Depression mirtazapine

When compared with the selective serotonin reuptake inhibitors (SSRIs), mirtazapine may show an earlier onset of action (although data are currently not well established). Mirtazapine has also been found to be efficacious in the treatment of elderly patients with depression. Mirtazapine has been shown to be effective in the treatment of panic disorder, social phobia, and post-traumatic stress disorder. In one study, mirtazapine combined with citalopram in obsessive-compulsive patients induced an earlier response when compared with citalopram plus placebo. It was suggested that antagonism of presynaptic a2-adrenergic receptors does not enhance serotonin neurotransmission directly, but rather disinhibits the norepinephrine activation of serotonergic neurons and thereby increases serotonergic neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. 

Maprotiline, Moclobemide, Mianserin, Fluoxetine (Prozac), Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxin (generic IR formulation and the brand Venlafaxine XR), Mirtazapine, Flupentixol-melitracen (Deanxit), Tianeptine, Extract of St. John s Wort, Buspirone Depression and anxiety... 

Winokur et al. (Winokur et al. 2000) found that mirtazapine significantly decreased sleep latency and increased total sleep time and sleep efficiency from baseline levels during week 1, with similar results observed after week 2. Mirtazapine did not significantly alter REM sleep parameters. Clinically, the Hamilton Depression Rating Scale and sleep disturbance ratings improved after treatment. 

Salin-Pascual R. J. (2005). Comparative study between mirtazapine vs. zolpidem in isomnia associated with major depression management. Rev. Mex. Neurosci. 6, 212-17. 

Winokur A., Sateia M. J., Boyd Hayes J. el al. (2000). Acute effects of mirtazapine on sleep continuity and sleep architecture in depressed patients a pilot study. Biol. Psychiatry 48, 75-7. 

Mirtazapine (Remeron). Mirtazapine is the newest of the atypical antidepressants. It mainly works by blocking the alpha-2 negative feedback receptor and thus increases norepinephrine and serotonin activity. In addition, mirtazapine blocks serotonin-2 and serotonin-3 receptors to produce a specific serotonin action like nefazodone. Mirtazapine is approved for the treatment of depression. Its use in the anxiety disorders is being studied. 

Antidepressants. There are numerous reasons to expect that antidepressants may be helpful in the treatment of AN. First, depressed mood and other symptoms of depression such as anhedonia, decreased energy, poor concentration, and psychomotor retardation are common in cases of starvation from any cause. Second, AN patients and their family members have high rates of comorbid MDD and OCD, illnesses best treated with antidepressant medications. Finally, weight gain is a well-documented side effect of many antidepressants including the tricyclic antidepressants (TCAs) and mirtazapine. 

Depression SSRIs SNRIs Mirtazapine Bupropion Nortriptyline Desipramine ... 

Serotonin-Boosting Antidepressants. The SSRIs have also been studied in the treatment of generalized social anxiety disorder, and paroxetine, sertraline, and venlafaxine are effective. Preliminary data suggests that the serotonin-boosting atypical antidepressants (mirtazapine and nefazodone) may also be helpful. Like the MAOIs, they appear to be effective at doses comparable to those used to treat depression. They may help avoidant patients to gradually increase their social interaction and become more assertive. 

Serotonin-boosting antidepressants or longer-acting benzodiazepines are also both suitable first-line treatments for APD. For APD patients who are also troubled by depression, an antidepressant is obviously preferable. We also prefer to use antidepressants rather than benzodiazepines to treat APD patients who have a history of substance abuse. The current data suggests that any of the SSRls as well as nefazodone, mirtazapine, and venlafaxine may be helpful. When these do not work, a MAOI is a reasonable alternative provided the patient is willing to commit to the dietary regimen. 

Antidepressants. The most widely used psychiatric medicines with the broadest range of application in TBI patients are undoubtedly the SSRI antidepressants. They are well tolerated, unlikely to worsen any of the preexisting deficits associated with TBI, and offer relief from not only depression but also impulsivity and virtually all variants of anxiety in these patients. As such, SSRIs are the preferred first-line treatment for all anxiety disorders after TBI. Other newer antidepressants that also work (at least in part) by boosting serotonin activity, namely, mirtazapine (Remeron), nefazodone (Serzone), venlafaxine (Effexor XR), and duloxetine (Cymbalta) can also be considered, but they have not been well studied in patients with TBI. In... 

