Dystonia Induced by Mirtazapine

Letter to the Editor

Sir: Mirtazapine is a new antidepressant that exerts its effects through antagonism at central α₂ receptors instead of through an uptake or enzyme inhibitor. Unlike tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), mirtazapine enhances central noradrenergic and serotonergic activity by acting as an antagonist at central presynaptic α₂-adrenergic inhibitory autoreceptors and presynaptic α₂ heteroreceptors. Mirtazapine is also a potent antagonist of serotonin 5-HT₂ and 5-HT₃ receptors, with minimal affinity for the 5-HT₁ receptor, thus incurring minimal occurrence of serotonergic side effects.