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Olanzapine/Fluoxetine Combination Effective In Psychotic Depression

A combination of olanzapine and fluoxetine appears to be effective in treating psychotic depression, research from the United States indicates.

Investigators from Massachusetts General Hospital in Boston report the combination was promising in a study of 27 patients enrolled in a six-week open trial. Double-blind studies are required to confirm the results, however.

Participants in this open trial included 17 women (63%) and 10 men. Mean age was 41.2 years. All had major depressive disorder with psychotic features, defined using Diagnostic & Statistical Manual of Mental Disorders-IV (DSM-IV) criteria.

Twenty patients (74.1%) met criteria for melancholic features. There were 4 patients (14.8%) with delusions alone, 5 (18.5%) with hallucinations alone and 18 (66.7%) with both delusions and hallucinations.

The patients received 5 to 20 milligrams per day of olanzapine plus 20 to 80 mg/d of fluoxetine. They were assessed, at each visit, with the 17-item Hamilton Rating Scale for Depression and both the psychotic and mood modules of the Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition.

Twenty two (81.5%) patients completed the trial. Only two patients (7.4%) dropped out because of side effects.

Overall rates of response for the intent-to-treat group were 66.7% for depression, 59.3% for psychosis and 55.6% for psychotic depression. The remission rate for psychotic depression was 40.7%.
Journal of Clinical Psychiatry, 2002;63:1164-1170. "An open study of olanzapine and fluoxetine for psychotic major depressive disorder: interim analyses."

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