Medication Explained 💊

Mirtazapine

What is Mirtazapine?

Mirtazapine is an atypical antidepressant and is used primarily for the treatment of a major depressive disorder. The drug has sedative, antiemetic, anxiolytic, and appetite stimulant effects, which explains its off-label use for the following conditions: insomnia, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, generalised anxiety disorder, social anxiety disorder, headaches, and migraines. Most commonly, clinicians prescribe mirtazapine when individuals have not achieved success with initial pharmacological therapies for major depressive disorder, and they use it predominantly in depressed individuals with insomnia and/or individuals who are underweight.

Mirtazapine was first synthesized and written about in 1989. Mirtazapine first received approval for the treatment of a major depressive disorder in the Netherlands in 1994. It was finally FDA-approved in the United States in 1996 for the treatment of moderate and severe depression.

In 2010, the National Institute for Health and Care Excellence in the United Kingdom published a guideline for treating depression, and this study also included a review of various antidepressants. Concerning mirtazapine, it stated that there was no difference between mirtazapine and other antidepressants currently in use on any efficacy measure, but mirtazapine had a higher chance of achieving remission in a statistical though not clinical setting. It also showed a statistical advantage over current SSRIs in terms of decreasing the symptoms of depression, but the finding was not clinically meaningful. However, the guideline still recommended generic SSRIs as the first-line treatment for depression as they were equally as effective as other antidepressants but had a favorable risk-benefit ratio.

A systemic review and network meta-analysis conducted in 2018 comparing the efficacy and acceptability of 21 different antidepressant drugs demonstrated mirtazapine as one of the most effective when compared to other antidepressants in head-to-head studies.

Currently, the available evidence shows that mirtazapine is effective in all stages of severity of depressive illness and also for a broad range of symptoms associated with depression.

Mode of Action

Mirtazapine is part of the tetracyclic antidepressants (TeCA) group that works by exerting antagonist effects on the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine. Mirtazapine is also sometimes called a noradrenergic and specific serotonergic antidepressant (NaSSA). Noradrenaline is known to have an activating effect on the sympathetic nervous system, and this could explain the general increase in activity and increased metabolism seen with mirtazapine. It also acts as a potent antagonist of H1 histamine receptors (producing a sedating, calming effect) and 5-HT2A, 5-HT2C, and 5-HT3 serotonin receptors.

Mirtazapine in Addiction Treatment

Because of the way mirtazapine acts in the body, it has been considered for use in treating addictions of various kinds, including but not limited to:

• Alcohol

• Benzodiazepines (benzos)

• Opiate substances

• Cocaine

• Marijuana

As mentioned above, mirtazapine acts on serotonin balance. Based on recent research, most psychoactive drugs affect the serotonin system in the brain, and consistent use or abuse can cause adaptive changes in that system that coincide with the addictive cycle. In other words, substance abuse causes changes in the ways serotonin is created and used in the body, which in turn contributes to the development of addictive behaviors. This occurs in combination with other factors, such as genetic dispositions and other brain chemistry pathways.

Mirtazapine also affects the production and use of norepinephrine, a stress hormone produced in the adrenal glands. The anxiety response that is common in some drug addictions, like those of opiates and cocaine, is correlated to changes in norepinephrine function caused by the substances that are being abused.

Even before this research came out, mirtazapine was tested for use in treating addiction to various substances. According to multiple research reports and case studies indicating that the medication shows promise in helping people manage substance addiction.

Because of the medication’s action in several different areas of brain chemistry, it appears that mirtazapine can help to calm cravings and reduce drug-seeking behaviors. Also, in clinical cases involving opiate drugs and co-occurring alcohol and depression, and in a study of people being treated for depression, mirtazapine was able to help not only reduce drug cravings, but also reduce the co-occurring psychological issues.

Things to Consider

Some people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Remeron. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Mirtazapine is not approved for use in children.

It may take up to several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment.

Drinking alcohol can increase certain side effects of mirtazapine.

Dosing Information

Usual Adult Dose for Depression:

Initial dose: 15 mg orally once a day at bedtime (this dose is also when Mirtazapine works best for insomnia and sleeping problems so it will make you drowsy. You will also have a dry mouth when you wake up).

Maintenance dose: 15 to 45 mg orally once a day

Maximum dose: 45 mg/day

Side Effects

Like all medicines, mirtazapine can cause side effects in some people, but many people have no side effects or only minor ones.

Some of the common side effects of mirtazapine will gradually improve as your body gets used to it.

Common Side Effects

These side effects happen in more than 1 in 100 people.

Keep taking the medicine, but tell your doctor or pharmacist if these side effects bother you or don’t go away:

• dry mouth

• increased appetite and weight gain

• headaches

• feeling sleepy

• constipation

Serious Side Effects

Serious side effects are rare and happen in less than 1 in 10,000 people when taking mirtazapine.

Call your doctor straight away if you experience:

• severe pain in your stomach or back, and nausea – these can be signs of inflammation of the pancreas (pancreatitis)

• thoughts about harming yourself or ending your life

• constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can be signs of low sodium levels in your blood (which can cause seizures in severe cases)

• yellow skin, or the whites of your eyes go yellow – this can be a sign of liver problems

• high fever, sore throat and mouth ulcers – these signs of infection could be due to a problem with your blood cells.

Serious Allergic Reaction

In rare cases, it’s possible to have a serious allergic (anaphylaxis) reaction to mirtazapine.

Published by Rochdalestu

I’m a 38 year old male who has recently been diagnosed with bipolar disorder. I have found it as a new chapter in my life that has opened my eyes to a whole new perspective on myself and everything around me.

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