SYMPOSIA

Poster Presentations
22.7%, bipolar affective disorder depressive episode 9.1%, unipolar depression 27.4%, and obsessive compulsive disorder, dissociative
disorder, and schizoaffective disorder, each 4.5%. When the treatments of the patients were evaluated according to their diagnosis
we found that 13.6% of schizophrenia patients were treated with ECT, 9.09% with haloperidol and 4.5% with atypical antipsychotics;
the patients with bipolar depression were treated with mood stabilizers and ECT plus mood stabilizers at the same rate of 4.5%; 18.1%
of the patients with mania were treated with ECT plus haloperidol; and of the unipolar depressed patients 13.6% were treated with
psychotherapy and 9.09% with ECT and haloperidol.
Conclusion: ECT was used commonly as a treatment option in our patient group. ECT treatment was added onto haloperidol treatment
in severe cases. This treatment is consistent with the recommendations of the APA and with those in the literature.
Key words: Pregnancy, mental illness, treatment, ECT, antipsychotic drugs
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S195-6
[PP-120] Ref. No: 278
Peripheral edema associated with mirtazapine: Presentation of a case
Birmay Çam 1 , Hüseyin Kurt 2
1Gönen Devlet Hastanesi Psikiyatri Kliniği, Gönen, Balıkesir, Turkey
2Gönen Devlet Hastanesi İç Hastalıkları Kliniği, Gönen, Balıkesir, Turkey
E-mail: birmaycam@mynet.com
In the medical literature, occurrence of edema during treatment with mirtazapine is stated as the least frequently reported side effect. A
case of edema occurring during mirtazapine treatment is reported below.
Case: A 34 year-old female patient was admitted to the psychiatric ward with a diagnosis of recurrent depressive disorder. There were no specific
findings in the patient’s medical history other than high blood pressure and irregularly administered antihypertensive drugs. There was no use
of alcohol or illicit drugs. The treatment regimen of the patient included escitalopram 5 mg daily, alprazolam 0.5 mg daily, and hydroxyzine 12.5
mg daily. Mirtazapine 15 mg daily was added to the medical treatment, as the depression and insomnia continued. The day after beginning
the treatment with mirtazapine pretibial edema developed. The CBC, ALT, AST, GGT, ALP, bilirubin, albumin, urea, creatinine, Na, K, Cl, Ca, urine
analysis, thyroid function tests and chest X-ray were repeated and all were within normal limits, as before. Cardiac insufficiency, cirrhosis, nephrotic
syndrome, and venous insufficiency, all of which can cause edema, were ruled out by the internal medicine consult. The patient was not in the
premenstrual period and not pregnant. It was also reported that such a side effect was observed during the administration of escitalopram to the
patient. The edema was assessed as being due to mirtazapine. The edema decreased three days after the cessation of the mirtazapine treatment
and the administration of furosemide 40 mg/day at the recommendation of internal medicine. It disappeared ten days later. Escitalopram 10
mg daily and hydroxyzine 25 mg daily were continued. The patient, whose depressive symptoms decreased and anxiety disappeared, has
continued to be followed up as an outpatient after discharge. The patient’s depressive symptoms did not recur and her blood pressure remained
within normal limits although she did not receive any antihypertensive treatment. She had no edema at her two month follow up visit. Her CBC,
electrolytes, biochemical and thyroid function tests, and urine analysis all remained within normal limits.
Discussion: In our case, the occurrence of edema simultaneously with the administration of mirtazapine, the exclusion of systemic
diseases that can cause edema, the lack of continuation or recurrence of the edema even as the patient remained on escitalopram
between the previous and the current depressive episodes, and finally the disappearance of the edema right after the cessation of
mirtazapine treatment made us to think that the edema was caused by mirtazapine. In the medical literature, it is reported that MAOIs,
escitalopram, and sertraline can cause edema. Kutscher et al. reported that peripheral edema occurred in a male patient of 60 years of age
after the use of mirtazapine and disappeared right after the cessation of mirtazapine treatment (1,2,3,4). More detailed studies should be
conducted to explore and understand this issue better.
Key words: Edema, mirtazapine
References:
1. Remick RA,Froeze C,Keller FD(1989)Common side effects associated with monoamine oxidase inhibitors.Prog Neuropsychopharmacol Biol Psychiatry 13:497-504.
2. Masdrakis VG,Oulis P,Kouzoupis AV,Masdrakis GV,Soldatos CR(2009)Bilateral ankle oedema in a patient taking escitalopram.World J Biol Psychiatry 10:939-41.
3. Dadic-Hero E,Ružic K,Grahovac T,Graovac M,Palijan TZ,Sepic-Grahovac D(2011) Allergic reactions--outcome of sertraline and escitalopram treatments.Psychiatr
Danub. Mar;23(1):120-2.
4. Kutscher EC,Lund BC,Hartman BA(2001)Peripheral edema associated with mirtazapine. Ann Pharmacother.35(11):1494-5.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S196
S196 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org