Hypomania Associated With Mirtazapine Augmentation of Sertraline

Sir: Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA). Its novel mechanism of action involves α₂-adrenergic autoreceptor and heteroreceptor blockade, enhancing serotonin (5-HT) and norepinephrine release; and 5-HT₂, 5-HT₃, and histamine H₁ antagonism. Because mirtazapine blocks 5-HT₂ and 5-HT₃ receptors, 5-HT₁-mediated transmission is enhanced.