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