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Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female

Mirtazapine is a novel tetracyclic antidepressant which enhances noradrenergic and serotonergic transmission by blocking central α2-adrenergic auto- and hetero-receptors. Due to favorable safety and adverse effect profile, it is often viewed as a promising agent for treatment of depression. Particul...

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Autores principales: Menon, Vikas, Madhavapuri, Pravallika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820750/
https://www.ncbi.nlm.nih.gov/pubmed/29472752
http://dx.doi.org/10.4103/jpp.JPP_116_17
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author Menon, Vikas
Madhavapuri, Pravallika
author_facet Menon, Vikas
Madhavapuri, Pravallika
author_sort Menon, Vikas
collection PubMed
description Mirtazapine is a novel tetracyclic antidepressant which enhances noradrenergic and serotonergic transmission by blocking central α2-adrenergic auto- and hetero-receptors. Due to favorable safety and adverse effect profile, it is often viewed as a promising agent for treatment of depression. Particularly, its anxiolytic and sleep-improving properties have led to its favorable positioning for the management of depression with insomnia. Our objective is to describe a case of depression with treatment-emergent nightmares induced by mirtazapine. A 21-year-old female medical student was diagnosed with moderate depression with prominent insomnia and initiated on tablet mirtazapine 7.5 mg subsequent to a failed trial of selective serotonin reuptake inhibitor. On each of the next 7 days, she developed nightmares that were quite distressing and terrifying. As per the patient's request, tablets were stopped. The side effect abated within 2 days of stopping the agent, and this close temporal relationship suggests a causal role for mirtazapine in inducing the adverse reaction. Nightmares are usually associated with rapid eye movement (REM) sleep, and literature is inconsistent about the effect of mirtazapine on REM sleep parameters. Nevertheless, clinicians need to be forewarned about the possibility of developing treatment-limiting REM sleep phenomena such as nightmares when using antidepressants without prominent REM suppressant properties such as mirtazapine. The putative mechanisms behind these rare adverse reactions are discussed.
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spelling pubmed-58207502018-02-22 Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female Menon, Vikas Madhavapuri, Pravallika J Pharmacol Pharmacother Case Report Mirtazapine is a novel tetracyclic antidepressant which enhances noradrenergic and serotonergic transmission by blocking central α2-adrenergic auto- and hetero-receptors. Due to favorable safety and adverse effect profile, it is often viewed as a promising agent for treatment of depression. Particularly, its anxiolytic and sleep-improving properties have led to its favorable positioning for the management of depression with insomnia. Our objective is to describe a case of depression with treatment-emergent nightmares induced by mirtazapine. A 21-year-old female medical student was diagnosed with moderate depression with prominent insomnia and initiated on tablet mirtazapine 7.5 mg subsequent to a failed trial of selective serotonin reuptake inhibitor. On each of the next 7 days, she developed nightmares that were quite distressing and terrifying. As per the patient's request, tablets were stopped. The side effect abated within 2 days of stopping the agent, and this close temporal relationship suggests a causal role for mirtazapine in inducing the adverse reaction. Nightmares are usually associated with rapid eye movement (REM) sleep, and literature is inconsistent about the effect of mirtazapine on REM sleep parameters. Nevertheless, clinicians need to be forewarned about the possibility of developing treatment-limiting REM sleep phenomena such as nightmares when using antidepressants without prominent REM suppressant properties such as mirtazapine. The putative mechanisms behind these rare adverse reactions are discussed. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5820750/ /pubmed/29472752 http://dx.doi.org/10.4103/jpp.JPP_116_17 Text en Copyright: © 2018 Journal of Pharmacology and Pharmacotherapeutics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Menon, Vikas
Madhavapuri, Pravallika
Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title_full Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title_fullStr Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title_full_unstemmed Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title_short Low-Dose Mirtazapine-Induced Nightmares Necessitating its Discontinuation in a Young Adult Female
title_sort low-dose mirtazapine-induced nightmares necessitating its discontinuation in a young adult female
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820750/
https://www.ncbi.nlm.nih.gov/pubmed/29472752
http://dx.doi.org/10.4103/jpp.JPP_116_17
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