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Comment in:
Mirtazapine-induced
serotonin syndrome.
Ubogu EE, Katirji
B.
Division 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
An
85-year-old woman developed sudden confusion and dysarthria progressing
to mutism, orobuccal dyskinesias, generalized tremors worse with
activity, ataxia, and rigidity with cog wheeling without high-grade
fevers or dysautonomia. These findings were related temporally to the
institution of mirtazapine as monotherapy for a major depressive illness
with superimposed anxiety disorder. Withdrawal of the agent resulted in
early notable clinical resolution with only residual hypertonia after 2
weeks. This is a rare report of serotonin syndrome induced by
mirtazapine monotherapy. The hypothesized pathophysiologic mechanism in
this case is overstimulation of serotonin (5-hydroxytryptamine or 5-HT)
type 1A receptors (5-HT(1A)) in the brainstem and spinal cord in an
individual with risk factors for hyperserotoninemia resulting from
reduced, acquired endogenous serotonin metabolism.
Publication
Types:
PMID: 12671522 [PubMed - indexed for
MEDLINE]
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