Abstract
I am writing to you about my clinical observations concerning other uses for the atypical antipsychotic olanzapine. I am finding doses of 2.5–10 mg per day of olanzapine, given in the early evening, to be often remarkably effective for patients who have a history of severe childhood physical, emotional and/or sexual abuse. These patients have high background levels of anxiety, sleep poorly with intrusive distressing dreams, experience intrusive flashbacks of their earlier abuse experiences and tend to ruminate in a markedly anxious fashion about the past, present and future. They may or may not be clinically depressed and may or may not also be prescribed a serotonin antidepressant.
None of these patients gaining a marked benefit from olanzapine would meet clinical criteria for schizophrenia or bipolar affective disorder, but all find that they can sleep better, the dreams settle, the flashbacks diminish and the anxiety reduces.
I have always been concerned about using antipsychotics as adjunctive treatment in anxiety disorders because of the risk of the patient developing tardive dyskinesia, but I am reassured by the reputed minimal risk of olanzapine causing this troublesome and serious adverse effect. The noted beneficial effect of olanzapine is greater than any adjunctive benefit one might get with the concurrent use of older antipsychotic drugs such as thioridazine or chlorpromazine, and in the patients I describe, these older medications had been used with little benefit, and markedly more side-effects. One of the most impressive aspects of the use of olanzapine is the frequently reported comment from patients, both those described above, and those with a schizophrenia, that their thinking achieves a progressively improved clarity.
I would be interested in hearing from other colleagues about similar findings with olanzapine.