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mirtazapine

introduction

Due to its chemical structure, mirtazapine is one of the so-called tetracyclic antidepressants, ie drugs used in depression. In Germany it can be found on the market under the trade name Remergil®.
It is a prescription preparation, which is available in different potencies and dosage forms. For example, there are film-coated tablets containing 15 mg, 30 mg or 45 mg of the active substance mirtazapine, orodispersible tablets containing 15 mg, 30 mg or 45 mg mirtazapine or a solution for oral administration, 1 ml of which contains 15 mg mirtazapine. All these forms are so oral, that is supplied via the mouth and can be taken with or without food.
In addition, there is also a concentrate which is administered via the vein (iv).

applications

The antidepressant mirtazapine is used because of its mood-improving effect in various diseases of the depressive spectrum and is also approved only for depressive disorders. Due to its sedative effect, mirtazapine is especially suitable for those who suffer from sleep disorders at the same time.

So it is especially suitable for tension-laden melancholic people. In studies comparing the effects of mirtazapine with other medicines used to treat depression, mirtazapine has performed well and has been tolerated by most patients. In addition to the illnesses mentioned in their approval, medicines can also be used for other illnesses; One speaks then of a so-called "off-label use". In addition to being off-label, mirtazapine is also used to treat generalized anxiety disorder, panic disorder, social phobia, post-traumatic stress disorder and sleep disorders.

Problem with weaning

The antidepressant mirtazapine does not cause addiction. Nevertheless, a sudden discontinuation of the drug may cause discomfort. Most of these, however, are only slightly pronounced and disappear again by themselves. Symptoms that can occur after a sudden withdrawal are, for example, sleep disorders, restlessness, anxiety, headache and nausea. How pronounced these symptoms are depends on the duration of treatment and the daily dose of mirtazapine. In order to minimize the symptoms, mirtazapine should be swabbed, that is, it should be lowered slowly until the drug is completely discontinued.

interactions

The interactions of mirtazapine with other medicines are low.
The antiepileptic drugs carbamazepine and phenytoin may accelerate the breakdown of mirtazapine in the body, possibly resulting in a dose increase of mirtazapine.
Mirtazapine, taken with lithium, which is also antidepressant, may increase the effects and side effects of mirtazapine.
The attenuating effect of other substances, such as alcohol or benzodiazepines, may also be enhanced with concomitant use of mirtazapine.

Contraindications

Mirtazapine should not be part of its treatment plan if it is prone to hypersensitivity reactions to the active substance or other components of this preparation.
In addition, it must not be taken with simultaneous use of a drug from the drug group of monoamine oxidase inhibitors (MAO inhibitors). For safety reasons, a period of at least 14 days should be allowed between discontinuation of a monoamine oxidase inhibitor and initiation of therapy with mirtazapine.
Even after stopping mirtazapine and starting therapy with a monoamine oxidase inhibitor, 14 days should elapse. Another contraindication for treatment with mirtazapine is leukopenia, a lower than normal white blood cell count (leucocytes) that can be detected by taking blood.

Caution should be exercised in the following conditions:

  • severe liver dysfunction
  • severe kidney dysfunction
    and
  • a tendency to seizures

If there are any uncertainties, you should consult your doctor or pharmacist.

Mirtazapine and pregnancy / breastfeeding

In the first 12 weeks of pregnancy no harmful effects on the embryo could be observed when using mirtazapine. This finding is based on approximately 100 pregnancies observed with mirtazapine therapy. If mirtazapine is also used in the further course of pregnancy until birth, it may cause adjustment disorders in the newborn, such as hyperexcitability and tremor.
The use of mirtazapine in pregnancy should always be closely coordinated with the psychiatrist and gynecologist.

After the birth the therapy should be taken up again immediately with the usual dosage. In general, mirtazapine can be prescribed in certain cases during pregnancy, for example, when other medicines with more experience in pregnancy (eg, sertraline or citalopram) have no effect.
In patients who are stable with mirtazapine, no change in therapy should be made despite pregnancy.
It is known that mirtazapine is slightly excreted in breast milk. Despite this, in eight breastfed infants, no clinical symptoms were observed with maternal mitrazapine therapy. Therefore, mirtazapine may be prescribed while breast-feeding with restrictions if other medications with more experience are inappropriate.
Please discuss taking mirtazapine with your doctor during pregnancy and breast-feeding.

mode of action

Mirtazapine acts as a tetracyclic antidepressant centrally in the brain and inhibits there very effectively certain receptors (so-called presynaptic? 2 receptors).
Because these receptors are blocked, mirtazapine may also be referred to as the "2" receptor antagonist. In addition, receptors for serotonin, also known as 5-hydroxytryptamine (5-HT) are blocked.
There are several groups of serotonin receptors. Mirtazapine specifically blocks the 5-HT2A receptors and the 5-HT3 receptors. The blockade of these receptors leads to an increased release of the neurotransmitters norepinephrine and serotonin from the nerve endings. This should have a positive effect on a depressive mood, as a lack of these messengers is blamed for a depression ( read also: The role of serotonin / neurotransmitters in depression).
Because of this mechanism of action, mirtazapine is also referred to as "NaSSA". This abbreviation stands for "noradrenergic and specific serotonergic antidepressant", which means in German as much as noradrenergic and specific serotonergic antidepressant.
In addition, another group of receptors is blocked. These are histamine receptors (postsynaptic histamine H1 receptors). The sedating, so calming effect of mirtazapine is attributed to this blockade.

In summary, the antidepressant mirtazapine mainly blocks presynaptic? 2 receptors, serotonin receptors of the 5-HT2A and 5-HT3 type, and postsynaptic histamine H1 receptors.

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