Letter to the Editor

Does Olanzapine-Fluoxetine Combination Increase the Risk of Mania in Poorly Compliant Bipolar Depressed Patients?

Authors: Roy R. Reeves, DO, PhD, Mark E. Ladner, MD

Abstract

Fluoxetine is useful for the treatment of depression and olanzapine for the treatment of schizophrenia and acute bipolar mania. In 2001, olanzapine-fluoxetine combination was found to be effective in a small sample of patients with nonbipolar depression.1 Subsequently, a controlled study demonstrated olanzapine to be more effective than placebo and olanzapine plus fluoxetine more effective than olanzapine plus placebo for treatment of bipolar depression, without significant risk of development of mania.2 We describe a patient with bipolar depression with development of mania related to treatment with olanzapine-fluoxetine combination.

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References

1. Shelton RC, Tollefson GD, Tohen M, et al. A novel augmentation strategy for treating resistant major depression. Am J Psychiatry 2001;158:131–134.
 
2. Tohen M, Vieta E, Calabrese J, et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 2003;60:1079–1088.
 
3. Eli Lilly and Company. Symbyax (olanzapine and fluoxetine) package insert. Indianapolis, IN; 2003.
 
4. Peet M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants.Br J Psychiatry 1994;164:835–836.
 
5. Rachid F, Bertschy G, Bondolfi G, et al. Possible induction of mania or hypomania by atypical antipsychotics: an updated review of reported cases. J Clin Psychiatry 2004;65:1537–1545.