Mirtazapine for Symptomatic Relief on a Psychiatric Consultation Service: A Case Series.
With a complex pharmacologic profile, mirtazapine may promote sleep, stimulate appetite, improve nausea, and reduce pain. Some practitioners working on the Mayo Clinic inpatient psychiatric consultation/liaison service have recommended mirtazapine in medically ill patients with or without formal psychiatric comorbidity to target these symptoms.



To assess the success of this practice, we conducted a retrospective chart review covering a 4.5-year period.



For patients recommended to start mirtazapine, global improvement in specific symptoms and suspected side effects were recorded.



During the study period, 528 medically ill patients started mirtazapine following a recommendation from the psychiatric consultation service. In total, 475 patients were provided mirtazapine to specifically target sleep, nausea, pain, or appetite. There was documented improvement in these symptoms for 37.7%, 37.0%, 36.4%, and 23.5% of the patients, respectively. These rates of improvement are conservative for the 229 patients without documented response, i.e., 48% of the patients who were given the medication for a somatic symptom were counted as having no improvement. Commonly documented adverse effects were daytime sedation (5.3%), worsening mental status (2.3%), and nightmares (1%).



Despite the limitations of this retrospective, qualitative study, these data confirm that mirtazapine is generally well tolerated and can provide at least short-term relief of certain symptoms in medically ill patients. Controlled trials are needed to assess these benefits more systematically, and it is not clear how long mirtazapine should be used for these symptoms.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: allen.nicholas@mayo.edu.
Nicholas D
ND
Allen
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Jonathan G
JG
Leung
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Hannah K
HK
Betcher
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Kristin L
KL
Borreggine
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Daniel K
DK
Hosker
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Blaine A
BA
Minton
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Eliza M
EM
Sukiennik
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Jacob J
JJ
Wilson
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Kemuel L
KL
Philbrick
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Keith G
KG
Rasmussen
D000328:Adult; D000368:Aged; D000855:Anorexia / Q000188:drug therapy*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009325:Nausea / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D011570:Psychiatry; D012017:Referral and Consultation; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D000078785:Mirtazapine
Consultation Liaison Psychiatry; antidepressants; appetite; nausea; pain; psychopharmacology; sleep