more of the following: consumption of peculiar forms of food or toxic substances, insomnia related to sleep disruption with daytime fatigue or sleepiness, sleep-related injury, dangerous behaviors performed while in pursuit of food or while cooking food, morning anorexia, and adverse health consequences from recurrent binge eating of high-caloric foods. 1 Because our patient exhibited recurrent episodes of binge and uncontrollable eating after arousal from sleep, she could not remember her ab- normal eating behavior; her symptoms met the diagnostic criteria for SRED. Sev- eral drugs, such as zolpidem, triazolam, olanzapine, risperidone, and quetiapine related to SRED, 3Y9 and topiramate, clo- nazepam, and dopaminergics showed ther- apeutic benefits through case reports and small uncontrolled studies. 10Y12 Mirtazapine enhances serotonin re- lease by blocking >-2 autoreceptors and heteroreceptors, selectively antagonizing the serotonin 5-HT2 and 5-HT3 receptors in the central and peripheral nervous sys- tem. Blockade of 5-HT2 and 5-HT3 re- ceptors may produce antidepressant effects by relieving sleep disturbance or increasing appetite. Mirtazapine also has a potent an- tagonist effect on histamine 1 receptors, which may augment the sedative and appetite-increasing effects. The pathophysiology of SRED is still unclear. However, because SRED is prev- alent in patients with RLS and PLMD, there is evidence that SRED may be related to dopaminergic dysfunction. 2,10,13,14 Some investigators have reported that combined selective >-2 adrenoceptor antagonists and norepinephrine transporter inhibitors caused a marked and selective increase of extracel- lular dopamine in prefrontal cortex. 15,16 However, second-generation antide- pressants alone may cause RLS in 9% of patients, and mirtazapine induced or ex- acerbated RLS in 28% of patients. 17 More- over, recent reports showed an association of mirtazapine with PLMD-like symp- toms. 18 Although serotonin-mediated do- pamine inhibition might be a mechanism, 19 it is uncertain which mechanism of mirtazapine causes SRED. Here, we report the first case of mirtazapine-related SRED. The use of mirtazapine should, therefore, be consid- ered a possible precipitating factor for developing SRED, and it will not neces- sarily have an immediate onset. AUTHOR DISCLOSURE INFORMATION The authors declare no conflicts of interest. This is an open access article dis- tributed under the terms of the Creative Commons Attribution-NonCommercial- NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Jong-Hyun Jeong, MD, PhD Department of Psychiatry St Vincent’s Hospital College of Medicine The Catholic University of Korea Suwon, Korea Won-Myong Bahk, MD, PhD Department of Psychiatry St Mary’s Hospital College of Medicine The Catholic University of Korea Seoul, Korea wmbahk@catholic.ac.kr REFERENCES 1. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005. 2. Provini F, Antelmi E, Vignatelli L, et al. Association of restless legs syndrome with nocturnal eating: a case-control study. 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Donepezil-Associated Mania in Two Patients Who Were Using Donepezil Without a Prescription To the Editors: M ore than 40 years ago, it was pos- tulated that excess acetylcholine was associated with depression and de- creased acetylcholine was associated with mania. 1 Although the prevailing notion that increased cholinergic status is asso- ciated with depression, to date, there are 7 case reports of mania related to the use of donepezil in subjects with dementia. 2Y7 Donepezil is a reversible acetylcholines- terase inhibitor, which acts on the nervous system when used in the treatment of de- mentia of the Alzheimer type. We report the first 2 cases of mania associated with donepezil use in healthy men who took donepezil that was not originally pre- scribed for them. Journal of Clinical Psychopharmacology & Volume 34, Number 6, December 2014 Letters to the Editors * 2014 Lippincott Williams & Wilkins www.psychopharmacology.com 753 Copyright © 2014 Lippincott Williams & Wilkins. 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