|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 69-70
Mirtazapine for the treatment of psychosis in Parkinson’s disease: Any silver linings?
Department of Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
|Date of Submission||23-Feb-2020|
|Date of Decision||04-Mar-2020|
|Date of Acceptance||08-Mar-2020|
|Date of Web Publication||01-Apr-2020|
Dr. Abhishek Lenka
Department of Neurology, MedStar Georgetown University Hospital, Washington, DC 20007.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lenka A. Mirtazapine for the treatment of psychosis in Parkinson’s disease: Any silver linings?. Ann Mov Disord 2020;3:69-70
|How to cite this URL:|
Lenka A. Mirtazapine for the treatment of psychosis in Parkinson’s disease: Any silver linings?. Ann Mov Disord [serial online] 2020 [cited 2020 Aug 4];3:69-70. Available from: http://www.aomd.in/text.asp?2020/3/1/69/281753
I appreciate the letter to the editor on the review article on “Approach to the management of psychosis in Parkinson’s disease” published in the last issue of the journal. The author has highlighted the potential role of mirtazapine in the treatment of psychosis in Parkinson’s disease (PD). Mirtazapine is a potent tetracyclic antidepressant having a complex mechanism of action. It augments norepinephrine and serotonin release through central presynaptic α2-adrenergic antagonistic effects. In addition, mirtazapine also antagonizes 5-hydroxytryptamine2 (5-HT2), 5-hydroxytryptamine3 (5-HT3), and H1 histamine receptors. As pointed out by the author, a number of case reports have observed clinically meaningful amelioration of psychotic symptoms by mirtazapine in patients with PD.,, However, the biggest problem lies in the fact that we do not have further evidence to justify the claim that mirtazapine leads to a promising therapeutic avenue for PD-associated psychosis. Moreover, several reports have documented acute psychosis after initiating treatment with mirtazapine., Hyponatremia, delirium, and drowsiness have also been noted as the side effects of mirtazapine. In view of these adverse effects and the lack of higher level of evidence, mirtazapine does not stand out well among the currently available pharmacological options (pimavanserin, quetiapine, and clozapine) for PD-associated psychosis. In summary, mirtazapine seems to be far from being recognized as a first-line agent for the treatment of psychosis in PD until we attain better insights into its role through larger clinical trials. However, the only silver lining would be the fact that mirtazapine can be preferred over other antidepressants if patients with PD have coexisting depression and psychosis. As depression is frequently associated with psychosis in PD, treatment with mirtazapine while being vigilant about the aforementioned adverse effects may be effective.
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Conflicts of interest
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| References|| |
Lenka A, Gomathinayagam V, Bahroo L. Approach to the management of psychosis in Parkinson’s disease. Ann Mov Disord 2019;2:83. [Full text]
Anttila SA, Leinonen EV. A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev 2001;7(3):249-64. DOI: 10.1111/j.1527-3458.2001.tb00198.x
Tagai K, Nagata T, Shinagawa S, Tsuno N, Ozone M, Nakayama K. Mirtazapine improves visual hallucinations in Parkinson’s disease: A case report. Psychogeriatrics 2013;13:103-7.
Nagata T, Shinagawa S, Tagai K, Nakayama K. A case in which mirtazapine reduced auditory hallucinations in a patient with Parkinson disease. Int Psychogeriatr 2013;25:1199-201.
Godschalx-Dekker JA, Siegers HP. Reduction of parkinsonism and psychosis with mirtazapine: A case report. Pharmacopsychiatry 2014;47:81-3.
Felthous AR, Wenger PJ, Hoevet R. Acute psychosis associated with dissociated sleep-wakefulness state after mirtazapine treatment. Pharmacotherapy 2010;30:145e-50e.
Padala KP, Padala PR, Malloy T, Burke WJ. New onset multimodal hallucinations associated with mirtazapine: A case report. Int Psychogeriatrics 2010;22:837-9.
Ghosh A, Hegde A, Grover S. Mirtazapine-associated hyponatremia presenting as delirium. Indian J Pharmacol2014;46:448-9.
] [Full text]
Lenka A, Herath P, Christopher R, Pal PK. Psychosis in Parkinson’s disease: From the soft signs to the hard science. J Neurol Sci 2017;379:169-76.