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Dystonia Induced by Mirtazapine

J Clin Psychiatry 2002;63(5):452-453 [letter]

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.