[Effective treatment of depressive disorder with psychotic symptoms by olanzapine combination therapy].
METHODS
Four days after swallowing lithium and amitriptyline tablets with suicidal intent, a 48-year-old man was admitted. He was known to be suffering from recurrent depression which had led to 7 previous hospital admissions. At psychiatric assessment he appeared to be depressed with reduced ability of affective changes and impaired formal reasoning. He exhibited delusions of guilt and reference. His sleep was impaired and appetite diminished.


METHODS
Serum lithium level was 1.98 mmol/l (therapeutic range 0.8-1.0 mmol/l). An ECG demonstrated sinus tachycardia, the EEG showed theta waves with mild general changes.


METHODS
He was diagnosed as suffering from severe depressive syndrome with psychotic symptoms. He was given both antidepressive and neuroleptic drugs: mirtazapine 30 mg daily (p.d.) and halperidol 10 mg p.d.. When both the depressive and psychotic symptoms were treatment-resistant, even after a change from mirtazapine to venlafaxine (300 mg p.d.), the drug regimen was changed to sertraline, 150 mg p.d., and olanzapine, 20 mg p.d.. While this brought about improvement, his condition deteriorated when olanzapine was withdrawn. But all symptoms completely disappeared when olanzapine was again given. Spontaneous remission in the future thus seems unlikely to occur.


CONCLUSIONS
This case illustrates that the atypical antipsychotic drug olanzapine has some advantages over such typical antipsychotic drug olanzapine has some advantages over such typical antipsychotic medication as butyrophenone. The underlying mechanism for this greater efficacy is probably the difference in receptor-binding capacity between these drugs, the former inhibiting some serotonin receptors so that it is synergistic with antidepressives that inhibit serotonin transport.
Schmitt
A
A
Zentralinstitut für Seelische Gesundheit, J5, Mannheim. dfbraus@as.200.zi-mannheim.de
Braus
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DF
D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001569:Benzodiazepines; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010890:Pirenzepine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D020280:Sertraline / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D000077152:Olanzapine; D020280:Sertraline