Zyprexa & OCD
Hello. Our 25 year old son takes 15 mg. zyprexa and 450 mg lithium for bipolar
with psychosis. While the zyprexa has controlled the mania and psychosis, he has
now developed OCD very badly. He might have had a slight tendency toward OCD
earlier, but that's hard to say for sure. His psychiatrist does not believe that
zyprexa can cause OCD and does not want to add an SSRI for treatment of OCD for
fear of inducing mania again. He has been stable for a year, since this all
began 4 years ago. Can you point me toward evidence that backing off the zyprexa
can alleviate the OCD? Or would another antipsychotic like abilify be worth the
try? Stuck with OCD and no treatment options from psychiatrist.
Dear George -
Unfortunately, the good news here for me it is bad news for you: I find myself
agreeing with his psychiatrist. But that is just the standard way of thinking.
A broader way of thinking is as follows: "medications are
guilty until proven innocent", regarding nearly anything that happens after they
are started. By this logic, even an increase in OCD symptoms has to be
considered as possibly induced by Zyprexa.
The logic here is the same one we use when a very unusual
side effect comes on right after a medication is started. Even if that side
effect has hardly ever been recorded in association with that medication, is the
temporal association is very tight, the medications still has to be considered
"probably guilty" until proven otherwise.
How does one do that? Unfortunately, there is really only
one way: you start to taper it downward and watch what happens to the problem.
So for your son's case, the idea would be to gradually lower Zyprexa and watch
what happens to the OCD symptoms (obviously).
Of course, the problem is that when Zyprexa is the
mainstay medication for the prevention of the return of mania, such reductions
will make everyone nervous -- or should. Particularly if the mania was extreme,
Further, it is also possible that OCD symptoms are a manic
manifestation and that they will actually get worse if Zyprexa is lowered.
Nevertheless, and here perhaps is the evidence you are
asking me for, it is recognized that Zyprexa has an effect on serotonin. The
precise effect is not very clear. It is plausible that in some particular cases
-- probably rare, if at all -- the serotonin effect of Zyprexa would have a
paradoxical impact, worsening OCD.
Good luck getting this figured out. Be gentle with the
Published January, 2009