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Occurrence of mirtazapine-induced
delirium in organic brain disorder.
Fischer P, Kufferle B, Stastny J, Kasper S.
General Psychiatry, University Hospital of Psychiatry, Vienna, Austria.
Mirtazapine is the first of a new
class of antidepressants, the noradrenergic and specific serotonergic
antidepressants. Its antidepressant effect appears to be related to its
dual enhancement of both noradrenergic neurotransmission and serotonin
5-HT1 receptor-mediated serotonergic neurotransmission. Mirtazapine has
demonstrated superior tolerability to the tricyclic antidepressants,
primarily on account of its relative absence of anticholinergic,
adrenergic and serotonin-related adverse effects. We observed
mirtazapine-induced delirium in one organically depressed and two major
depressed patients with subclinical brain disease. The appearance of
hallucinations, psychomotoric agitation and cognitive changes after
initiation of mirtazapine, and their prompt improvement after drug
discontinuation, led to the impression that these were drug-induced
phenomena. One possible hypothesis for the observed deliria is a central
increase of norepinephrine after acute administration of mirtazapine.
Subclinical brain disease might have favoured the occurrence of delirium
in the three cases.
PMID: 10954066 [PubMed - indexed for