two birds with one stone. I would also consider adding low-dosages of lithium (300-600mg) in there. If all of that crap ends up unlocking the door to the rest of your life, be sure to tell me. Hopefully, I'll be following right behind you taking the same combination.
>
> I have come to two conclusions:
>
> 1. Life sucks.
> 2. Life is great.
>
> I'm hanging around for #2. I can't wait!!!
>
>
> Love,
> Scott
>
>
> -------------------------------------------------------
>
>
> 1: J Affect Disord 1997 Nov;46(2):151-6 Related Articles, Books, LinkOut
>
>
> Breast enlargement during chronic antidepressant therapy.
>
> Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M
>
> Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
>
> Recent reports of mammoplasia during selective serotonin re-uptake inhibitor (SSRI) therapy suggested that this side effect may be more common than previously reported. We examined 59 women receiving > or = 2 months treatment with an SSRI or venlafaxine for changes in breast size in relation to menopausal status, weight gain and duration of drug therapy. Serum prolactin, estradiol and beta-hCG were also measured before and during treatment in a subgroup of patients. Twenty-three out of 59 patients (39%) reported some degree of mammoplasia. Significantly more SSRI vs. venlafaxine patients reported mammoplasia (p < 0.01). Eighty-four percent with mammoplasia had weight gain vs. 30% without mammoplasia (p < 0.001). The rate of mammoplasia was unrelated to age, menopausal status or duration of treatment. Serum prolactin increased during treatment in the paroxetine subgroup (p < 0.03). In conclusion, antidepressant-induced mammoplasia may be more common than previously expected.
>
> PMID: 9479619, UI: 98140246
Posted by SLS on November 26, 2000, at 19:50:08
In reply to To Scott, posted by natg on November 26, 2000, at 11:42:33
Dear NatG,
How are you today?
> I have decided to get off the Prozac and see what happens. Effexor may be my next choice.
Good luck. I'll be thinking of you. I don't think you have anything to worry about. Effexor is a very logical choice. I hope it will work well without producing the side effect of issue. Please post as you progress through your drug trials. I am glad that you feel so positive and confident in your decision.
> I have another question for you: Risperdal was perhaps the best medication I have tried thus far. I think that for the first time in my life I felt alive and " normal".
This is a very encouraging predictor of your finding a successful treatment. I am glad to hear this.
This is also good news for me. I started taking Risperdal last night. I still don't know what dosage I will want to target. Although my doctor wanted me to begin at 1.0mg, I am inclined to begin at a lower dosage. Because I only have 1.0mg tablets to work with, I can only divide them into 0.5mg halves. I might have started at 0.25mg if I had that dosage tablet.
How much Risperdal were you taking?
> I quit taking it after 8 weeks because of the same problem. Also, it sort of pooped out on me. Having said that, I think if I had lowered my dose, I might have recaptured the initial effect.
You possess an effective intellect. :-) Someone here has had the experience of losing an antidepressant effect at 0.50mg of Risperdal, but was able to recapture it when she lowered the dosage to 0.25mg. I haven't seen any follow-up posts from her, so I don't know if the lower dosage has produced a stable improvement. Everyone is different. Perhaps 0.50mg is my optimal dosage. I am crossing my fingers. It has been far too long for me.
> Do you think the other anti- psychotics you mentioned might be a better alternative? I have tried Zyprexa but the weight gain was pretty bad.
Aside from the weight gain, what was your experience with Zyprexa? Did it help?
> My other concern is that I would like to have children in the next 5-7 years, do you think that gallactorhea would in anyway affect my fertility? ( To answer your question, I have birthed a child)
I am going to see what I can find on this. If the galactorrhea is the result of elevated prolactin levels, the answer is yes. Hyperprolactinemia is associated with amenorrhea and infertility. It will also impair fertility in men.
> Maybe, these are difficult questions. I really appreciate your time and your valuable knowledge.
All knowledge is valuable. Mine is more limited than you might think. I would consider it a great favor if you would share some of yours when I need it. Even when I don't need it. I just like learning stuff. This seems to be a wonderfully pervasive trait amongst Psycho-Babblers. We are truly special people.
> One more thing, would Amantadine be comparable to bromocriptine?
You see! You taught me something. I didn't know that amantadine has been used to treat drug-induced hyperprolactinemia. You've done your homework. Amantadine seems to be used but very infrequently. However, a couple of the abstracts I found on Medline (NIH / NLM medical database) showed it to be effective to treat the elevation in prolactin that the older antipsychotics and Risperdal can cause. However, bromocriptine is still the drug of choice for hyperprolactinemia and is very effective.
According to the Jay Amsterdam study, the breast enlargement seen with the various SSRIs was not associated with elevated prolactin levels. Paxil did produce some elevation, but they didn't specify how much.
