Talk:Mirtazapine

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[edit] Mirtazapine Mechanism of Action

"The primary mechanism of action of mirtazapine is antagonism at central pre-synaptic alpha2-receptors. Normally, these receptors are involved in a negative feedback loop and activation causes inhibition of further norepinephrine (NE) release. By blocking pre-synaptic alpha2-receptors, mirtazapine defeats negative feedback to the presynaptic nerve and causes an increase in NE release. Antagonism at central alpha2-receptors is 10-fold higher than at peripheral alpha2-receptors which results in a reduced incidence of peripheral adverse effects. Mirtazapine also antagonizes several subtypes of serotonin (5-HT) receptors. The drug is a weak antagonist at 5-HT1 receptors and a potent antagonist at 5-HT2 (particularly subtypes 2A and 2C) and 5-HT3 receptors. Blockade of these receptors may result in a lower incidence of certain adverse effects such as anxiety, insomnia, and nausea that occur with other agents like the selective serotonin reuptake inhibitors (SSRIs). Serotonergic neurons also contain alpha2-receptors, called heteroreceptors and blockade of heteroreceptors results in enhanced release of 5-HT. The increased amount of 5-HT released interacts with 5-HT1 receptors which may be relevant to the antidepressant and anxiolytic effects of mirtazapine. Mirtazapine has no effects on the reuptake of either NE or 5-HT. In addition, mirtazapine exhibits significant antagonism at H1-receptors. Histamine H1-receptor blockade is generally associated with sedation, however, the enhancement of NE release may offset the sedative potential of the drug at higher doses. Mirtazapine has minimal activity at dopaminergic and muscarinic receptors." [1]will//defective words, defective thoughts (talk) 18:51, 4 April 2008 (UTC)

[edit] Need some references

It would be nice to have references to the statements about mechanism of action involving post-synaptic 5-HT activity and the concept of low dose effecting different neurotransmitters than higher doses. I have heard of both of these ideas but never quite sure where they come from. I will attempt to research it, but added the citation needed tag until me or someone else can look this up.--Psychofarm 21:55, 29 November 2006 (UTC) 71.221.87.211 (talk) 08:04, 1 March 2008 (UTC) I was started on Mirtazapine 3 weeks ago, I'm normally a healthy 130 lbs and three weeks after taking it I now weigh 155 lbs, which is not healthy in my book. 71.221.87.211 (talk) 08:04, 1 March 2008 (UTC)

[edit] My side effects and positive effects using this drug

Yea Ive been using this drug for about a year now. Ive tried Zoloft also but got no positive effects. This one helps me in my depression. When using this drug I need to use a pretty healthy diet to maintain and/or loose weight. I have no problem even losing weight using this drug when eating healthy. The worst side-effect I get from this drug is rigid nightmares but Ive found a cure to that and it is by doing meditation before bedtime. I use zazen. Another thing is that this drug can give you bipolar-depression if you don't introspect yourself and talk to a doctor if you get extreme mood-swings. Like super-high and super-low changes reguarly. That's all from me atm. —The preceding unsigned comment was added by Krillejs (talk • contribs) .

I'm also on the drug and found it to have less side-effects then zoloft. It's made me very hungry and sleepy, which is good because I'm an underweight insomniac. --121.217.98.20 05:42, 14 August 2007 (UTC)

I am 18 years old and I currently take 30 mil of mirtazapine nightly. Before Remeron I tried different SSRIs with only negative results. I am a big fan of mirtazapine because it not only combats my depression but helps fight my insomnia and stimulates my appetite. The only downside I have expierenced is that it either reveiled or caused me to have ADD (according to my psychiatrist). The medication made me slightly indifferent to my surroundings, especially during school. I now take Vyvanse every morning. For me, this is the perfect combination and I have minimal adverse side effects if any at all. —Preceding unsigned comment added by 216.160.214.132 (talk) 17:21, 9 November 2007 (UTC)

