To show that a combination of psychopharmacotherapy can result in unwanted side effect.

We are presenting a 31-year-old patient addmitted to the hospital with diagnosis of a Acute stress reaction due to divorce. Before hospitalization, the patient was in occesional psychiatric treatment because of Anorexia Nervosa on Axis I, and with Borderline personality disorder on Axis II. The pre-hospital pharmacological treatment were consisted of olanzapine, diazepam and fluvoxamine.Upon addmitence the patient was restless and in persistent moving and diagnosis of akathisia was established. In the mental status dominated depressive ideas, listless.

After addmission to the hospital, to the pharmacotherapy mentioned earlier were added lamotrigine as a mood stabilizer,and propranolol for akathisia, and the dose of fluvoxamine was reduced. After four days of hospitalization (the patient insists on a discharge from the hospital) was succeeded partially to regulate sleep, but there were still present early-morning awakening, appetite was slightly better, there was no loss of weight. Patient was less intrapsychic tense. Depressive ideas were paler but present. Symptoms of akathisia were reduced.

Considering that the patient was treated with fluvoxamine and olanzapine, we believe that their synergistic effect was responsible for the occurrence of akathisia. Although the antipsychotic alone can have this side effect,in combination with fluvoxamine these side effect may intensify. Specifically fluvoxamine is an inhibitor CY P1A2. This cytochrome is responsible for the metabolic pathway of olanzapine,so when using fluvoxamine may increase serum concentrations of olanzapine, which may result in the appearance of akathisia.