Psychosis during chronic levodopa therapy triggered by the new antidepressive drug mirtazapine.
We report the case of a patient developing psychosis after the addition of mirtazapine, a novel antidepressant enhancing serotonergic neurotransmission, to a chronic levodopa regimen. There was complete and rapid recovery upon low-dose clozapine treatment. To our knowledge, this is the first published case of a mirtazapine-levodopa interaction and the second case report of a psychosis induced by a serotonergic antidepressant in a patient with Parkinson's disease (PD). This phenomenon might be due to a postsynaptic serotonin receptor supersensitization caused by low central serotonin levels in treated PD.
Normann
C
C
Department of Psychiatry and Psychotherapy, University of Freiburg, Germany.
Hesslinger
B
B
Frauenknecht
S
S
Berger
M
M
Walden
J
J
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D000978:Antiparkinson Agents / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives*; D000078785:Mirtazapine; D010300:Parkinson Disease / Q000188:drug therapy; D011605:Psychoses, Substance-Induced / Q000209:etiology*; D013406:Suicide, Attempted
D000929:Antidepressive Agents, Tricyclic; D000978:Antiparkinson Agents; D008803:Mianserin; D007980:Levodopa; D000078785:Mirtazapine