Abstracts

Rationale: Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA) used in the treatment of depression. It is thought to have a very low likelihood of inducing seizures with reports of incidence ranging from 0.0008% to 0.04% among users. A single post-marketing survey indicating possibility of seizures with Mirtazapine is not well-known. Methods: We describe 2 patients who presented with complex partial seizures following recent exposure to Mirtazapine. Patient 1 is a 61-year-old man who developed acute transient confusion and impaired language capacity followed by witnessed automatisms. This event, including post-ictal confusion was observed by healthcare professionals. He was being treated for depression with Mirtazapine which was increased 3 days prior to presentation. Patient 2 is a 40-year-old man who reported visual imagery of rain falling on his right hemi-field while driving his car, progressing to tonic-clonic activity observed by a passenger in the car, leading to a crash. He had a history of a single seizure in his childhood. He was recently started on Mirtazapine. In both patients, acute EEG showed transient abnormalities with subsequent resolution.Results: The temporal proximity of exposure to escalating doses of Mirtazapine and seizures in our patients who had no other identifiable risk factors for seizures implies a causative role for the drug.Conclusions: Depression co-exists in a significant percentage of epileptics and Mirtazapine is a favored drug due to its low epileptogenicity. Our experience with Mirtazapine and seizures urges caution when using this drug in a patient at risk for seizures. Physician sensitization to this possibility would help delineate the seizure potenital of this medication.