Olanzapine SSRIs

Agitation (chronic) Sodium divalproex Risperidone Olanzapine SSRI Trazodone Ziprasidone Haloperidol... 

Among these choices, bnspirone is preferred if the patient is also experiencing anxiety. If the patient is depressed and agitated, a SSRI should be tried first. Second line choices inclnde carbamazepine (Tegretol) or one of the atypical antipsychot-ics—ziprasidone (Geodon), risperidone (Risperdal), olanzapine (Zyprexa), quetiap-ine (Seroquel), or aripiprazole (Abilify) can be tried. If psychotic symptoms are present, one of the atypical antipsychotics should be tried first. 

Drugs that may be affected by SSRIs Drugs that may be affected by SSRIs include alcohol, benzodiazepines, beta blockers, buspirone, carbamazepine, cisapride, clozapine, cyclosporine, diltiazem, digoxin, haloperidol, hydantoins, lithium, methadone, mexiletine, nonsedating antihistamines, NSAIDs, olanzapine, phenothiazines, phenytoin, pimozide, procyclidine, ritonavir, ropivacaine, sumatriptan, sulfonylureas, sympathomimetics, tacrine, theophylline, tolbutamide, tricyclic antidepressants, and warfarin. 

Studies of the use of the specific serotonin-uptake inhibitors (SSRIs) to treat OCD suggest that, compared to non-tic-related OCD, tic-related OCD is less responsive to SSRI monotherapy (McDougle et al., 1993, 1994). Addition of a neuroleptic, such as haloperidol (McDougle et ah, 1994), risperidone (McDougle et al., 2000), or olanzapine (Bogetto et al., 2000), appears to be useful in improving treatment-resistant individuals response to a SSRI. It is unclear whether this pattern of treatment response is specifically associated with a comorbid tic disorder the pattern of obsessive compulsive symptoms characteristic of TS or yet some other predictors. 

Marangeh LB, Johnson CR, Kertz B, et al Olanzapine in the treatment of apathy in previously depressed participants maintained on SSRIs an open label, flexible-dose study. J Clin Psychiatry 63 391-395, 2002... 

In an open study of 11 patients with typical borderline personality, Schulz et al. ( 253) found substantial improvement with olanzapine, particularly in psychosis, but also in anergia, hostility, and interpersonal sensitivity. Szigethy and Schulz ( 254) reported improvement in one patient whose BPRS went from 46 to 28 with risperidone. Remission of self-mutilation has also been reported in one borderline patient undergoing treatment with risperidone, as well as an SSRI, for depression (255). This patient was then able to return to a full-time job. Although one should reserve judgment until more definitive studies are completed, the more favorable side effect profile of risperidone and olanzapine suggests that these drugs may be useful when psychotic or near psychotic symptoms are present. 

Stein MB, Kline NA, Matloff JL (2002) Adjunctive olanzapine for SSRI-resistant combat-related PTSD a double-blind, placebo-controlled study. Am J Psychiatr 159 1777-1779... 

Symbyax (olanzapine plus Prozac, an SSRI antidepressant) Zyprexa (olanzapine)... 

This infant s symptoms were similar to those described in other neonates whose mothers took SSRIs shortly before delivery, although in this case a contributory effect from olanzapine was also possible. The authors made the point that it can be difficult to decide from the clinical presentation whether neonatal problems, such as those described above, represent SSRI withdrawal (5HT deficiency) or SSRI toxicity (5HT excess). The fact that no paroxetine was detected in the infant s plasma led them to conclude that SSRI withdrawal was responsible for the symptoms in this case. 

Of the SSRIs, fluvoxamine is the most potent inhibitor of CYP1A2 and is therefore likely to increase plasma olanzapine concentrations. The extrapyramidal effects in this case were presumably due to excessive blockade of dopamine D2 receptors by raised olanzapine concentrations. 

Olanzapine, mean dose 5.4 mg/day, has been given to 21 patients with apathy in the absence of depression after long-term treatment with SSRIs for non-psychotic depression in an open, flexible-dose study (111). The more frequent adverse effects were sedation (n = 12), increased appetite (n = 8), stiffness (n = 7), edema (n = 6), and dry mouth (n = 5). 

Initial case reports of risperidone s improvement in aggressive behavior, hyperarousal, and flashbacks has led to further investigation into the adjunctive use of atypical antipsychotics in refractory PTSD. Quetiapine (mean dose 100 mg/day range, 25 to 300 mg/ day) reduced core PTSD symptoms over a 6-week period when added to current therapy. Olanzapine (mean dose 15 mg/day) added ad-junctively to SSRIs decreased PTSD symptoms and significantly improved sleep compared with placebo. Patients gained an average of 13.2 pounds over the course of the 8-week trial. ... 

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