Mmh, I had expected more of this wikipedia page on Mirtazapine. Looks very uncontroversial, like written by the producer of Mirtazapin. I started taking the drug after one month of severe sleeping problems due to a depression, in rising doses: 15mg, 30mg, 45mg. The sleeping problems were solved very quickly, but in acute phases of the depression the problems would return inspite of the drug. From the beginning, the drug had a bad effect on my motorics, making me clumsy. For instance, my hands will not find things automatically as they used to. E.g., if I intend to grab a door handle but do not concentrate on it, like doing it "in the background" without looking, I will miss it by 10 cm. I also bump into door frames by miscalculating the turns if I do not concentrate. A friend has reported similar side-effects. I consider this a damage to my nervous system, I hope it is reversible one I stop taking the drug. 84.57.63.53 (talk) 23:04, 27 November 2007 (UTC)

[edit] Question

I am wondering if Mirtazapine is used to treat any other conditions? My husband has been told he has been given this drug for a suspected heart condition. How would this drug help someone's heart? —The preceding unsigned comment was added by 58.84.113.227 (talk • contribs) .

I suppose it can only help, if the disease has a strong psychological component, so the sedative and anxiolytic properties of Mirtazapine would help your husband. Otherwise, it could even be deleterious to heart conditions, due to some cardiovascular side-effects of the drug. But you said, that the disease is only suspected? So your husband should ask for precise diagnosis of the heart condition. Perhaps Mirtazapine can then be terminated. All the best of luck. Klaus —The preceding unsigned comment was added by 84.44.132.229 (talk • contribs) .

just a thought. could stimulation of the sympathetic nervous system lower heart rate. i know mertazapine can increase heart rate and also make it rise more easily in response to heartrate rising events from experience. but there are also times when the heart rate drops to a fairly low 58-65 bpm. good luck. —Preceding unsigned comment added by 220.101.95.249 (talk) 08:17, 10 March 2008 (UTC)

[edit] Drug-Drug Interactions

I have been taking mirtazapine (Remeron) for the past 3 years and it is the only antidepressant (out of 4 others) that works for me. However,in January 2008, I was prescribed tramadol for pain from an automobile accident, and was taking it concurrently with the mirtazapine (15mg daily). I was supposed to take 50 mg of tramadol every 4 hours as needed for pain. After the first dose I started to notice this strange side effect though. I was very tremuluous (trembling). I just put some more clothes on and ignored the trembling. Then that night, my back was hurting pretty badly, so I took two of the 50 mg tramadol (Ultram). Instead of falling asleep, 30 minutes later I lept out of bed and started cleaning the house. While I was cleaning, I started sweating profusely and had to stop because I was shaking so bad, I couldn't even stand. I was sitting on the sofa and my mother happened to come into the room and she noticed my condition. She took my temperature, and it was 104 degrees farenheit. My pupils were completely dilated (mydriasis). Anyway I was rushed to the hospital, were I was diagnosed with Serotonin Syndrome. They gave me 2 mg of intravenus lorazepam , and I recovered fully. I would just like someone to add that mixing mirtazapine with other serotonin agonists (such as tramadol), and not just MAOI's, can cause a potentially fatal case of serotonin sydrome. I've researched the interaction myself and have found that I am not the only person who suffered this reaction. There are references that can be cited. Just want to save someone else from going through the serotonin syndrome ordeal through knowledge. If you have to take a medication, you should know all the "do's and don'ts associated with it, including all interactions. Dsnider1988 (talk) 09:27, 28 January 2008 (UTC)

[edit] Mirtazipine

Not too sure about using it for a heart condition. That sounds very strange to me. Read the PI sheet and get a second opinion. I wanted to post something about appetite and drowsiness. This is one of those drugs that your doctor will (or should) tell you to take immediately before getting in bed. I'm just speaking from personal experience of being on this drug for ~2 years now, but for someone who just started taking it, you will probably be asleep 10-15 minutes after taking it...whether you make it to bed or not. Absolutely do not get out of bed to eat after taking it. You will only end up falling asleep on the kitchen floor with food IN your mouth. (I am still known to do this on occasion.) The cravings and the drowsiness will level off after a while, but they have never gone away for me. On the upside, I'm bipolar and it's one of the only two drugs (the other is Effexor, also not an SSRI) that ever worked for the depression side of that. If SSRI's don't work on you, this might be something to try. I doubt anyone would offer it as a first choice for newly diagnosed depression unless they were both not eating and not sleeping. Again, this is all from my personal experience having been on it for ~2 years. I'd like to see some more content on this page about those issues. In future I may put the full PI sheet (the huge folded up paper with tiny incomprehensible print in the back of the brochure) with research results, etc. up. 65.247.225.96 01:13, 8 December 2005 (UTC)irayna

