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Mirtazapine-induced serotonin syndrome
Eroboghene E Ubogu1, Bashar Katirji
1Division of Neuromuscular Diseases, Department of Neurology, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Hanna House 5th Floor, 11000 Euclid Avenue, Cleveland, OH 44106-5040, USA. eeubogu@excite.com
Clinical Neuropharmacology
|April 3, 2003
Summary
Mirtazapine monotherapy can rarely cause serotonin syndrome (SS) in elderly patients. This case highlights the importance of recognizing SS symptoms like confusion and tremors, even with single-drug treatment.
Area of Science:
- Neuroscience
- Clinical Pharmacology
- Psychiatry
Background:
- Mirtazapine is an antidepressant commonly used for major depressive and anxiety disorders.
- Serotonin syndrome (SS) is a potentially life-threatening condition caused by excessive serotonergic activity.
Observation:
- An 85-year-old woman presented with acute confusion, dysarthria, mutism, orobuccal dyskinesias, tremors, ataxia, and rigidity.
- These neurological symptoms emerged shortly after initiating mirtazapine monotherapy for depression and anxiety.
Findings:
- Discontinuation of mirtazapine led to significant clinical improvement, with residual hypertonia noted after two weeks.
- This case represents a rare instance of serotonin syndrome induced solely by mirtazapine monotherapy.
Implications:
- The findings suggest a potential risk of serotonin syndrome with mirtazapine, particularly in elderly individuals with altered serotonin metabolism.
- Clinicians should maintain a high index of suspicion for serotonin syndrome when patients present with these neurological symptoms after starting mirtazapine.
- Further research into the specific risk factors and pathophysiological mechanisms of mirtazapine-induced serotonin syndrome is warranted.