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[Mirtazapine-Induced Mania: A Case Report].
Catarina Freitas1, Rui Barranha2, Tânia Abreu2
1Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real. Portugal.
Acta Medica Portuguesa
|October 19, 2019
Summary
Mirtazapine infrequently causes manic episodes, but a case study showed a patient developed dysphoric mania. Treatment involved discontinuing mirtazapine and starting olanzapine for remission.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Antidepressant-induced manic and hypomanic states are known side effects.
- Mirtazapine is generally associated with infrequent occurrences of these states.
Observation:
- A clinical case is presented involving a patient with no prior psychiatric history.
- The patient experienced a manic episode with dysphoric features two weeks after initiating mirtazapine (30 mg/day).
Findings:
- The episode resolved upon discontinuation of mirtazapine and initiation of olanzapine (10 mg).
- Mirtazapine's unique pharmacodynamics, involving blockade of serotonergic and alpha-2 adrenergic receptors, are considered.
Implications:
- The case suggests a potential link between mirtazapine and a noradrenergic syndrome, manifesting as dysphoria, irritability, insomnia, and agitation.
- This highlights the importance of monitoring for paradoxical mood elevation during mirtazapine treatment, even in patients without prior psychiatric conditions.
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