Please correct me if I am wrong, however, I am under the impression that Avanza, being a stimulant, may increase the heart rate. I am not sure how this would help a heart condition, but make what you want of it. —The preceding unsigned comment was added by 141.168.50.193 (talk • contribs) .

To the first poster: please do not put up the entire PI sheet. Such information is easily accessible on a wide variety of websites. One needs only perform a google search. To the second poster: mirtazapine is not a stimulant. --Muugokszhiion 06:08, 4 May 2006 (UTC)

[edit] First paragraph

Recent edits have turned the first paragraph into a muddy discussion: "...although there is only modest evidence from their research department to support its claimed effects. Indeed, recent work by researchers independent of Organon International has failed to replicate...". This is not encyclopedic and has no place anywhere near the top of the article. The paragraph does not describe what mirtazapine is; it only debates what it is not, or may be. This needs to be cleaned up to be clear and concise. Please discuss these issues on the talk page rather than on the article itself. --Muugokszhiion 06:47, 2 November 2006 (UTC)

I agree the first paragraph needs to be a concise overview of the article. As many people will only read the first paragraph. The independant research has raised an interesting point but it belongs lower down in the article. I will change it when I have time. --Benjaminevans82 00:57, 3 November 2006 (UTC)
The Mayo Clinic refers to mirtazapine as a tetracyclic antidepressant and notes that it is the only antidepressant with a tetracyclic chemical structure to have FDA approval to treat depression (http://www.mayoclinic.com/health/mental-health/MH00069). As re the controversy, the link to the pubmed abstract substantiates the criticism. Nevertheless, it shouldn't headline the article. --Substantiate 23:30, 5 April 2007 (UTC)

Isn't Ludiomil also a tetracyclic? I believe it is. The first one, actually. It is older, but nonetheless, approved by the FDA for Tx of depression. It is not a NaSRI, but we must be honest and precise, so as not to mislead.--User:wgeoff00775.50.51.87 (talk) 22:56, 30 December 2007 (UTC)

I also have experienced the side effect of getting up in my sleep and eating while taking Remeron. It was a relief to become aware that this is from Remeron as I have never done this. I'm am glad to hear it will lessen and hopefully go away. —Preceding unsigned comment added by 66.91.194.88 (talk) 03:56, 2 March 2008 (UTC)

[edit] Remeron in the morning?

I have been taking Remeron 45mg for about six months now and it has seemed to resolve my depression. For the first time in a long time I feel not-depressed. Also I have an anxiety disorder and take 4-6mg of Ativan a day. Remeron is sediating and taken at bed time. I found that true for me. The idea came to me about taking Remeron in the morning to use the sedating side effects to help with my anxiety and maybe be able to take less Ativan. I could not find any information about taking Remeron in the morning. I would appreciate any feedback.

Remeron is generally taken at night because it is sedating. You will probably be more tired if you take it in the morning, but I'm no doctor. Discuss this issue with your doctor. —Preceding unsigned comment added by 67.173.19.210 (talk) 02:37, 5 June 2008 (UTC)

[edit] Dosage

I moved the following from the article to this talk page. --Ishi Gustaedr (talk) 14:46, 2 May 2008 (UTC)

Doses 90-210mg are extremely effective in alliviating major depression with predomenant symptoms of insomnia/anxiety/lethergy and loss of appetite. I submit tests with this dose should be carried out and may prove to be the fastest/safest and most tolorable antidepressant superseeding all others in the treatment of the aformentioned symptoms. PLEASE HELP RESEARCH THIS FURTHER. --80.193.69.13 (talk) 11:35:42, 2008-05-01 (UTC)