Rapid efficacy of mirtazapine in the treatment of hyperemesis gravidarum with esophagus perforation and ketonuria in a normoglycemic patient: a case report

Hyperemesis gravidarum is a medical condition that may cause serious consequences for fetus and mother. The treatment regimen in patients with severe and treatment-resistant conditions is unclear. While antiemetics are known to be used for hyperemesis gravidarum in the literature, mirtazapine has been used effectively in some treatment-resistant cases. On the other hand, to the best of our knowledge, no reports on the efficacy of mirtazapine in cases of severe and treatment-resistant hyperemesis gravidarum have been published in the literature. The aim of our report was to present a successful treatment with mirtazapine for a 28-year-old pregnant patient who developed esophageal perforation and ketonuria while being normoglycemic due to severe and treatment-resistant hyperemesis gravidarum. This case revealed that mirtazapine may be effective even in severe cases of hyperemesis gravidarum. In addition, the effectiveness of mirtazapine in the treatment of hyperemesis gravidarum has been confirmed. However, the appropriateness of using mirtazapine in the treatment of pregnant patients needs to be discussed.

___

1. de Boer TH, Nefkens F, van Helvoirt A, van Delft AM. Differences in modulation of noradrenergic and serotonergic transmission by the alpha-2 adrenoceptor antagonists, mirtazapine, mianserin and idazoxan. J Pharmacol Exp Ther 1996; 277:852-860.

2. Guclu S, Gol M, Dogan E, Saygili U. Mirtazapine use in resistant hyperemesis gravidarum: report of three cases and review of the literature. Arch Gynecol Obstet 2005; 272:298-300.

3. Ozcankaya R, Acar A. A comparison of amitriptyline and mırtazapine side effects in depression treatment. Bull Clin Psychopharmacol 2001; 11:17-27.

4. Hrdlicka M, Beranova I, Zamecnikova R, Urbanek T. Mirtazapine in the treatment of adolescent anorexia nervosa. Case-control study. Eur Child Adolesc Psychiatry 2008; 17:187- 189.

5. Pae CU. Low-dose mirtazapine may be successful treatment option for severe nausea and vomiting. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:1143-1145.

6. Kim SW, Shin IS, Kim JM, Kang HC, Mun JU, Yang SJ, et al. Mirtazapine for severe gastroparesis unresponsive to conventional prokinetic treatment. Psychosomatics 2006; 47:440- 442.

7. Simsek Y, Celik O, Yilmaz E, Karaer A, Yildirim E, Yologlu S. Assessment of anxiety and depression levels of pregnant women with hyperemesis gravidarum in a case-control study. J Turk Ger Gynecol Assoc 2012; 13:32-36.

8. Kender EE, Yuksel G, Ger C, Ozer U. Eating attitudes, depression and anxiety levels of patients with hyperemesis gravidarum hospitalized in an obstetrics and gynecology clinic. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2015; 28:119-126.

9. Chan RL, Olshan AF, Savitz DA, Herring AH, Daniels JL, Peterson HB, et al. Maternal influences on nausea and vomiting in early pregnancy. Matern Child Health J 2011; 15:122-127.

10. Buyukkurt S, Demir SC, Ozgunen FT, Evruke IC, Kadayifci O, Guzel AB. Evaluation and Treatment of the Patients with Nausea and Vomiting in Pregnancy: Review. Turkiye Klinikleri J Gynecol Obst 2008; 18:106-116.

11. Kavakci O, Yenicesu GI. Eye movement desensitization and reprocessing [EMDR] for hyperemesis gravidarum: a case series. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2014; 27:335-341.

12. Saks B. Mirtazapine: treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient. A report of 7 cases. Arch Womens Ment Health 2001; 3:165-170.

13. Naguy A. Mirtazapine for major depression developed after hyperemesis gravidarum. Am J Ther 2019; 26:e661-e662.

14. Rohde A, Dembinski J, Dorn C. Mirtazapine (Remergil) for treatment resistant hyperemesis gravidarum: rescue of a twin pregnancy. Arch Gynecol Obstet 2003; 268:219-221.

15. Uguz F. Low-dose mirtazapine in treatment of major depression developed following severe nausea and vomiting during pregnancy: two cases. Gen Hosp Psychiatry 2014; 36:125.e5-6.

16. Montgomery SA. Safety of mirtazapine: a review. Int Clin Psychopharmacol 1995; 10:37-45.

17. Theobald DE, Kirsh KL, Holtsclaw E, Donaghy K, Passik SD. An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage 2002; 23:442-447.

18. Schwarzer V, Heep A, Gembruch U, Rohde A. Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine. Arch Gynecol Obstet 2008; 277:67-69.
Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık
Sayıdaki Diğer Makaleler

Relationship between quality of life, depression and anxiety in type 1 and type 2 diabetes

Soner ÇAKMAK, Emirhan GEN

Valproicacid- induced hyperammonemic encephalopathy

Naciye HOCAOGLU, Saliha ÖZSOY, Kadir BULUT, Sevda İSMAİLOĞULLARI, Mustafa ERDOĞAN

Aggravating influence of atomoxetine on the severity of stuttering and its successful treatment with methylphenidate: a case report

Ayla Uzun CİCEK

Relationship between somatization and psychiatric symptoms, especially anxiety, depression, alexithymia, and severity of addiction in male patients with alcohol and heroin addiction

Muhammed Hakan AKSU, Safak Yalcin SAHİNER, Ismail Volkan SAHİNER, Buket KOPARAL, Çisem UTKU, Behcet COŞAR, Zehra ARIKAN

Validity and reliability of the Benevolent Childhood Experiences (BCEs) Scale in Turkish

Rumeysa Gunay OGE, Fatmatuz Zehra PEHLİVAN, Sedat IŞIKLI

Evaluation of domestic physical violence in a male sample in a psychiatric outpatient clinic: a controlled study

Vahap KARABULUT, Başak ÖZÇELİK, Oğuz KARAMUSTAFALIOĞLU

Substance use patterns, psychosocial traumas, psychiatric comorbidities, and gender differences among adolescent inpatients at an addiction treatment center

Deniz YILDIZ, Arzu ÇİFTÇİ, Özhan YALÇIN

Replication analysis of the Coronavirus Anxiety Scale

Sherman A. LEE

Acute stress disorder with panic episodes induced by exposure to COVID-19 outbreak news in a child

Duygu KABA, Burcu AKİN SARİ

Hiccups associated with switching from quetiapine to aripiprazole in an adolescent patient

Mert BEŞENEK