Mirtazapine effectiveness in a patient with refractory psychotic depression

The author describes a patient with recurrent depression, according to DSM-IV diagnostic criteria. The features were of a delusional depressive episode lasting 5 years, associated with severe impairment of psychosocial functioning. The patient also had chronic hepatitis, of unknown aetiology, and portal hypertension with some high gastrointestinal bleeding episodes. The depressive episode had been treated unsuccessfully with therapeutic doses of imipramine and lithium augmentation associated with haloperidol and, afterwards, with risperidone. Mirtazapine was introduced, coadministered with haloperidol and after 8 weeks there was an improvement in delusional depressive and other negative symptoms. The patient remained well for 9 months. This case indicates that mirtazapine is an option for patients with psychotic depression who are refractive to tricyclic antidepressants. Mirtazapine is also a safe drug, well tolerated in this severe clinical condition.