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Olanzapine May Work as Adjunctive Therapy for Non-Responsive GAD Patients: Presented at ADAA

By Jerry Ingram

MIAMI, FL -- March 16, 2004 -- Olanzapine, a D2/5HT-2 antagonist with anxiolytic effects, may be an effective adjunctive therapy for patients with generalized anxiety disorder (GAD) who remain symptomatic despite initial treatment with fluoxetine.

"Some of the other antipsychotics have serious side effects. People are starting to consider using combination medications; adding medications like olanzapine to antidepressants," said Mark Pollack, MD, Massachusetts General Hospital. "In our study, we found that patients with generalised anxiety disorder received added benefit from augmentative treatment with olanzapine. This is an important step because it attempts to offer augmentative therapy for patients who are non-responders to antidepressant medications."

Dr. Pollack presented his findings here on March 13^th at the Anxiety Disorders Association of America 24^th Annual Conference.

For this investigation, Dr. Pollack enrolled 50 patients who were diagnosed with GAD and were being treated with the selective serotonin reuptake inhibitor fluoxetine at a mean dose of 20 mg/day. Treatment failure was defined as a Clinical Global Impression of Improvement (CGI-I) score > 4, "moderately ill" and <50% reduction in Hamilton Anxiety Rating Scale (HAM-A).

Researchers randomized the 20 who remained symptomatic despite 6 weeks of treatment with fluoxetine to 6 weeks of adjunctive therapy with either olanzapine 2.5 to 20 mg/day (mean dose 7.1 mg/day) or placebo.

In light of the relatively small group of patients randomised, researchers generated effect sizes. They found that olanzapine demonstrated large effect sizes (by Cohen's standards) for reduction in anxiety as assessed by the CGI-Severity Scale (d =.95) and medium effect sizes (d =.68) as assessed by the HAM-A, they said.

Olanzapine may be an effective adjunctive treatment for patients with GAD who remain symptomatic despite initial therapy with SSRI, the authors concluded. However, Dr. Pollack noted, more studies are needed to confirm the suggestion of benefit and to examine the impact of using atypical antipsychotic medications in patients who are not psychotic.


[Study title: Adjunctive Olanzapine for SSRI Refractory Generalized Anxiety Disorder. Abstract 70]

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