Medications that enhance norepinephrine activity are used to treat depression and ADHD. Boosting norepinephrine can also produce numerous side effects including nervousness and anxiety, insomnia, and loss of appetite. With mirtazapine and the TCAs, these side effects are usually not a problem because these antidepressants also block histamine receptors. Their antihistamine effects promote increased appetite and drowsiness that tend to offset the side effects that might be experienced from increased norepinephrine activity. 

In cases where the antidepressant response has not been resounding, we prefer switching antidepressants to avoid sexual side effects. The options include bupropion, nefazodone, and mirtazapine, which all effectively treat depression but produce minimal effects on sexual function. Sometimes, if a patient has responded well to one antidepressant but experiences a side effect such as sexual dysfunction, switching within the same class can be a useful approach. 

Mirtazapine Blocks histamine receptor KNorepinephrine KSerotonin Depression... 

Mirtazapine is indicated for major depression. Its side-effects include sedation and, less commonly, dizziness, abnormal dreams (rarely) and, very rarely, angle-closure glaucoma. 

Mirtazapine has a novel mechanism of action that in theory should promote anxiolytic effects, although evidence from studies of anxiety disorders is awaited. It increases synaptic release of serotonin and noradrenaline via blockade of presynaptic inhibitory a2-adrenoceptors, as well as blocking post-synaptic 5-HT2 and 5-HT3 serotonin receptors and Hi histamine receptors. Mirtazapine has good efficacy for anxiety symptoms associated with depression (Fawcett and Barkin 1998), and in controlled studies was superior to... 

Enkelmann R (1991) Alprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology (Berl) 105 428-432 Faravelli C, Rosi S, Truglia E (2003) Treatments benzodiazepines. In Nutt DJ, BaUenger JC (eds) Anxiety disorders. Blackwell Science, Oxford, pp 315-338 Fawcett J, Barkin RL (1998) A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety. J Clin Psychiatry 59 123-127 Febbraro GA, Clum GA (1998) Meta-analytic investigation of the effectiveness of self-regulatory components in the treatment of adult problem behaviors. Clin Psychol Rev 18 143-161... 

Mirtazapine has been found to have synergistic depressant effects on motor and cognitive performance when used in conjunction with benzodiazepines or alcohol (Kuitunen, 1994). Somnolence and increased appetite accompanied by weight gain are common adverse effects. Lower doses are clearly associated with more sedative effects than those with higher doses. It is unclear if a similar pattern is noted for appetite and weight gain. 

Owen, J.R. and Nemeroff, C.B. (1998) New antidepressants and the cytochrome P450 system focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety 7 Suppl l) 24-32. 

Other new antidepressants, including bupropion, ven-lafaxine, nefazodone, and mirtazapine, have been found to be efficacious in the treatment of depressed adults, but only a few open-label studies have been carried out in children and adolescents (e.g., Daviss et ah, 2001). Bupropion and velanfaxine may be useful in treating youth with MDD and ADHD (Plizka, 2000 Daviss et ah, 2001). Because of the sedative effects of mirtazapine and trazodone, these medications have been used as adjunctive treatments for patients with severe insomnia. 

Mirtazapine is an antidepressant with a novel mechanism of action affecting both 5-HT and noradrenergic function. A recent systematic, open-label study found that 9 (34.6%) of 26 subjects (5 females, 21 males mean age, 10.1 +/— 4.8 years, age range 3.8-23.5 years) with autistic disorder and other PDDs were much improved or very much improved on the CGI after a mean duration of treatment of 5 months (Posey et al., 2001). The dosage range for mirtazapine was 7.5 to 45 mg/day with a mean daily dose of 30.29 mg +/— 12.64 mg. Target symptoms of aggression, self-injury, irritability, hyperactivity, anxiety, depression, and insomnia showed improvement. Adverse effects were transient and minimal and included increased appetite, irritability, and sedation. Based upon these preliminary data, a double-blind, placebo-controlled trial appears warranted. 

On the basis of the large placebo-controlled studies, mirtazapine has undoubted antidepressant action and is licensed in both Europe and the United States [Claghorn and Lesem 1995 Sitsen et al. 1995). The evidence for superior efficacy is again limited by the failure to set up studies that were large enough to provide an adequate test of two active antidepressants. Nevertheless, mirtazapine has been shown to be more effective than trazodone in hospitalized patients with major depression (van Moffaert et al. 1995) and in a more recent study, mirtazapine was more effective than fluoxetine given in a dose of 20 mg [S. A. Montgomery 1996). 

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