Mania Associated with Mirtazepine Treatment and Mixed Depression

Mixed depressive states are a challenge for practitioners because reinforcement of antidepressant treatment might cause a switch to mania. We report the case of a mirtazepine-associated switch to mania in a patient presenting with mixed depressive symptoms. Currently only one mirtazepine-associated case of a switch to mania in mixed depression has bee reported. In contrast to that case, our patient was previously not treated with an SSRI before the medication was changed to mirtazepine. This makes complex pharmacological interactions in our case unlikely and highlights the relevance of the factor mixed depression. Although currently the concept of mixed states is not fully acknowledged in the diagnostic manuals, it should be recognized in order to choose the appropriate treatment options for patients at risk to develop manic symptoms.

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