Mirtazapine: Effects And Uses Of This Antidepressant Drug
Major depression is one of the most well-known and common mental problems worldwide. The high level of suffering and anguish generated by this disorder and its high prevalence have meant that numerous ways to treat it have emerged throughout history.
Currently we have a wide range of possibilities, one of the most common strategies being the combined use of psychotherapy and psychopharmacology. Regarding the latter, it has generated various substances to combat depressive symptoms, one of them being mirtazapine
Mirtazapine is a substance with psychoactive properties useful in combating depressive symptoms, forming part of the group of antidepressants
It is a relatively recent drug, a piperazane-azepine compound analogous to mianserin, which has a tetracyclic structure and which acts as an agonist of norepinephrine and serotonin , increasing its levels at the brain level. Thus, within antidepressants it is classified as Noradrenergic and Specific Serotonergic Antidepressant or NaSSa.
Mirtazapine is a drug whose effectiveness is high and at a level similar to that of other antidepressants such as SSRIs, apparently acting with similar or slightly greater speed than these and having relatively few side effects (with 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 medication is usually given alone, although in some cases of severe depression it can be combined with other drugs such as venlafaxine in what is known as California Rocket Fuel to enhance the antidepressant effects. demonstrating greater effectiveness than some MAOIs and a better response and remission rate.
The main mechanism of action of mirtazapine is due to its action on the norepinephrine 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 the aforementioned 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 generates It increases the release of serotonin and norepinephrine, although it does not greatly alter their reuptake.
In addition, it must be taken into account that has an antihistamine effect , which can generate undesirable side effects by blocking and antagonizing histamine. To a much lesser extent but which nevertheless must be taken into account, it has been found that mirtazapine also has mild anticholinergic effects, affecting the synthesis and transmission of acetylcholine.
Applications of this antidepressant
Mirtazapine Its main approved indication is major depression in which it is effective and appears to act more quickly than compared to other antidepressants such as SSRIs.
However, although it is not indicated for other disorders, different trials have been carried out in other mental conditions and even in medical problems in which mirtazapine seems to have a certain level of effectiveness. For example, It has been shown to be effective in the treatment of anxiety disorders 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 what happens, 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 relieve the symptoms of itching and headaches.
Mirtazapine is a very useful medication in the treatment of depression and other problems, but its action at the brain level can generate undesirable side effects for those who consume it.
Among these side effects, sedation and weight gain stand out as the most common that can generate their antihistamine effects. It is also common for dizziness and nausea to occur, as well as other problems such as constipation or dryness. It is also not strange that it generates a decrease in blood pressure. Less common are facial edema, vertigo and an increase in cholesterol and triglycerides, as well as polyuria, agitation or anxiety. It can also cause hyper or hypokinesia. Finally, although very unlikely, there is a risk of agranulocytosis, dehydration, seizures, sexual problems, hallucinations, manic episodes and depersonalization.
The main contraindications of this psychotropic drug are in those cases in which potential users suffer from heart problems (especially if they have recently had a heart attack), liver or kidney problems. Patients with epilepsy, glaucoma or diabetes mellitus should not use it either Patients with urinary problems or mental disorders such as bipolar disorder or psychotic disorders also have it contraindicated. Its use is also not recommended during pregnancy or breastfeeding.
Likewise, although it is sometimes used in combination with venlafaxine, its consumption with other psychotropic drugs is contraindicated, and its combination with MAOI antidepressants is especially dangerous. can lead to serotonin syndrome which can lead to cardiorespiratory arrest, hyperthermia, seizures, coma or even death. It should also not be combined with alcohol or other drugs.
