Q. Currently on Zyprexa for bipolar & to help with dissociation. I am also an abuse survivor and I am having a hard time with the meds in regards to the uncomfortably with how slow, fatigue and lack of alertness it causes. Not to mention the weight gain. (I have struggled with anorexia most of my life). I am able to use tools to help the negative behavior, however every time I go back on meds I can't tolerate the sluggishness & weight gain. I cannot take antidepressants. Any suggestions?


  A. My hunch is that the dissociative behavior is an anxiety symptom. The Zyprexa is a drug that works on two different neurotransmitters in the brain, dopamine (D2 antagonist) and serotonin (5HT2 antagonist). I would try using the antidepressant nefazodone (Serzone) as it is also a 5HT2 antagonist, has no weight gain, works on anxiety, works on depression, and will not get you jittery or hypomanic. Take it all at night in dosages of 500 to 600 mg. Work up by 100 mg at bedtime every three or four days as tolerated. Taper the Zyprexa, if it helps. Make sure you do all this under your doctor's supervision.