Can cabergoline cause mood disorders?

Cabergoline and Mood Disorders

Yes, cabergoline can cause mood disorders including depression, anxiety, mania, and other psychiatric symptoms as documented side effects. 1, 2, 3

Evidence for Cabergoline-Induced Mood Disorders

FDA-Documented Psychiatric Side Effects

• Depression occurs in approximately 3% of patients taking cabergoline for hyperprolactinemic disorders 1
• Other psychiatric adverse events documented in the FDA label include:
  • Anxiety (1%)
  • Insomnia (1%)
  • Nervousness (1%)
  • Impaired concentration (1%)
  • Somnolence (2%) 1

More Serious Psychiatric Adverse Events

• Post-marketing surveillance has identified additional psychiatric concerns:
  • Impulse control/compulsive behavior symptoms
  • Hypersexuality
  • Increased libido
  • Pathological gambling
  • Aggression
  • Psychotic disorders 1

Case Reports and Clinical Evidence

• The first documented case of cabergoline-induced mania was reported in 2016 3
• Psychotic exacerbation has been observed in schizophrenic patients receiving cabergoline for antipsychotic-induced hyperprolactinemia 4
• Dose-independent psychological intolerance (mood changes, depression, aggression, hypersexuality and impulse control disorder) has been reported in both adults and children/adolescents 2

Mechanism of Action and Risk Factors

Cabergoline is a potent dopamine D2 receptor agonist with a very long duration of action. This prolonged effect offers advantages for treatment but may complicate management of psychiatric side effects:

• The long elimination half-life (up to 21 days after a single dose) means psychiatric side effects may persist even after discontinuation 3
• Dopaminergic stimulation is a known risk factor for psychiatric symptoms, particularly in vulnerable individuals 3
• The frequency of psychological adverse events may be higher in children and adolescents than in adults 2

Management Recommendations

Monitoring and Prevention

• Before initiating cabergoline:
  • Screen for history of mood disorders, impulse control problems, or psychotic disorders
  • Consider lower starting doses in patients with psychiatric history
  • Start with small nocturnal dose increments to reduce adverse effects 2

If Mood Disorders Develop

• For mild symptoms:

  • Consider dose reduction if clinically feasible
  • Monitor more frequently for symptom progression

• For moderate to severe symptoms:

  • Consider discontinuation of cabergoline
  • Evaluate for alternative treatments for hyperprolactinemia
  • In prolactinoma patients with intolerable psychiatric side effects, surgical intervention may be warranted 2

Special Populations

• Use with extreme caution in patients with:
  • Pre-existing psychiatric conditions
  • History of impulse control disorders
  • Concurrent medications that affect dopaminergic systems

Clinical Pearls

• The psychiatric side effects of cabergoline are often dose-independent, meaning they can occur at any dosage level 2
• Symptoms may emerge at any point during treatment, not just during initiation
• Some patients who cannot tolerate cabergoline may be able to tolerate bromocriptine, though bromocriptine has a higher overall side effect profile 5
• The risk-benefit ratio should be carefully considered in patients with or at risk for psychiatric disorders 3

In susceptible individuals, cabergoline can trigger significant mood disorders including depression, anxiety, mania, and psychosis, requiring careful patient selection, monitoring, and prompt intervention if psychiatric symptoms emerge.