Obsession to shout on olanzapine (Zyprexa)

Q: I am psychiatrist from India. I was treating a Bipolor affective disorder currently mania with psychotic feature. She was on Litium 900mg/day and olanzapine 5mg day since 2 month. Currently no manic or psychotic feature.but since one week she developed obsessive impulse to shout . once olanzapine was stoped, her OCD symptoms was remitted.

Dear Doctor S' --
You too have seen obsessive type symptoms on olanzapine, then?  Yes, I have seen two variations of anxiety symptoms emerge on olanzapine.  First, and seemingly most common, the medication makes a few people with clear bipolar disorder worse.  There are a few case reports of mania induced by olanzapine (e.g. this review; although far, far fewer with olanzapine than risperidone, whereas the review implies they may be rougly equivalent).

Secondly, although OCD has been treated successfully by augmenting with olanzapine (Koran, Bogetto), there are reports of OCD symptoms emerging with olanzapine treatment (e.g. Lykouras, Mottard).  I think I've seen the exacerbation of OCD by olanzapine myself, though not emergence de novo, as some of the patients described in these articles manifested. 

On the whole, I still use olanzapine with much less hesitation than risperidone, as far as inducing symptoms goes (in bipolar disorder); however, the weight gain risk is so severe, I try to avoid it as a long term solution (though have had a few "saves" through topiramate as appetite suppressor!). 

Dr. Phelps

Published February, 2001