Venlafaxine in a Patient With Idiopathic Leukopenia and Mirtazapine-Induced Severe Neutropenia

Letter to the Editor

Sir: Severe neutropenia, defined as less than 0.5 ×— 10⁹/L mature neutrophil cells, is a potentially life-threatening side effect with tricyclic antidepressants,1 but it also occurs with mirtazapine with an approximate risk of up to 1 in 1000. Here, we present a patient with a known idiopathic leukopenia and cross-intolerance between tricyclic antidepressants and mirtazapine who developed agranulocytosis with mirtazapine. After discontinuation of mirtazapine, she was safely treated with venlafaxine.