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Ask the Mental Health Expert Archives 2001-2004

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Zyprexa with Paxil for Depression

Q. Is it common to prescribe Zyprexa with Paxil for depressive symptoms? A colleague tells me that it can help reduce the agitation associated with the Paxil. What's your take on this?

A. I'd say it is not common to prescribe Zyprexa with Paxil for depression, unless that depression is accompanied by psychotic features (auditory hallucinations, delusions, etc.) But I am saying this based on my own experience, mainly with other psychiatrists, and can't speak to the situation in family practice, general practice, etc. That said, there is certainly increasing interest in using the atypical antipsychotics, particularly olanzapine (Zyprexa) and risperidone (Risperdal) for the treatment of mood disorders.

As you may know, Zyprexa now has FDA-approved labeling for the treatment of mania, and there is evidence it may have antidepressant effects as well. There is a recent study by Shelton et al in the January 2001 American Journal of Psychiatry, finding that the addition of olanzapine to fluoxetine (Prozac) led to improvement in patients who had not responded well to either medication alone (the benefits of olanzapine alone were modest). The combination was well-tolerated, though there was no evidence that olanzapine reduced Prozac-related side effects. Weight gain was associated with use of olanzapine, and there are growing concerns about this agent's adverse effects on blood lipids and glycemic control.

Also, keep in mind that while rates of tardive dyskinesia appear to be much lower with the atypicals than with the older neuroleptics, the rates are not zero. Thus, in a non-psychotic depressed patient, I don't think there is a good reason to use Zyprexa or any antipsychotic simply as a means of reducing the side effects of an SSRI; however, if the patient is extremely agitated as a direct result of their depressive illness, short-term use of an atypical antipsychotic might be considered, though a benzodiazepine or gabapentin might work just as well.

February 2001

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