Mirtazapine for Treatment of Visual Snow Syndrome: A Case Series with Insights into Pathophysiology and Therapy

Background: Patients with visual snow syndrome (VSS) describe tiny flickering dots in the entire visual field resembling the noise of a poorly adjusted channel of analogue television with additional symptoms. Little is known about the pathophysiology and therapeutic options for this debilitating condition. Objectives: We present a case series of three patients with VSS taking mirtazapine, one of the most often prescribed antidepressants, and discuss the utility of antidepressants by reviewing our current understanding of pathophysiology and therapy. Results: Mirtazapine has no effect on VSS, neither positive nor negative. This is in line with the reports from the literature suggested only some beneficial effects from lamotrigine. Conclusions: Since the pathophysiology of VSS is not fully understood, we still rely on the reports of individual cases or patient series. This includes not only the positive, but also the negative results to avoid unnecessary treatment trials. Looking into the literature, antidepressants do not seem to be a solution for the visual symptoms. So far, best data exists for the anticonvulsant lamotrigine.