Perhaps amantadine would help in this SSRI situation in particular. Amantadine is nothing like bromocriptine. It does seem to increase dopamine activity, as does bromocriptine, but in an entirely different way and with less potency. Amantadine does a bunch of different things. Both amantadine and bromocriptine are used to augment antidepressant therapy. Maybe you can kill... - what a nasty metaphor. I hope you will have no need of either of these two drugs. If you do, you may end up being a pioneer of a remedial treatment for SSRI-induced macromastia using amantadine.
Speak to you soon.
- Scott
Posted by AndrewB on November 28, 2000, at 4:04:07
In reply to To Scott, posted by natg on November 26, 2000, at 11:42:33
Bromocryptine is the drug most commonly used to deal with milk leakage, breast enlargement and irregular menses due to elevated prolactin levels.
You stated that your prolactin levels are normal, but considering the safety of bromo., it is worth a try anyway. Ask your doctor.
Note that bromo. has been combined with antipsychotics, of which Risperdal is one, to eliminate the above symptoms. If bromo. is successful, you can consider resuming risperdal or another antipsychotic (i.e. amisulpride).
Mirapex (pramipexole) may be a better choice than bromocryptine. Like bromo., it also lowers prolactin. It can be an effective AD on its own or in combo with SSRI whereas bromo., if it has an AD effect, tends to poop out. Mirapex also has been used to counter SSRI side effects.
Dosage varies but 5mg./day divided into three separate doses seems to be generally most effective. 6.25 mg/day is probably the upper limit.
It needs to be titrated up slowly to minimize its transitory side effects, namely nausea and headaches. Start at a dose of 1/4mg. and raise the dose by 1/4mg. each time after the side effects have subsided.
Lisuride, available from Europe, is effective when taken with Mirapex in eliminating the nausea.
AndrewB
Posted by natg on November 28, 2000, at 14:08:20
In reply to Re: To natg, posted by AndrewB on November 28, 2000, at 4:04:07
> Bromocryptine is the drug most commonly used to deal with milk leakage, breast enlargement and irregular menses due to elevated prolactin levels.
>
> You stated that your prolactin levels are normal, but considering the safety of bromo., it is worth a try anyway. Ask your doctor.
>
> Note that bromo. has been combined with antipsychotics, of which Risperdal is one, to eliminate the above symptoms. If bromo. is successful, you can consider resuming risperdal or another antipsychotic (i.e. amisulpride).
>
> Mirapex (pramipexole) may be a better choice than bromocryptine. Like bromo., it also lowers prolactin. It can be an effective AD on its own or in combo with SSRI whereas bromo., if it has an AD effect, tends to poop out. Mirapex also has been used to counter SSRI side effects.
>
> Dosage varies but 5mg./day divided into three separate doses seems to be generally most effective. 6.25 mg/day is probably the upper limit.
>
> It needs to be titrated up slowly to minimize its transitory side effects, namely nausea and headaches. Start at a dose of 1/4mg. and raise the dose by 1/4mg. each time after the side effects have subsided.
>
> Lisuride, available from Europe, is effective when taken with Mirapex in eliminating the nausea.
>
> AndrewBThanks for the info.
I was thinking of adding Mirapex to my regimen.
Andrew and Scott, I read some old posts that you wrote regarding Mirapex and relayed some of the info. to my Psychiatrist. I'm going to give it a try with Risperdal again.
Scott, to answer your question, I was taking 1 mg of Risperdal when it quit working. I'm going to try lowering the dose this time around.
How are you doing on it?
I wish you all the best.
I must admit, that I have plummeted into a deep depression in the last week so I hope this combo. works for me.
Andrew, you suggested Selegiline in one of your posts, I've been thinking about adding it but it also scares me. What dosage are you on? does it help?Thanks guys for your knowledge and time.
Best of health to both of you.
Nat
Posted by AndrewB on November 29, 2000, at 2:58:53
In reply to Re: To natg-- thanks Scott and AndrewB, posted by natg on November 28, 2000, at 14:08:20
Nat,
I take selegiline in low doses and it is in general very safe when taken at these dosages and in fact, indicatiions are, it maintains or improves the long term health of the dopaminergic system.
It should be considered if one has anergia, lack of motivation and a general sense of a lack of vitality. I t has helped me and others at this dose tremendously but some people experience anxiety on it. I have a pet theory that if combined with an antipsychotic, the anxiety may otherwise be avoided.
AndrewB
Posted by shellie on November 29, 2000, at 13:21:17
In reply to Re: To Scott » natg, posted by SLS on November 26, 2000, at 19:50:08
Hi Scott.
Sent fax to pdoc this yesterday questioning
could my breast pain/discomfort and enlargement could be related to an increase in prolactin. answer:yes
Does she think the weight gain is related to the breast pain. answer: yes
If breast discomfort is treated (danazol or bromocriptine, or whatever) would weight loss also be an effect. answer: yes
I don't completely trust my pdoc. She is so anxious for me to go back on lamictal, she'd probably tell me anything (really). But I am willing to go back on lamictal if she will work with me on a strategy for the above problems.
back to work now, shellie
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.