Inner restlessness and sleep disturbances are symptoms of depression. Mirtazapine can relieve these: It helps to calm down and to sleep restfully through the night again. For this reason, this antidepressant is used primarily in depressives with nocturnal restlessness (agitation). Since it has a sleep-promoting effect, the drug is usually taken before going to bed. Disturbances in falling asleep with circling thoughts and very early awakenings are thereby reduced. Nevertheless, side effects should be noted.
Effect of mirtazapine
Mirtazapine belongs to the class of dual antidepressants: in particular, it affects the neurotransmitters norepinephrine and serotonin. Therefore, it is called a NaSSA antidepressant (norepinephrine-specific serotonergic antidepressant). It belongs to the so-called new generation of antidepressants, a fairly young but proven group of drugs. Mirtazapine enhances the effect of the two signal generators serotonin and norepinephrine in the brain by binding to alpha2 receptors. The drug blocks these receptors, acting antagonistically, i.e. in the opposite direction to the effect of the substances that normally act there. Normally, or without the activity of mirtazapine, the signaling pathway via the alpha2 receptors would inhibit the release of serotonin and norepinephrine. Thus, as with most other antidepressants, the effect of mirtazapine results in an increased supply of the neurotransmitters norepinephrine and serotonin. A deficiency of these substances is held responsible for the symptoms and development of depression, among other things.
Mirtazapine helps with depression
The antidepressant mirtazapine is widely used by psychiatrists because it has performed well in various international studies. For example, a meta-analysis compared 12 different antidepressants in terms of their efficacy and tolerability and showed that mirtazapine, in particular, had good efficacy and was relatively well tolerated by most patients. Citalopram, an antidepressant that can be considered as a drug for another form of depression with, again, different side effects, also achieved good results. It is administered for its drive-enhancing effects in those depressions characterized primarily by sadness and lack of drive.
Dosage of mirtazapine
The drug mirtazapine is usually taken orally in the form of melting tablets. Alternatively, it is on the market in solution for administration in drop form and as a concentrate for intravenous infusion. Preferably, the antidepressant should be taken late in the evening, as mirtazapine has a sleep-inducing effect. The drug is available only on prescription in Germany. The daily dose for maintenance therapy in depression is 30 to 45 milligrams per day.
Side effects of mirtazapine
The main and most common side effects of mirtazapine are:
- Fatigue
- Dizziness
- Headache
Taking the drug may generally cause a feeling of mild drowsiness, sometimes due to the antihistaminergic activity of mirtazapine. Also common are side effects such as increased appetite and weight gain, and water retention (edema). Rarely, in patients with a predisposition to it, side effects include.
- Circulatory problems with low blood pressure
- Involuntary tremor (tremor)
- Skin rashes (exanthema)
- Seizures
- Muscle and joint pain
- A decreased blood formation
- An increase in liver enzymes
- Nightmares
Interactions of mirtazapine
In general, mirtazapine hardly interacts with other drugs. However, in combination with lithium, which is also an antidepressant, there may be an increase in the effects as well as side effects. In addition, mirtazapine can intensify the sleep-inducing effect of other drugs taken at the same time, such as benzodiazepines or alcohol. In combination with carbamazepine and phenytoin, there may be an accelerated breakdown of mirtazapine in the body and a possible dose adjustment may be necessary.
Notes on the active substance mirtazapine
The following are some general notes to keep in mind when using mirtazapine.
- Well-acting antidepressant, yet dosage and use must be discussed with a psychiatrist.
- If symptoms improve, do not discontinue the drug independently.
- The maximum recommended dose of mirtazapine should not be exceeded.
- Do not use mirtazapine in combination with MAO inhibitors and in cases of known intolerance.
- Relative contraindications to use include severe hepatic and renal impairment, urinary retention, and glaucoma.
- With prolonged use, it is advisable to have regular blood count checks performed by a doctor to detect disorders of hematopoiesis at an early stage.
