Annals of Movement Disorders

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


N Uvais 
 Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

Correspondence Address:
Dr. N Uvais
Iqraa International Hospital and Research Centre, Calicut, Kerala.
India




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 27 ];3:67-68
Available from: https://www.aomd.in/text.asp?2020/3/1/67/281752


Full Text



Dear Editor,

I read the article titled “Approach to the management of psychosis in Parkinson’s disease” with great interest.[1] Lenka et al.[1] 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.[1]

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.[2] 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.[2] Godschalx-Dekker and Siegers[3] 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.[3] Nagata et al.[4] 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.[5] 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.[6],[7]

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Conflicts of interest

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References

1Lenka A, Gomathinayagam V, Bahroo L. Approach to the management of psychosis in Parkinson’s disease. Ann Mov Disord 2019;2:83-90.
2Tagai 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.
3Godschalx-Dekker JA, Siegers HP. Reduction of parkinsonism and psychosis with mirtazapine: A case report. Pharmacopsychiatry 2014;47:81-3.
4Nagata 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.
5Hamadjida A, Nuara SG, Veyres N, Frouni I, Kwan C, Sid-Otmane L, et al. The effect of mirtazapine on dopaminergic psychosis and dyskinesia in the parkinsonian marmoset. Psychopharmacology (Berl) 2017;234:905-11.
6Ikeguchi K, Kuroda A. Mianserin treatment of patients with psychosis induced by antiparkinsonian drugs. Eur Arch Psychiatry Clin Neurosci 1995;244:320-4.
7Zoldan J, Friedberg G, Livneh M, Melamed E. Psychosis in advanced Parkinson’s disease: Treatment with ondansetron, a 5-HT3 receptor antagonist. Neurology 1995;45:1305-8.