Dysphoric mania induced by high-dose mirtazapine: a case for 'norepinephrine syndrome'?
Dysphoric mania induced by high-dose mirtazapine: a case for 'norepinephrine syndrome'?
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DOI：
10.1097/00004850-200211000-00009
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发表时间：
2002-11-01
影响因子：
2.6
通讯作者：
Chouinard, G
中科院分区：
文献类型：
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作者：
Bhanji, NH;Margolese, HC;Chouinard, G
抗抑郁药米氮平拮抗中枢突触前α（2）-肾上腺素能自身受体和异源受体，导致中枢去甲肾上腺素和5-羟色胺活性增加。组胺H1受体也被拮抗，突触后5-羟色胺5-HT 2和5-HT 3受体也被拮抗，主要通过5-HT 1A受体导致多巴胺能活性。基于一个病人谁开发躁狂症与高于推荐剂量的米氮平的病例报告，我们回顾了文献的非典型性质的躁狂症状与米氮平。包括我们研究中的受试者在内的8例受试者被确定为发生了米氮平诱导的躁狂症，具有非典型特征，包括烦躁不安、易怒、失眠、精神性激越和步态异常。诱发特征可能包括存在潜在的脑功能障碍和某些选择性5-羟色胺再摄取阿托米氮平组合。具有非典型特征的抑郁性躁狂可能由米氮平诱发，这为一种常见的假设提供了支持，如“中枢去甲肾上腺素过度活跃”是米氮平引起躁狂的基础。国际临床精神药理学17：319-322（C）2002 Lippincott威廉姆斯威尔金斯。
The antidepressant mirtazapine antagonizes central presynaptic alpha(2)-adrenergic auto- and heteroreceptors resulting in increased central norepinephrine and serotonin activity. Histamine H, receptors are also antagonized, as are postsynaptic serotonin 5-HT2 and 5-HT3 receptors, leading to serotonergic activity primarily via 5-HT1A receptors. Based on the case report of a patient who developed mania with higher than recommended dosage of mirtazapine, we review the literature on the atypical nature of manic symptoms with mirtazapine. Eight subjects, including those in our study, were identified as having developed mirtazapine-induced mania with atypical features, consisting of dysphoria, irritability, insomnia, psychomotor agitation and abnormal gait. Predisposing features may have included the presence of underlying brain dysfunction and certain selective serotonin reuptake inhibitormirtazapine combinations. Dysphoric mania with atypical features may be induced by mirtazapine, providing support for a common hypothesis such as 'central norepinephrine hyperactivity' as the basis for development of mania with mirtazapine. Int Clin Psychopharmacol 17:319-322 (C) 2002 Lippincott Williams Wilkins.