From the Research
Mirtazapine can be used cautiously in Parkinson's disease patients, particularly when depression and sleep disturbances are present, starting at a low dose of 7.5-15mg at bedtime, which may be gradually increased if needed, as evidenced by a study suggesting its potential to alleviate PD psychosis and dyskinesia without hindering L-DOPA anti-parkinsonian action 1. When considering the use of mirtazapine in Parkinson's disease patients, it's essential to weigh the potential benefits against the risks. Mirtazapine works by blocking certain serotonin receptors and increasing norepinephrine and serotonin in the brain, which helps with depression while causing less movement-related side effects than many other antidepressants.
- The medication's sedating properties can also help with insomnia, which is common in Parkinson's.
- However, patients should be monitored for potential side effects including increased drowsiness, weight gain, and rarely, worsening of movement symptoms.
- It's crucial to start with a low dose and adjust slowly while watching for any impact on Parkinson's symptoms.
- The medication should be taken consistently at the same time each evening to maintain steady blood levels and optimize sleep benefits. A study published in 2019 found that the lower range of the licensed dose of mirtazapine achieves the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of major depression 2.
- Another study from 2017 suggested that mirtazapine may be effective in alleviating PD psychosis and dyskinesia without hindering L-DOPA anti-parkinsonian action 1.
- While earlier studies, such as those from 2008 and 2010, provided insights into the comparison of mirtazapine with selective serotonin reuptake inhibitors (SSRIs) and its use in Parkinson's disease, the most recent and highest quality study 1 supports the cautious use of mirtazapine in Parkinson's disease patients.