First report of mirtazapine overdose

Hoes, M.J.A.J.M.; Zeijpveld, J. H.B.

doi:10.1097/00004850-199606000-00009

Cited by 10 publications

(3 citation statements)

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“…The antidepressant mirtazapine (MTZ) was introduced in the market for the first time in The Netherlands, in 1994. Until now, few data have been available about the risk of MTZ overdose since there have been only five reports (MEDLINE, March 2001) of attempted suicide with this drug [1][2][3][4][5].…”

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confidence: 99%

Mirtazapine overdose with benign outcome

Raja

Azzoni

2002

Eur. psychiatr.

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confidence: 99%

Mirtazapine overdose with benign outcome

Raja

Azzoni

2002

Eur. psychiatr.

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“…There is not a single case report of typical ST with MIRT alone, in either overdose or therapeutic dose. There are eight separate reports in the literature containing a total of 14 patients with MIRT-alone overdoses, none of whom exhibited any signs of serotonergic toxicity (Bremner et al, 1998;Garlipp et al, 2003;Gerritsen, 1997;Hoes and Zeijpveld, 1996a;Holzbach et al, 1998;Raja and Azzoni, 2002;Retz et al, 1998;Velazquez et al, 2001). There are four reports of ST with MIRT in combination with other SRIs that are known to cause ST by themselves (Benazzi, 1998;Demers and Malone, 2001), 2 of which are with venlafaxine (Dimellis, 2002;Houlihan, 2004), which is a particularly potent precipitator of ST by itself.…”

Section: Individual Case Reports Concerning Mirtazapinementioning

confidence: 99%

A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status

Gillman¹

2006

Hum. Psychopharmacol. Clin. Exp.

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A systematic review of published work concerning mirtazapine was undertaken to assess possible evidence of serotonergic effects or serotonin toxicity (ST) in humans, because drug toxicity and interaction data from human over-doses is an useful source of information about the nature and potency of drug effects. There is a paucity of evidence for mirtazapine having effects on any indicator of serotonin elevation, which leads to an emphasis on ST as an important line of evidence. Mirtazapine is compared with its analogue mianserin, and other serotonergic drugs. Although mirtazapine is referred to as a dual-action 'noradrenergic and specific serotonergic drug' (NaSSA) little evidence to support that idea exists, except from initial microdialysis studies in animals showing small effects; those have not subsequently been replicated or substantiated by independent researchers. Also, new data indicate its affinity for Alpha 2 adrenoceptors is not different to mianserin. It appears to exhibit no serotonergic symptoms or toxicity in over-dose by itself, nor is there evidence that it precipitates ST in combination with monoamine oxidase inhibitors, as would be expected if it raises intra-synaptic serotonin levels. Mirtazapine has no demonstrable serotonergic effects in humans and there is insufficient evidence to designate it as a dual-action drug.

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“…Only a few cases of mirtazapine overdoses have been reported and the patients seemed to suffer no serious medical consequences [1−5]. In this case the patient was somnolent and ataxic only for a few hours.…”

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confidence: 94%

A Non-Fatal Mirtazapine Overdose in a Suicide Attempt

Garlipp¹,

Brüggemann²,

Machleidt³

2003

Aust N Z J Psychiatry

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issue [1] and sadly I have to agree with most of what he had to say about the treatment of comorbidity or 'dual diagnosis' patients. In particular, MacQueen makes the pertinent point that most comorbidity in the substance abuse field is actually anxiety and depressive disorders and that the classic 'dual diagnosis' patient (e.g. a person suffering from schizophrenia who smokes marijuana), is only the tip of the iceberg. The incidences and prevalences of psychiatric disorder in those presenting with substance abuse are far higher than the incidence of substance abuse in those presenting with psychiatric disorders, so it turns out that it is much more relevant to train those in the drug and alcohol field in recognizing and treating psychiatric disorder, rather than the other way around [2].However, I do feel that MacQueen has basically missed the point in issuing his challenge to psychiatrists as individuals. In fact, psychiatrists have been put in an impossible position as the powers that be, for politically correct reasons, have artificially separated substance abuse and psychiatric services. They have, in fact, attempted to unscramble the egg and thus we now have this ludicrous situation with patients being bounced between the two services and never receiving adequate treatment.As Harvey Whiteford stated in this Journal,The high rates of comorbidity, especially with alcohol and illicit drugs confirms clinicians' experience. In the light of this I am even more certain that the administrative separation of mental health and substance abuse services makes little sense, especially to the consumer and their carers [3].

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First report of mirtazapine overdose

Cited by 10 publications

References 0 publications

Mirtazapine overdose with benign outcome

Mirtazapine overdose with benign outcome

A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status

A Non-Fatal Mirtazapine Overdose in a Suicide Attempt

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