Reduction of Parkinsonism and Psychosis with Mirtazapine: A Case Report

 

 Buy Article Permissions and Reprints

Abstract

Introduction: Psychosis in Parkinson disease is a therapeutic challenge. Regular strategies of treatment are aimed at reducing dopamine medication, and if necessary addition of clozapine.

Methods: We describe the case of a patient with persistent psychosis. Nocturnal visual hallucinations persisted in spite of reduced dopaminergic medication and sequential treatment with atypical antipsychotic medication (quetiapine and clozapine) in combination with an acetylcholinesterase inhibitor (rivastigmine). After dispensing a dopamine enhancing antidepressant (mirtazapine), prescribed to improve sleeping, the psychotic symptoms almost immediately disappeared while Parkinsons symptoms declined.

Results: One other case about a positive effect of mirtazapine on (auditory) hallucinations in Parkinson has been published. The reason for the reduction of psychosis in Parkinson-related disease could have been the effect of antagonism of serotonin (5HT)-2 A and/or antagonism of 5HT-2C leading to dopamine release.

Discussion: Therapeutic effects of medication with strong antagonism for 5HT-2 A and 5HT-2C, like mirtazapine, mianserine, trazodone and nefazodone, in Parkinson-related diseases should be subject for further research. Serotonin might be associated with psychosis in Parkinson-related disease.

• References

• 1 Hoehn NM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442
  CrossrefPubMedGoogle Scholar
• 2 Aslan S, Isik E, Cosar B. The effects of mirtazapine on sleep: a placebo controlled, double-blind study in young healthy volunteers. Sleep 2002; 25: 677-679
  PubMedGoogle Scholar
• 3 Huot P, Johnston TH, Visanji NP et al. Increased levels of 5-HT1A receptor binding in ventral visual pathways in Parkinson’s disease. Mov Disord 2012; 27: 735-742
  CrossrefPubMedGoogle Scholar
• 4 Matteo V, di Cacchio M, Di Giulio C et al. Role of serotonin (2C) receptors in the control of brain dopaminergic function. Pharmacol Biochem Behav 2002; 71: 727-734
  CrossrefPubMedGoogle Scholar
• 5 Nagata T, Shinagawa S, Tagai K et al. A case in which mirtazapine reduced auditory hallucinations in a patient with Parkinson disease. Int Psychogeriatr 2012; 30: 1-3
  PubMedGoogle Scholar
• 6 Normann C, Hesslinger B, Frauenknecht S et al. Psychosis during chronic levodopa therapy triggered by the new antidepressive drug mirtazapine. Pharmacopsychiatry 1997; 30: 263-265
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Friedman JH. Parkinson disease psychosis: Update. Behav Neurol 2013; 27: 469-477
  CrossrefPubMedGoogle Scholar
• 8 Fujimoto K. Management of non-motor complications in Parkinson’s disease. J Neurol 2009; 256 (Suppl. 03) 299-305
  PubMedGoogle Scholar
• 9 Ikeguchi K, Kuroda A. Mianserin treatment of patients with psychosis induced by antiparkinsonian drugs. Eur Arch Psychiatry Clin Neurosci 1995; 244: 320-324
  CrossrefPubMedGoogle Scholar
• 10 Lebert F. Serotonin reuptake inhibitors in depression of ’Alzheimer’s disease and other dementias. [Article in French] Presse Med 2003; 32: 1181-1186
  PubMedGoogle Scholar
• 11 Rojas-Fernandez CH, MacKnight C. Dementia with Lewy bodies: review and pharmacotherapeutic implications. Pharmacotherapy 1999; 19: 795-803
  CrossrefPubMedGoogle Scholar
• 12 Geroldi C, Frisoni GB, Bianchetti A et al. Drug treatment in Lewy body dementia. Dement Geriatr Cogn Disord 1997; 8: 188-197
  CrossrefPubMedGoogle Scholar
• 13 Stahl SM. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. Cambridge University Press; 2011
  Google Scholar
• 14 Gordon PH, Pullman SL, Louis ED et al. Mirtazapine in Parkinsonian tremor. Parkinsonism Relat Disord 2002; 9: 125-126
  CrossrefPubMedGoogle Scholar
• 15 Pahwa R, Lyons KE. Mirtazapine in essential tremor: a double-blind, placebo-controlled pilot study. Mov Disord 2003; 18: 584-587
  CrossrefPubMedGoogle Scholar
• 16 Uccellini D, Grampa G, Spina I et al. Mirtazapine in the treatment of essential tremor: an open-label, observer-blind study. Neuropsychiatric Disease and Treatment 2006; 95-100
  PubMedGoogle Scholar
• 17 Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias. Neurology 1999; 53: 1154
  PubMedGoogle Scholar
• 18 Avila A, Cardona X, Martin-Baranera M et al. Does nefazodone improve both depression and Parkinson disease? A pilot randomized trial. J Clin Psychopharmacol 2003; 23: 509-513
  CrossrefPubMedGoogle Scholar