重鬱症老年病患使用Olanzapine併發肺栓塞：案例報告

Olanzapine Associated with Pulmonary Embolism in an Elderly Patient with Major Depressive Disorder: A Case Report

Olanzapine治療憂鬱症病患，發生血管栓塞的個案相當罕見，本文報告一位老年患者使用Olanzapine治療後發生肺栓塞的情形。一位66歲女性的重鬱症患者，曾經接受數類的抗憂鬱藥物但療效不佳，因此接受Olanzapine 5-10 mg/day來強化抗憂鬱藥物的療效，但是在治療的第13天，個案出現胃口差、倦怠及呼吸困難的情形，胸部電腦斷層血管攝影發現個案的右肺動脈有栓塞的情形，個案停用Olanzapine並接受抗凝血藥物的治療，肺動脈栓塞在治療2週後改善。抗精神病藥物可能會增加血管栓塞的風險，醫師在開立抗精神病藥物時，需要留心血管栓塞的相關症狀表現，尤其是老年病患。

There have been rare case reports of Olanzapine-related thromboembolism in patients with depressive disorder. Herein, we report an older patient with major depressive disorder who developed pulmonary embolism after initiating treatment with Olanzapine. A 66-year-old woman, diagnosed with major depressive disorder, had been prescribed several antidepressants but had an inadequate treatment response. She was later prescribed Olanzapine 5-10mg/day as augmentation therapy. Starting the thirtieth day of Olanzapine treatment, the patient began having poor appetite, lethargy and shortness of breath. Computed tomographic pulmonary angiography confirmed pulmonary thromboembolism in the right main pulmonary artery for which she received anticoagulation therapy and discontinuation Olanzapine. The pulmonary thromboembolism improved two weeks later. Antipsychotic exposure might raise the risk of thromboembolism. Clinicians should prescribe antipsychotics with caution and monitor the symptoms and signs of thromboembolism, especially in older populations.