Mirtazapine: clinical overview.

Aug 14, 1999The Journal of clinical psychiatry

Overview of Mirtazapine's Uses and Effects

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Abstract

Drugs combining 2 synergistic mechanisms of action may yield superior therapeutic efficacy compared to selective serotonin reuptake inhibitors.

Dual-acting drugs may be particularly effective for patients with endogenous depression, severe depression, or those who are hospitalized.
Mirtazapine differs from other dual-acting antidepressants as it does not act as a reuptake inhibitor.
Its antidepressant activity may stem from enhancing noradrenergic neurotransmission by blocking specific receptors.
Mirtazapine can rapidly increase serotonin levels, which could enhance certain neurotransmission pathways.
Antidepressant efficacy of mirtazapine has been established in multiple placebo-controlled trials across various levels of depression severity.

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There is currently available evidence that suggests that drugs combining 2 synergistic mechanisms of action (e.g., enhancement of both noradrenergic and serotonergic neurotransmission) may yield superior therapeutic efficacy compared with a single therapeutic mechanism of highly selective agents such as selective serotonin reuptake inhibitors (SSRIs). The differences in antidepressant efficacy favoring dual-acting drugs may exist in particular for 3 difficult-to-treat groups of patients: those with endogenous depression, those with severe depression, or hospitalized depressed patients. Mirtazapine differs from other new dual-acting antidepressants by not being a reuptake inhibitor. Its antidepressant activity may be related to a direct enhancement of noradrenergic neurotransmission by blockade of alpha2-autoreceptors. The rapid increase in serotonin (5-HT) synaptic levels by blockade of alpha2-heteroreceptors indirectly enhances 5-HT1A-mediated neurotransmission since 5-HT2 and 5-HT3 are blocked by mirtazapine. The antidepressant efficacy of mirtazapine was established in several placebo-controlled trials. Currently available evidence suggests that mirtazapine is effective in all levels of severity of depressive illness, as well as is in a broad range of symptoms associated with depression.

Mirtazapine: clinical overview.

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