Remeron effectiveness

Mirtazapine (Remeron) is a newer antidepressant that also blocks 5-HT reuptake, but additionally has antagonistic effects at adrenergic o2, 5-HT2, and 5-HT3 receptors (Stahl 1998). Mirtazapine appears to have indirect agonistic effects on 5-HTlA receptors, which may contribute to its antidepressant effect (Berendsen and Broekkamp 1997). Nefazodone, as well, has SSRI and 5-HT2 antagonist effects. The 5-HT2 antagonist effects of these antidepressants is believed to be responsible for their lower incidence of sexual side effects (Nutt 1997). 

A controlled trial of duloxetine (Cymbalta)—like venlafaxine a dual serotonin-norepinephrine reuptake inhibitor—in the treatment of GAD is currently underway. Anecdotal data suggests that nefazodone (Serzone) and mirtazapine (Remeron) may be effective in the treatment of GAD, though no controlled data is available. In addition, recent concerns regarding nefazodone and liver toxicity have limited this medication s utility. Please refer to Chapter 3 for more information regarding these antidepressants. 

Rachel was between a rock and a hard place. Like many others, she had become dependent on medications whose effectiveness is uncertain but whose side effects are often certainly bad. After so many years, she had lost sight of the person she might be without medications, and she had surrendered to a life bounded by them. Her newest medication, Remeron, captured her dilemma. The drug knocked her out at night, ensuring sleep, but caused her to walk into many more walls than I used to each morn-... 

Mirtazapine [Remeron] Exact mechanism unclear may increase norepinephrine and serotonin activity by blocking inhibitory presynaptic autoreceptors Low incidence of sedative, anticholinergic, and cardiovascular side effects May cause agitation, anxiety, other mood changes... 

Mirtazapine (Remeron) is a new antidepressant with an entirely new mode of action. It is an alpha2-adrenoreceptor blocker, producing increased noradrenergic and serotonergic activity. Common side effects include sedation and nausea. 

Remeron s greatest strength is its ability to relieve anxiety as well as depression. It also helps cure insomnia, a problem many depressed people have. It even increases appetite, helping reverse the weight loss that often accompanies depression. Unfortunately, increased appetite is also the predominant reason why people stop taking Remeron, after finding they have put on unplanned weight. Also, in some cases, people who take Remeron sleep too much or suffer chronic exhaustion. Usually a physician can tailor the dose so only the benefits, not the side effects, remain. However,... 

NOTE Most of the drugs are hydrochloride salts, but SURMONTIL and LUVOX are maleates CELEXA is a hydrobromide, and remeron is a free-base. Selegiline is approved for early Parkinson s disease, but may have antidepressant effects, especially at daily doses 20 mg, and is under investigation for administration by transdermal patch. 

Many noncyclic antidepressants are now available, including trazodone (Desyrel l), nefazodone (Serzone ), fluoxetine (Prozac ), sertraline (Zolotf ), citalopram (Celexa ), escitalopram (Lexapro ), paroxetine (Paxil ), tluvoxamine (Luvox ), venlafaxine (Effexor ), and bupropion (Wellbutrin ). Bupropion is also marketed under the brand name Zyban tor smoking cessation. Mirtazapine (Remeron ), a tetracyclic antidepressant, has recently become available. In general, these drugs are much less toxic than the tricyclic antidepressants (see p 90) and the monoamine oxidase (MAO) inhibitors (p 269), although serious effects such as seizures and hypotension occasionally occur. Noncyclic and tricyclic antidepressants are described in Table 11-7. 

These drugs target both serotonin and norepinephrine neurotransmitter systems in the brain. The group includes duloxetine (Cym-balta), venlafaxine (Effexor), and mirtazapine (Remeron). Side effects may include dry mouth, headache, sedation, nausea, and tremors. 

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