The Hunger for Mirtazapine: A Discontinuation Syndrome

Area of Science:

• Pharmacology
• Clinical Medicine

Background:

• Mirtazapine is primarily used for major depressive disorder.
• Its use for anorexia secondary to disease states is less common.
• While generally well-tolerated, mirtazapine discontinuation syndrome is a potential adverse event.

Observation:

• A 53-year-old male patient experienced anxiety, nausea, tremor, appetite loss, and weight loss after abruptly discontinuing mirtazapine (15 mg/day).
• Symptoms began within 48 hours of cessation and persisted for 14 days.
• Restarting mirtazapine at the same dose led to immediate symptom resolution.

Findings:

• This case demonstrates acute and significant adverse events following inadvertent mirtazapine discontinuation.
• Even low doses of mirtazapine (15 mg/day) can precipitate a discontinuation syndrome.
• Symptoms included psychological and physical manifestations impacting appetite and weight.

Implications:

• This case underscores the importance of gradual mirtazapine tapering when discontinuing the medication.
• Clinicians should be aware of potential discontinuation syndromes, even at lower therapeutic doses.
• Further research is needed to fully characterize mirtazapine discontinuation profiles across different patient populations and dosages.