Hoarding medication and suicide attempts with 1180 tablets of mirtazapine overdose: A case report

Confirming a patient's consistent adherence to prescribed medication remains a persistent challenge for healthcare professionals. One reason for nonadherence is that patients accumulate their prescribed medicines with the intent of taking large quantities as a suicidal attempt. We present a case involving hoarding and overdosing on the highest quantity of mirtazapine ever reported.Our patient, a 44‐year‐old man suffering from depression, was admitted to our emergency department due to an overdose of 1180 mirtazapine tablets, equivalent to 17,700 mg. He exhibited a prolonged disturbance of consciousness, liver enzyme abnormalities, and serotonin syndrome. After 7 weeks in the intensive care unit, he was transferred to a psychiatric ward. Over time, his depressive symptoms improved, as did his suicidal ideation. On the 73rd day of his illness, he was discharged without any lasting effects, although he experienced retrograde amnesia.In this case, ensuring the patient's medication adherence is paramount. Implementing electronic prescription technologies may offer the potential to enhance healthcare by avoiding medication duplication, preventing stockpiling of duplicated medicine, and preventing overdosing.