LETTER TO THE EDITOR
Year : 2020 | Volume
: 3 | Issue : 1 | Page : 67--68
The role of mirtazapine in the management of psychosis in Parkinson’s disease
Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
Dr. N Uvais
Iqraa International Hospital and Research Centre, Calicut, Kerala.
|How to cite this article:|
Uvais N. The role of mirtazapine in the management of psychosis in Parkinson’s disease.Ann Mov Disord 2020;3:67-68
|How to cite this URL:|
Uvais N. The role of mirtazapine in the management of psychosis in Parkinson’s disease. Ann Mov Disord [serial online] 2020 [cited 2020 Oct 1 ];3:67-68
Available from: http://www.aomd.in/text.asp?2020/3/1/67/281752
I read the article titled “Approach to the management of psychosis in Parkinson’s disease” with great interest. Lenka et al. described the prevalence, phenomenology, diagnosis, pathogenesis, and treatment of psychosis in Parkinson’s disease comprehensively. The authors mentioned pimavanserin, clozapine, quetiapine, and cholinesterase inhibitors as pharmacological treatment options for psychosis in Parkinson’s disease.
Another therapeutic option in the management of psychosis in Parkinson’s disease is mirtazapine, an atypical antidepressant with dopamine acceleration and specific serotonin (5HT) receptor blockade. Tagai et al. described the case of an 83-year-old woman with Parkinson’s disease who developed visual hallucinations accompanied by feelings of being monitored. She showed little response to antipsychotic medications (aripiprazole, risperidone, and quetiapine), but responded well to oral mirtazapine 30mg per day. Godschalx-Dekker and Siegers also reported the case of a 67-year-old man with Parkinson’s disease who developed visual hallucinations and persecutory delusions and who responded to oral mirtazapine 30mg per day, which was given as a substitute for clonazepam to restore the sleep cycle. The authors speculated that the mechanism of action of mirtazapine in reducing psychotic symptoms in this case could be due to the alteration of the serotonin-dopamine balance through its anti-5HT-2C and anti-5HT-2 A activity. Nagata et al. reported the case of a 41-year-old woman with Parkinson’s disease who developed auditory hallucinations, which responded completely to oral mirtazapine 15mg per day. Hamadjida et al. recently studied the effects of mirtazapine on dopaminergic psychosis in the parkinsonian marmoset and found that the addition of mirtazapine 10mg/kg to l-DOPA reduced psychosis-like behaviors by 50% (P < 0.05) when compared to l-DOPA/vehicle. Other pharmacological agents reportedly shown effective in psychosis in Parkinson’s disease were mianserin and ondansetron.,
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|1||Lenka A, Gomathinayagam V, Bahroo L. Approach to the management of psychosis in Parkinson’s disease. Ann Mov Disord 2019;2:83-90.|
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