Tsai Lee-Hou, Lin Jeng-Wen, Lee Maw-Sheng, Huang Yennun
Department of Psychiatry, Taichung Hospital, Ministry of Health and Welfare, Taiwan.
Department of Civil Engineering, Feng Chia University, Taiwan; Research Center for Information Technology Innovation, Academia Sinica, Taiwan.
J Int Med Res. 2025 Jul;53(7):3000605251353195. doi: 10.1177/03000605251353195. Epub 2025 Jul 4.
Depression, dementia, and delirium comprise the "3 Ds" of mental illness diagnoses in the older population. Depression is a common condition. Older adults may passively deal with depression, may not adhere to their prescribed drug schedules, and may be prone to unexpected side effects. A 70-year-old man with depression was brought by his family to the clinic with a 2-month history of depressed mood and poor drug compliance. After being diagnosed with depression, mirtazapine treatment was started. The following day, his family members suspected that the use of psychiatric drugs had caused acute urinary retention; hence, they brought him back to the emergency department. The emergency physician diagnosed the patient with benign prostatic hyperplasia and admitted him to the psychiatric ward after urinary catheterization. This case illustrates the effects of mirtazapine on urinary function in older individuals, particularly those with a history of benign prostatic hyperplasia. Although low-dose short-acting benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) have been used to reduce the anticholinergic cognitive burden, mirtazapine inevitably induces acute urinary retention in older males with benign prostatic hyperplasia. Thus, the possibility of acute urinary retention caused by mirtazapine, particularly in patients with benign prostatic hyperplasia, cannot be ignored.
抑郁症、痴呆症和谵妄构成了老年人群精神疾病诊断中的“3D”。抑郁症是一种常见病症。老年人可能会消极应对抑郁症，可能不遵守规定的用药时间表，并且可能容易出现意外的副作用。一名患有抑郁症的70岁男性被家人带到诊所，有2个月情绪低落和药物依从性差的病史。被诊断为抑郁症后，开始使用米氮平治疗。第二天，他的家人怀疑使用精神药物导致了急性尿潴留；因此，他们把他带回了急诊科。急诊医生诊断该患者患有良性前列腺增生，导尿后将他收治到精神科病房。这个病例说明了米氮平对老年人泌尿功能的影响，特别是那些有良性前列腺增生病史的人。尽管低剂量短效苯二氮䓬类药物和非苯二氮䓬类催眠药（Z类药物）已被用于减轻抗胆碱能认知负担，但米氮平不可避免地会在患有良性前列腺增生的老年男性中诱发急性尿潴留。因此，米氮平引起急性尿潴留的可能性，尤其是在患有良性前列腺增生的患者中，不能被忽视。
