From the Research
Mirtazapine is generally considered to have a low risk of causing or worsening Parkinson's disease symptoms compared to other antidepressants, and it can be a preferred choice for patients with Parkinson's disease or those at risk for parkinsonism. This is due to its unique mechanism of action as an alpha-2 antagonist and 5-HT2/5-HT3 receptor antagonist, which doesn't significantly interfere with dopaminergic neurotransmission that is already deficient in Parkinson's disease 1. The typical starting dose is 7.5-15 mg at bedtime, which can be gradually increased to 30-45 mg if needed.
Key Points to Consider
- Mirtazapine's sedating effects at lower doses (15 mg or less) can help with sleep disturbances common in Parkinson's patients, while higher doses tend to be more activating 2.
- Patients should be monitored for potential side effects including sedation, increased appetite, weight gain, and dry mouth 1.
- If parkinsonism symptoms worsen after starting mirtazapine, which is uncommon but possible, the medication should be reevaluated 3.
- There is evidence to suggest that mirtazapine may be effective in alleviating PD psychosis and reducing dyskinesia without hindering L-DOPA anti-parkinsonian action 4.
Management and Treatment
- Mirtazapine can be considered as a treatment option for patients with Parkinson's disease or those at risk for parkinsonism who require antidepressant therapy 1.
- The medication's potential benefits in reducing psychosis and improving sleep disturbances should be weighed against its potential risks and side effects 2, 3.
- Further research is needed to fully understand the therapeutic effects of mirtazapine in Parkinson's disease and to determine its optimal dosage and treatment duration 4, 1.