Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects.

Mirtazapine has an elimination half-life of 20-40 hours, allowing for once-daily bedtime dosing.

• Mirtazapine acts as an antagonist on presynaptic alpha 2-adrenergic receptors, enhancing noradrenergic activity.
• It selectively increases serotonergic activity, particularly at 5-HT1A receptors, while minimizing common side effects associated with other antidepressants.
• The onset of clinical effect occurs within 2-4 weeks, with potential improvements in sleep disturbances and anxiety in the first week.
• Adverse effects include sedation, increased appetite, and weight gain, which are more prevalent than with placebo.
• Initial recommended dosage is 15 mg once daily, with an effective range of 15-45 mg.
• Overdose cases up to 975 mg resulted in significant sedation but no cardiovascular, respiratory effects, or seizures.

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