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Treatment-Resistant Depression

A type of depression one may have if he or she has had little or no response to treatment with 2 different antidepressants. This may happen even when the person takes the right dose for the right amount of time.

Doctor Discussion Guide

List your health history and how you have tried to treat your depression. Help your healthcare professional identify if your depression could be treatment-resistant.

Healthy Steps Tracker

A resource to help you when beginning your treatment with Symbyax. Record changes in how you feel to help your healthcare provider view your progress.

Talking to Your Healthcare Professional

If you have taken 2 or more different antidepressants in one episode of depression and you still have depression symptoms, you may have Treatment-Resistant Depression (TRD). Be sure to talk with your healthcare provider. Only your healthcare provider can diagnose TRD.

For those with TRD or who think they may have the condition, continuing to work with one's healthcare professional over time is a vital step. It may be easy for you to get discouraged if you don't immediately find the right treatment. However, the only way for you to stop experiencing the symptoms of TRD is to keep working with your healthcare professional.

Questions For Your Doctor

One way you can help work with your healthcare professional in treating your condition is to become familiar with the issues surrounding your personal health. When you have questions, ask your healthcare professional to get the answers about your treatment and condition that are important to you.

To make sure that you get all of your questions answered, it can be helpful to prepare a list of questions ahead of time. Think about what questions you have about your condition and possible treatment options. Here are some you may want to consider:

  • What is the difference between depression and TRD?
  • Do you think I have TRD? Why or why not?
  • How can I tell my friends and family members about my condition?
  • Should I take a medication for my condition? If so, do you recommend Symbyax?
  • How soon should I expect Symbyax to make me feel different?
  • How often do I need to take my Symbyax?
  • What should I do if I forget to take a dose of Symbyax?
  • What side effects might I feel from taking Symbyax?
  • What will happen if Symbyax doesn't improve my condition?
  • Besides taking Symbyax, do you recommend any additional treatments for my condition?
  • How can I contact you if I have additional questions about my condition and treatment?

Questions Your Doctor May Have For You

Because there is no single test for TRD, your healthcare provider may examine you to rule out other medical conditions. He or she may also ask the following questions. Your answers to these questions can help your healthcare provider know if you have TRD.

  • Have you been diagnosed with depression by a healthcare provider?
  • If yes:
    • What symptoms are most difficult for you to manage?
    • How severe are your symptoms?
    • How are your symptoms affecting your life?
  • Have you taken 2 or more antidepressants in this episode of depression?
  • If yes:
    • Were you on them for the recommended length of time?
    • Did any of your symptoms improve?

Take Suicidal Thoughts Seriously

If you experience any thoughts of death or suicide with your condition, it's important to take such thoughts seriously. If you feel like giving up or as if you might hurt yourself, get help immediately.

  • Call your healthcare professional
  • Go to the emergency room
  • Call 911
  • Call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433)

In addition to preparing a list of questions for your healthcare professional, it can also be helpful to provide some facts about your health history and whether depression runs in your family. To help you talk about these items with your healthcare professional and to further prepare for your appointment, you can complete the online Doctor Discussion Guide.

Important Safety Information about Symbyax® (olanzapine and fluoxetine HCl)

Please read the Medication Guide that comes with Symbyax before you start taking it and each time you get a refill

What are the possible side effects of Symbyax?

Symbyax is associated with possible side effects. Tell your doctor about any side effect that concerns you.

Symbyax may be associated with the following serious risks:

  • Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65. All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior. Symbyax is not approved for children and adolescents.
  • Elderly people with psychosis related to dementia (a brain disorder that lessens the ability to remember, think, and reason) are at increased risk of death when taking certain mental health medicines (such as Symbyax) compared with a sugar pill. Symbyax is not approved for these patients.
  • Suicidal thoughts or actions. Persons taking Symbyax may be more likely to think about killing themselves or actually try to do so, especially when Symbyax is first started or the dose is changed. People close to patients taking Symbyax can help by paying attention to changes in patient's mood or actions. Contact the doctor right away if someone using Symbyax talks about or shows signs of killing him or herself or has sudden changes in mood, behaviors, thoughts, or feelings. If you are taking Symbyax yourself and you start having any of these symptoms, tell your doctor about this right away.
  • Strokes and "mini-strokes" called transient ischemic attacks (TIAs). These are more common in elderly people with psychosis related to dementia. Symbyax is not approved for these patients.
  • Severe allergic reactions. Tell your doctor right away if you get red itchy welts (hives) or a rash alone or with fever and joint pain, while taking Symbyax. Call your doctor right away if you become severely ill and have swelling of your face, eyes or mouth, and/or trouble breathing.
  • Neuroleptic malignant syndrome (NMS). This is a rare but very serious condition that can happen in people who take certain medicines for mental health problems, including Symbyax. NMS can cause death and must be treated in a hospital. The symptoms include high fever; excessive sweating; rigid muscles; confusion; and changes in breathing, heartbeat, and blood pressure. Call your doctor right away if you become severely ill and have some or all of these symptoms.
  • High blood sugar (hyperglycemia). High blood sugar can occur if you have diabetes already or even if you have never had diabetes. In rare cases, this could lead to ketoacidosis (build up of acid in the blood due to ketones), coma, or death. Your doctor should do lab tests to check your blood sugar before you start taking Symbyax and during treatment. In people who do not have diabetes, sometimes high blood sugar goes away when Symbyax is stopped. People with diabetes and some people who did not have diabetes before taking Symbyax need to take medicine for high blood sugar even after they stop taking Symbyax. If you have diabetes, follow your doctor's instructions about how often to check your blood sugar while taking Symbyax.
    Call your doctor if you have any of these symptoms of high blood sugar (hyperglycemia) while taking Symbyax:
    • feel very thirsty
    • need to urinate more than usual
    • feel very hungry
    • feel weak or tired
    • feel sick to your stomach
    • feel confused, or your breath smells fruity.
  • High cholesterol and triglyceride levels in the blood (fat in the blood). These have been observed in patients treated with Symbyax, especially in teenagers (13-17 years old) who received olanzapine, one of the components of Symbyax. Symbyax is not approved for use in patients less than 18 years old. You may not have any symptoms, so your doctor should do blood tests to check your cholesterol and triglyceride levels before you start taking Symbyax and during treatment.
  • Increase in weight (weight gain). Weight gain is very commonly seen in patients who take Symbyax. Teenagers (13-17 years old) who received olanzapine, one of the components of Symbyax, were more likely to gain weight and to gain more weight than adults. Symbyax is not approved for use in patients less than 18 years old. Some patients may gain a lot of weight while taking Symbyax, so your doctor should check your weight regularly. Talk to your doctor about ways to control weight gain, such as eating a healthy, balanced diet, and exercising.
  • Tardive dyskinesia. This condition causes body movements that keep happening and that you cannot control. These movements usually affect the face and tongue. Tardive dyskinesia may not go away, even if you stop taking Symbyax. It may also start after you stop taking Symbyax. Tell your doctor if you get any body movements that you cannot control.
  • Serotonin syndrome. This is a condition that can be life threatening. Call your doctor right away if you become severely ill and have some or all of these symptoms: agitation; hallucinations; problems with coordination; racing heart beat; over-active reflexes; fever; nausea, vomiting, and diarrhea.
  • Abnormal bleeding. Tell your doctor if you notice any increased or unusual bruising or bleeding while taking Symbyax, especially if you take one of these medications: the blood thinner warfarin (Coumadin, Jantoven), a nonsteroidal anti-inflammatory drug (NSAID), aspirin.
  • Low salt (sodium) levels in the blood (hyponatremia). Call your doctor right away if you become severely ill and have some or all of these symptoms: headache, feel weak, confusion, problems concentrating, memory problems, feel unsteady.
  • Decreased blood pressure when you change position, with symptoms of dizziness, fast or slow heart beat, or fainting.
  • Decreases in white blood cells (infection fighting cells) have been reported in some patients taking antipsychotic agents, including SYMBYAX. Patients with a history of a significant decrease in white blood cell (WBC) count or who have experienced a low WBC count due to drug therapy should have their blood tested and monitored during the first few months of therapy.
  • Seizures.
  • Trouble swallowing.
  • Problems with control of body temperature. You could become very hot, for instance when you exercise a lot or stay in an area that is very hot. It is important for you to drink water to avoid dehydration. Call your doctor right away if you become severely ill and have some or all of these symptoms of dehydration: sweating too much or not at all, dry mouth, feeling very hot, feeling thirsty, not able to produce urine.

Common possible side effects of Symbyax include:

  • Tiredness
  • Feeling weak
  • Increased appetite
  • Sleeping for long periods of time
  • Blurred vision
  • Tremors (shakes)
  • Dry mouth
  • Swelling of your hands and feet

This is not a complete list of possible side effects. If you have questions or if you have any side effects that concern you, talk with your doctor and/or pharmacist.

Who should not take Symbyax?

  • Do not take Symbyax if you already take a Monoamine Oxidase Inhibitor (MAOI) or if you stopped taking an MAOI in the last 2 weeks. Do not take an MAOI within 5 weeks of stopping Symbyax. People who take Symbyax close in time to an MAOI can have serious and life-threatening side effects, with symptoms including: high fever, continued muscle spasms that you cannot control, rigid muscles, changes in heart rate and blood pressure that happen fast, confusion, unconsciousness. Ask your doctor or pharmacist if you are not sure if your medicine is an MAOI.
  • Do not take Symbyax if you already take Mellaril (thioridazine) or within 5 weeks of stopping Symbyax. Mellaril can cause serious heart rhythm problems and you could die suddenly.
  • Do not take Symbyax if you take the antipsychotic medicine pimozide (Orap).

Other important safety information

Tell your doctor if you are pregnant or may become pregnant while taking Symbyax. It is not known if Symbyax will harm your unborn baby. You should not breast-feed if you are taking Symbyax.

Tell your doctor if you are taking, or plan to take, any prescription or over-the-counter drugs including vitamins and herbal supplements. Symbyax and some medicines may interact with each other and may not work as well, or cause possible serious side effects. Do not start or stop any medicine while taking Symbyax without talking to your doctor first.

Symbyax may not be right for you. Before starting Symbyax, tell your doctor about all of your medical conditions.

If you take Symbyax, you should not take any other medicines that contain olanzapine (Zyprexa or Zyprexa Zydis) or fluoxetine hydrochloride (Prozac, Prozac Weekly, or Sarafem). You could take too much medicine.

Take Symbyax exactly as prescribed. To prevent serious side effects, do not stop taking Symbyax suddenly. If you need to stop taking Symbyax, your doctor can tell you how to safely stop taking it.

Symbyax can cause sleepiness and may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how Symbyax affects you.

Avoid the use of alcohol while taking Symbyax.

It is not known if Symbyax is safe and works in children under 18 years of age.

If you have any questions or concerns, or if you want to report any problems with the use of Symbyax, contact your doctor, pharmacist, or other healthcare provider. For more information, talk with your doctor or visit www.Symbyax.com or call 1-800-LillyRx.

Please see Important Safety Information, including Boxed Warnings and accompanying Full Prescribing Information, including Medication Guide