A review of the pharmacological and
clinical profile of mirtazapine

by
Anttila SA, Leinonen EV.
Department of Psychiatry,
Tampere University Hospital,
FIN-33380 Pitkaniemi, Finland.
samia@koti.tpo.fi
CNS Drug Rev 2001 Autumn;7(3):249-64


ABSTRACT

The novel antidepressant mirtazapine has a dual mode of action. It is a noradrenergic and specific serotonergic antidepressant (NaSSA) that acts by antagonizing the adrenergic alpha(2)-autoreceptors and alpha(2)-heteroreceptors as well as by blocking 5-HT(2) and 5-HT(3) receptors. It enhances, therefore, the release of norepinephrine and 5-HT(1A)-mediated serotonergic transmission. This dual mode of action may conceivably be responsible for mirtazapine's rapid onset of action. Mirtazapine is extensively metabolized in the liver. The cytochrome (CYP) P450 isoenzymes CYP1A2, CYP2D6, and CYP3A4 are mainly responsible for its metabolism. Using once daily dosing, steady-state concentrations are reached after 4 days in adults and 6 days in the elderly. In vitro studies suggest that mirtazapine is unlikely to cause clinically significant drug-drug interactions. Dry mouth, sedation, and increases in appetite and body weight are the most common adverse effects. In contrast to selective serotonin reuptake inhibitors (SSRIs), mirtazapine has no sexual side effects. The antidepressant efficacy of mirtazapine was established in several placebo-controlled trials. In major depression, its efficacy is comparable to that of amitriptyline, clomipramine, doxepin, fluoxetine, paroxetine, citalopram, or venlafaxine. Mirtazapine also appears to be useful in patients suffering from depression comorbid with anxiety symptoms and sleep disturbance. It seems to be safe and effective during long-term use.
TCAs
SSRIs
SNRIs
5-HT2
5-HT3
5-HT1a
Alpha-2
Options
Mirtazapine
Mirtazapine v SSRIs
Mirtazapine and sleep
Mirtazapine : overview
Mirtazapine v paroxetine
Mirtazapine v imipramine
Mirtazapine v venlafaxine
Mirtazapine: clinical profile
Mirtazapine and depression
Antidepressant mechanisms
Mirtazapine and the receptors
Mirtazapine: pharmacokinetics
Mirtazapine as an antidepressant: safety and efficacy
How effective are commonly prescribed antidepressants?
Mirtazapine (Remeron) and the serotonin 5-HT2c receptors

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