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Mirtazapine has been reported to target symptoms of anxiety (agitation, somatization, psychic anxiety, panic attacks) that often occur in depressed patients.^1-3 Enhancement of both noradrenergic and serotonergic transmission through autoreceptor and -heteroreceptor antagonism, respectively, coupled with the blockade of 5-HT₂ and 5-HT₃ receptors, has been considered the main mechanism of this apparent pharmacological efficacy for anxiety symptoms.^3-4 Additionally, H₁ receptor antagonism facilitates an initial soporific effect.

We evaluated response to mirtazapine in 15 patients meeting DSM-IV criteria for panic disorder (n = 11) with or without agoraphobia (n = 4). Study participants were between 18 and 65 years of age (mean ± SD, 41.13 ± 9.71). There were 8 men and 7 women. None had ever received pharmacological treatment for a psychiatric disorder. Diagnosis was established using the Structured Clinical Interview for DSM-IV (SCID).^5-6 Symptoms were evaluated using the Panic Disorder Severity Scale (PDSS),⁷ the Hamilton Anxiety Rating Scale (HARS), . . . [Full Text of this Article]