Mirtazapine: treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient. A report of 7 cases
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Objective: Though selective serotonin re-uptake inhibitors have been studied in pregnancy (Gupta, 1998), there is little information on the efficacy and safety of mirtazapine (Remeron®), a central alpha-2 blocker for treatment of depression and anxiety in pregnancy. Since mirtazapine blocks the 5HT-3 receptor postsynaptically, like ondansetron (Zofran®) but unlike any other antidepressant, there is reason to believe that mirtazapine may be of great use in treating not only depression and anxiety in pregnancy but also nausea and the more severe condition, hyperemesis gravidarum.
Method: Seven cases are reviewed in which mirtazapine was given in pregnancy for hyperemesis and depression. Five patients were treated as outpatients. Two patients were begun on mirtazapine as inpatients already on transparenteral nutrition, one having had a negative reaction to ondansetron and metoclopramide.
Results: All patients demonstrated improvement of depressed mood, and reduced nausea and vomiting. All seven babies were born at term, each with APGAR scores of 7 or 8 at one minute, 9 at five minutes.
Conclusions: Mirtazapine may prove a valuable treatment in pregnancy for depression, anxiety and/or hyperemesis, based on its dual action (serotonin and norepinephrine), efficacy in treating depression, and antagonism of 5HT-3. Further studies of its potential therapeutic use in pregnancy are warranted.
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