Reactions 2001, p243 - 30 Mar 2024 1

Multiple drugs S

Lack of efficacy, weight gain and reducing appetite

A 16-year-old girl exhibited lack of efficacy during treatment with sertraline, venlafaxine, diazepam, lorazepam and olanzapine for
post-traumatic stress disorder (PTSD) and depression. Additionally, she developed weight gain and reducing appetite during
treatment with olanzapine for PTSD and depression [routes, durations of treatments to reactions onsets and outcomes not stated].
The girl with a history of sexual abuse in childhood. She was hospitalised many times in the past 2 years for a diagnosis of PTSD
and depression. Two years ago, she was suffered from anxiety, sleep problem and depression. Since then she was hospitalised for
six times with a major complaints of anxiety and depression. She also experienced nightmares, memory loss and sleep disturbance.
She was victim of childhood sexual assault.On 29 October 2020, she started on sertraline 100 mg/day, venlafaxine 225 mg/day
extended-release, olanzapine 7.5mg every night and dose increased further to 10 mg every night and diazepam 10 mg/day.Later, she
received lorazepam 0.5mg every night, which increased to 1mg every night on 19 November 2020 to manage her PTSD and
depression. She also co-treated with four modified electroconvulsive therapy (MECT) between 29 October 2020 and
18 November 2020. Multiple times she attempted to commit suicide before the admission. Despite treatments with sertraline,
venlafaxine, diazepam, lorazepam and olanzapine, a diagnosis of treatment-resistant depression (TRD) was made (lack of efficacy)
and she was hospitalised. She was put on venlafaxine, bupropion extended-release, olanzapine and eight sessions of MECT.
However, she developed reducing appetite and weight gain secondary to olanzapine.
The girl treated with off label prazosin 0.25mg every night on 19 November 2020 and dose increased to 0.5mg every night to 1mg
every night.After the treatment with prazosin, her depressive symptoms, cognitive symptoms and PTSD symptoms improved. Four
days after the admission, she was discharged to home. She was doing well and able to continue her education.
Guo P, et al. Case report: Prazosin augmentation for treating comorbid treatment-resistant depression and chronic post-traumatic stress disorder. Frontiers in Psychiatry 13:
1-5, Jul 2022. Available from: URL: 10.3389/fpsyt.2022.803220 803849679