Depression Symptoms Treatment

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Olanzapine is authorised in the world under the following brand names: Olansek, Symbyax, Zydis, Zyprexa, Zyprexa Intramuscular, Zyprexa Zydis.

Atypical Antipsychotics vs. Typical Antipsychotics: Typical antipsychotics, particularly haloperidol, are still the most commonly used agents for treating agitation and aggression because of clinician comfort and experience with their use. Haloperidol is efficacious and can be given orally as a solution or tablet, IM or IV. Cardiovascular concerns are limited except in the critically ill population and with the IV route. However, the risk of dystonia makes haloperidol a less appealing option in some populations. There are now more data demonstrating the efficacy and safety of using atypical antipsychotics for the treatment of agitation and aggression. Olanzapine offers significant dosage form flexibility and is well tolerated in clinical trials to date, making it a reasonable choice, especially when olanzapine is also part of the long-term treatment plan. If oral olanzapine is initiated and supplemented with IM doses to treat acute symptoms, the patient should be monitored for orthostasis, especially until more clinical experience indicates whether there are any risks of using both dosage forms concurrently. Olanzapine is generally considered to have a low risk of resultant QTc prolongation, and no patients experienced a dystonic reaction on IM olanzapine in the four agitation trials. Initial study shows that the combination of oral risperidone and lorazepam is as effective as the use of IM medication combinations and holds promise. Monitoring for EPS and orthostasis is still needed for patients receiving risperidone and these adverse effects could preclude its use in certain patients. At this point, ziprasidone IM appears to be well tolerated, but concerns regarding QTc prolongation may limit its utility in patients at risk from this complication. The ultimate choice of an antipsychotic should be based on the specific patient’s current medical status, whether there are concerns about developing QTc prolongation, their risk for dystonia, orthostasis, or other medical complications from the potential treatment, dosage form availability, cost of the different products, and long-term treatment needs.

Others: Hydroxyzine and diphenhydramine are sometimes used alone to treat agitation and aggression. The literature does not support this practice as they offer no benefit over benzodiazepines and antipsychotics. They do not impact the underlying disease state, creating improvement only because of sedative effects, and carry a risk of anticholinergic effects or orthostasis.