Cardiac Arrest after Adding Mirtazapine in an Older Patient with Depression Who Already Used Escitalopram: A Case Report

Abstract

A 65-year-old woman with underlying hypertension and ischemic stroke was diagnosed with dysthymia and prescribed escitalopram 10 mg/day by a psychiatrist. Three months later, she received mirtazapine 15 mg/day from another physician to alleviate myofascial pain syndrome and sleeping problems. The following day, she developed jaw pain and later suffered cardiac arrest at the emergency unit, with her electrocardiogram revealing a prolonged QT interval. Emergency coronary artery angiography suggested myocardial infarction. Antidepressants were immediately discontinued, and she underwent coronary artery bypass grafting. After one year, her clinical symptoms had stabilised, allowing her to continue daily activities without chest pain, though she still experienced recurrent mild headaches and sleeping problems. This case underscores the importance of vigilant medication management in older adults with depression, especially in the context of a combination regimen and polypharmacy.