Olanzapine and Panic Attacks

Mr. A, a 32-year-old man without comorbid disorders, was seen for a panic disorder of 4 months’ duration. His panic attacks were initially nocturnal but later appeared at any time of the day. Mr. A was treated consecutively with 40 mg/day of paroxetine for 2 months, 200–300 mg/day of fluvoxamine for 6 months, and 150 mg/day of clomipramine for 2 months. He also received concomitant alprazolam, 2–4 mg/day, during this 10-month period. Mr. A was later hospitalized for suicidal thoughts and discharged 1 month later on a regimen of 2 mg/day of clonazepam, 15 mg/day of perphenazine, 30 mg/day of ketazolam, and 150 mg/day of venlafaxine. Five days after his discharge, his perphenazine dose was replaced with olanzapine, 7.5 mg at bedtime.

Two weeks later Mr. A was much calmer and sleeping well, but he had mild morning anxiety. His olanzapine dose was increased to 12.5 mg/day, and his venlafaxine was replaced with nefazodone, up to 600 mg/day. Mr. A improved progressively during the following weeks, and clonazepam and ketazolam were discontinued. After 4 months Mr. A was free from panic attacks, left his house alone, and enjoyed leisure activities.

Ms. B was a 40-year-old woman who was seen for panic attacks with agoraphobia that had lasted for 2 years. She had intense somatic worries and was away from work on sick leave. She had no comorbid conditions. She received treatment with 40 mg/day of paroxetine plus 2–3 mg/day of alprazolam for 6 months. She then received 400 mg/day of nefazodone, plus 10 mg/day of diazepam, 50 mg/day of sulpiride, and 1 mg/day of alprazolam for 6 months with no improvement. Then a combination of 12 mg/day of perphenazine, 75 mg/day of amitriptyline, and 10 mg/day of diazepam was tried. After 5 months, 10 mg/day of olanzapine was begun, while maintaining her doses of amitriptyline (75 mg/day) and diazepam (10 mg/day). After 15 days Ms. B was feeling calmer and in a better mood. After 2.5 months Ms. B was being treated with 10 mg/day of olanzapine, 50 mg/day of amitriptyline, and 2.5 mg/day of diazepam; she had had no crises since she began olanzapine treatment and had started going out alone.