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CT scanning may be appropriate in patients with focal neurologic findings, a history of trauma, or chronic ear disease.

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Ubogu and Katirji present a similar case in an 85-year-old female on mirtazapine monotherapy who developed cogwheeling, tremors, mutism with a normal temperature.

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Erythromycin and low dose tricyclic antidepressants have also been employed with some success, but erythromycin commonly causes diarrhea and tricyclics may cause anti-cholinergic effects that enhance symptoms.

In the treatment of depression, paroxetine (Paxil) is initiated at a dosage of 20 mg per day (); elderly patients or patients with anxiety disorders may start at a dosage of 10 mg per day.

If a patient develops a sore throat, fever, stomatitis or other signs of infection, along with a low WBC count, treatment with mirtazapine should be discontinued and the patient should be closely monitored.

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