Mirtazapine in Treating Anorexia Nervosa with Depression

Objectives

• Report on the use of Mirtazapine for anorexia nervosa (AN) with depression, focusing on its weight gain propensity.

Case Overview

• Patient: 16-year-old Malay girl.
• Initial BMI: 13.4 after 2 years of dietary restriction followed by binge-eating and compensatory behaviors.
• Symptoms: Weakness, hyperventilation, cold intolerance, dental hypersensitivities, secondary amenorrhea, major depression.
• Diagnosis: Anorexia nervosa (binge-eating type) with major depressive disorder.

Treatment Protocol

• Inpatient treatment was avoided; outpatient appointments were established.
• Multidisciplinary approach: medical, dental, nutritional, psychological.
• Mirtazapine prescribed: initial dose of 15 mg, increased to 30 mg over 2 weeks.

Results

• Weight gain: 2.5 kg over 3 months; stabilization at 37 kg (BMI ~15) after further 2 months.
• Depression: Full remission achieved at 6 weeks, motivating continued treatment.
• Decreased frequency of binge-eating.

Discussion

• Mirtazapine's Role: Antagonizes 5HT2C and H1 receptors leading to weight gain.
• Other medications considered: Olanzapine (risk factors for drug interaction).
• Weight restoration primary goal; psychotherapy more effective after some weight gain.
• Caution required when treating depression due to physical vulnerabilities of AN patients.

Conclusion

• Mirtazapine is a suitable option for treating depression in AN but requires careful management.
• Further controlled trials are necessary to solidify its efficacy for AN treatment.

Key Terms

• Anorexia Nervosa
• Mirtazapine
• Depression
• Weight Gain
• Multidisciplinary Approach
• Cognitive Behavioral Therapy (CBT)