Treatment of hot flushes with mirtazapine: four case reports

Objective: To evaluate the effect of mirtazapine on the severity of hot flushes and bouts of perspiration in women. Method: In two women with depression a reduction in hot flushes was noticed by serendipity during treatment with mirtazapine 15–30 mg/daily. On the basis of this observation clinical studies were extended with two non-depressed and non-anxious women with hot flushes. Both subjects were prescribed mirtazapine daily. Results: Four cases are described as case reports. All subjects reported a practically complete disappearance of hot flushes and associated perspiration, within the first week of treatment. Conclusion: Mirtazapine appears to have a substantial ameliorating effect on hot flushes and perspiration bouts. It is postulated that the 5-HT_2A blocking properties of mirtazapine is accounted in the symptomatic relief of hot flushes. In addition it is hypothesized that the serotonergic system is crucially involved in the pathogenesis of hot flushes and perspiration bouts. Further evaluation in double-blind placebo-controlled studies is encouraged.