Akathisia induced by mirtazapine after 20 years of continuous treatment

Clinical Neuropharmacology
Sofia MarkoulaAthanassios P Kyritsis

Abstract

Mirtazapine is an antidepressant blocking presynaptic alpha2-adrenergic receptors and an antagonist of 5-hydroxytryptamine 2A/2C, 5-hydroxytryptamine 3, and histaminergic (H) postsynaptic receptor. Acute dystonia restless legs syndrome (RLS) and manic syndromes are adverse effects of mirtazapine, whereas only few cases of acute akathisia, after the first doses of mirtazapine, are referred. Instead, mirtazapine is used to treat akathisia probably because of its antagonistic property at H1 postsynaptic receptors and dopaminergic action in the frontal cortex. A 72-year-old woman with depression, on mirtazapine treatment for almost 20 years, was admitted to an outpatient neurology clinic, with 1-week history of 3-kg weight loss and progressive intense "inner restlessness," constant movements of the legs and feet, remarkable distress, insomnia, and pacing up and down. Neurological examination had normal results, no deterioration of the depression was present, a magnetic resonance scan of the brain was unremarkable, and biochemical tests were within reference ranges. The disorder eventually resolved after the permanent withdrawal of the offending medication. After excluding other possible disorders, the diagnosis of severe akathisia,...Continue Reading

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Citations

Nov 12, 2015·Therapeutic Advances in Psychopharmacology·Samir Kumar PraharajPodila Satya Venkata Narasimha Sharma
Jul 15, 2011·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Crystal C WatkinsGlenn J Treisman
Nov 10, 2020·Tzu Chi Medical Journal·Jamir Pitton Rissardo, Ana Leticia Fornari Caprara

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