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Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias

Mirtazapine (Remeron; Organon, West Orange, NJ) is a novel antidepressant that disinhibits serotonergic and noradrenergic neurons by acting as an alpha-2 antagonist. We saw five patients in whom it reduced or eliminated parkinsonian tremor, action tremor (postural and kinetic), and levodopa-induced dyskinesias.

A 73-year-old woman had mild PD for 4 years. Her main complaint was a tremor that interfered with her ability to hold and deal cards while playing bridge. She had mild bradykinesia and slow parkinsonian gait, which were completely relieved with carbidopa/levodopa. She continued to experience resting and action tremor. She was started on mirtazapine 30 mg at night for depression. She reported that within days she could hold her cards without embarrassment. Two months later she stopped the mirtazapine because she was oversleeping, and the tremor (resting and action) returned. She restarted the mirtazapine …