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1: Clin Neuropharmacol. 2003 Mar-Apr;26(2):54-7. Related Articles, Links

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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.

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:
  • Case Reports

PMID: 12671522 [PubMed - indexed for MEDLINE]