Mirtazapine: effects and uses of this antidepressant drug

This drug is commonly used in the treatment of major depression.

Major depression is one of the best known and most common mental problems worldwide. The high level of suffering and distress generated by this disorder and its high prevalence has led to the development of numerous ways of treating it throughout history.

At present we have a wide range of possibilities, one of the most common strategies being the combined use of psychotherapy and psychopharmacology. With regard to the latter, it has generated a variety of substances to combat depressive symptoms. various substances to combat depressive symptoms, one of them being mirtazapine..

Mirtazapine: what is this drug like?

Mirtazapine is a substance with psychoactive properties useful in combating depressive symptoms, being part of the Antidepressant group..

It is a relatively recent drug, a piperazane-azepine compound analogous to mianserin, which has a tetracyclic structure and which It has a tetracyclic structure and acts as a noradrenaline and serotonin agonist, increasing their levels in the brain.It acts as an agonist of noradrenaline and serotonin, increasing their levels in the brain. Thus, within antidepressants it is classified as a Noradrenergic and Specific Serotoninergic Antidepressant or NaSSa.

Mirtazapine is a drug whose effectiveness is high and of a similar level to that of other antidepressants such as SSRIs, apparently acting with similar or slightly greater speed than these and having relatively few side effects (sexual and/or gastrointestinal symptoms being less likely to appear). In fact, in the treatment of depression, some studies seem to indicate that mirtazapine has a greater effect than SSRIs after a treatment of six to twelve weeks.

This drug is usually given on its own, although in some cases of severe depression it may be combined with other drugs such as venlafaxine in what is known as California Rocket Fuel to enhance the antidepressant effects, demonstrating a greater effectiveness than some MAOIs and a better response and remission rate and a better response and remission rate.

Mechanism of action.

The main mechanism of action of mirtazapine is due to its action on the noradrenaline and serotonin receptors of the nervous system, acting as an agonist of these hormones.

This action is not due to the inhibition of the reuptake of these neurotransmitters, but is carried out through the antagonism of the postsynaptic serotonin 5-HT2 and 5-HT3 receptors together with that of the presynaptic alpha 2 receptors. This increases the release of serotonin and norepinephrine, although it does not alter their reuptake to a great extent.

In addition, it should be noted that it also has an antihistamine effect. has an antihistamine effectwhich can generate undesirable side effects by blocking and antagonizing histamine. To a much lesser degree, but nevertheless to be taken into account, mirtazapine has also been found to have mild anticholinergic effects, affecting the synthesis and transmission of acetylcholine.

Applications of this antidepressant

Mirtazapine Its main approved indication is major depressionIt is effective and seems to act faster than other antidepressants such as SSRIs.

However, although it is not indicated for other disorders, different trials have been conducted in other mental conditions and even in medical problems in which mirtazapine seems to have some level of efficacy. For example, its efficacy in the treatment of anxiety disorders has been demonstrated.. Also in post-traumatic stress disorder and obsessive-compulsive disorder.

At a more physiological level, although sedation and weight gain are apparently undesirable secondary symptoms, they can sometimes be an advantage in some patients. This is the case, for example, with patients of advanced age or with anxiety problems, weight loss or insomnia.. It would also be applicable in patients with anorexia nervosa. Its antihistamine action could act to alleviate the symptoms of itching and headaches.

Side effects and contraindications

Mirtazapine is a very useful drug in the treatment of depression and other problems, but its action on the brain can generate undesirable side effects for those who take it.

Among these side effects, the most common are sedation and weight gain, which can be caused by its antihistamine effects. that can be caused by its antihistamine effects. Dizziness and nausea are also common, as well as other problems such as constipation or dryness. Less frequent are facial edema, vertigo and an increase in cholesterol and triglycerides, as well as polyuria, agitation or anxiety. It may also generate hyper- or hypokinesia. Finally, although very unlikely, there is a risk of agranulocytosis, dehydration, convulsions, sexual problems, hallucinations, manic episodes and depersonalization.

The main contraindications of this psychopharmaceutical are in those cases in which potential users suffer from cardiac (especially if they have recently suffered a heart attack), hepatic or renal problems. It should also not be used by patients with epilepsy, glaucoma or diabetes mellitus.. Patients with urinary problems or mental disorders such as bipolar disorder or psychotic disorders are also contraindicated. Its use is also not recommended during pregnancy or lactation.

Likewise, although it is sometimes used in combination with venlafaxine, its use with other psychotropic drugs is contraindicated, being especially dangerous its combination with MAOI antidepressants that can lead to a serotonin syndrome. can lead to a serotoninergic syndrome which can lead to cardiorespiratory arrest, hyperthermia, convulsions, coma or even death. It should also not be combined with alcohol or other drugs.