Hi Ali , thanks for sharing this.

I am looking for any data or studies in relation between TG levels and clinical response. 

In my clinical experience there is NOT a correlation between response to olanzapine and increase in triglycerides, although I have been told by some colleagues that patients who do best of olanzapine also gain the most weight.

I wonder what woud happen to a sustained clinical response when triglyceride leves are treated , say with fatty acids like eicosapentaenoic acid and good diet/exercise etc

Great idea!

That's a interesting question! While I'm not aware of a study looking directly at olanzapine response and TG, it might nevertheless be useful to look at the following studies which found a better response of clozapine in patients gaining more weight. 

Meltzer, Herbert Y., Edward Perry, and Karuna Jayathilake. "Clozapine-induced weight gain predicts improvement in psychopathology." Schizophrenia research 59.1 (2003): 19-27.

Lamberti JS, Bellnier T, Schwarzkopf SB: Weight gain among

schizophrenic patients treated with clozapine. Am J Psychiatry

1992; 149:689–690

Leadbetter R, Shutty M, Pavalonis D, Viewig V, Higgins P, Downs

M: Clozapine-induced weight gain: prevalence and clinical relevance.

Am J Psychiatry 1992; 149:68–72

Hi Muhammad,

You might be interested with a 2013 study published in our journal (Journal of Psychopharmacology) 

Lally J, Gallagher A, Bainbridge E, Avalos G, Ahmed M, McDonald C. Increases in triglyceride levels are associated with clinical response to clozapine treatment. J Psychopharmacol. 2013 Apr;27(4):401-3. doi: 10.1177/0269881112472568. PubMed PMID: 23325369.

The reduction in total PANSS score was strongly negatively correlated with increase in TG levels (r=−0.57, p

Olanzapine-treated patients had significantly greater mean baseline-to-endpoint changes in fasting triglycerides, fasting glucose, and total cholesterol compared with those treated with ziprasidone or aripiprazole.

Olanzapine-treated patients had significantly greater baseline-to-endpoint changes in fasting triglycerides compared with ziprasidone- (0.24 mmol/L [N = 365; ME = 168] versus -0.24 mmol/L [N = 316; ME = 140], p < 0.001) and aripiprazole-treated patients (0.28 mmol/L [N = 215; ME = 195] versus -0.19 mmol/L [N = 210; ME = 194], p < 0.001).

Osuntokun O, Millen B, Xu WI, Kryzhanovskaya LA, Robertson-Plouch C, Carlson JL, Acharya N, Corya SA. Metabolic parameters in patients treated with olanzapine or other atypical antipsychotics. J Psychopharmacol. 2011 May;25(5):630-8. doi: 10.1177/0269881110368872. Epub 2010 May 24. PubMed PMID: 20498135.

Krishna (How are you going by the way?)

I had a quick look at our database - no evidence that fixing people's TGs changes their apparent response to orexigenic antipsychotics. If anything (remembering we use a multidimensional outcome scale) there are improvements in some dimensions probably relating to the enhancements that follow from exercise regimens. In those with severe triglyceridaemia (>8) where we would be in the statin± fenofibrate± (real) fish-oil and dancing-on-one-leg field of play, we have too few numbers to comment on changes in outcome dimensions but as these patients tend to stick in your mind, I don' t feel there were any indicators that loss of 'effectiveness' followed control of dyslipidaemia.

Tim LAmbert

Collaborative CENTRE FOR CARDIOMETABOLIC HEALTH IN PSYCHOSIS