From the Guidelines
Remeron (mirtazapine) is an atypical antidepressant medication that belongs to the class of tetracyclic antidepressants. It works differently from other antidepressants by blocking certain serotonin receptors while enhancing norepinephrine and serotonin neurotransmission in the brain. This unique mechanism of action helps improve mood, increase appetite, and promote sleep. Mirtazapine is typically prescribed at doses ranging from 15 to 45 mg once daily, usually taken in the evening due to its sedative effects. The medication is commonly used to treat major depressive disorder and sometimes prescribed off-label for anxiety disorders, insomnia, and to stimulate appetite in patients with weight loss concerns. Side effects may include increased appetite, weight gain, drowsiness, dry mouth, and dizziness. Unlike some other antidepressants, mirtazapine has a lower risk of causing sexual dysfunction or increasing blood pressure, as noted in studies such as 1.
Key Points
- Mirtazapine has a faster onset of action compared to some other antidepressants, such as fluoxetine, paroxetine, or sertraline, as seen in studies 1.
- It is effective in treating major depressive disorder, with some studies showing similar efficacy to other second-generation antidepressants 1.
- Mirtazapine can be used off-label for anxiety disorders, insomnia, and to stimulate appetite in patients with weight loss concerns.
- Common side effects include increased appetite, weight gain, drowsiness, dry mouth, and dizziness, as reported in various studies 1.
Clinical Considerations
When prescribing mirtazapine, clinicians should consider the patient's medical history, current medications, and potential side effects. Regular monitoring of the patient's response to treatment and adjustment of the dosage as needed is crucial. As with any antidepressant, mirtazapine should be used with caution in patients with a history of suicidal thoughts or behaviors. The American College of Physicians recommends selecting second-generation antidepressants, including mirtazapine, based on adverse effect profiles, cost, and patient preferences 1.
Evidence Summary
The evidence from various studies, including those published in the Annals of Internal Medicine 1, supports the use of mirtazapine as an effective treatment option for major depressive disorder, with a unique mechanism of action and a favorable side effect profile compared to some other antidepressants.
From the FDA Drug Label
Mirtazapine has a tetracyclic chemical structure and belongs to the piperazino-azepine group of compounds. The class of medication of Remeron (mirtazapine) is tetracyclic antidepressant, specifically a piperazino-azepine compound 2.
- Key characteristics: tetracyclic chemical structure
- Classification: piperazino-azepine group of compounds
From the Research
Classification of Remeron (Mirtazapine)
- Remeron, also known as mirtazapine, is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA) 3, 4, 5, 6, 7.
- It is also considered a tetracyclic antidepressant due to its chemical structure 5.
- Mirtazapine's mechanism of action involves increasing noradrenergic and serotonergic neurotransmission via blockade of central α2-adrenergic auto- and heteroreceptors 4, 5.
Comparison with Other Antidepressants
- Mirtazapine has been compared to tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and other antidepressants in terms of efficacy and tolerability 3, 4, 5, 6, 7.
- It has been found to have equivalent efficacy to TCAs and SSRIs, but with a more favorable tolerability profile 3, 6, 7.
Pharmacological Characteristics
- Mirtazapine has a unique pharmacological profile, with a high affinity for serotonin 5-HT2 and 5-HT3 receptors, and a low affinity for 5-HT1, dopaminergic, and muscarinic cholinergic receptors 4, 5.
- It has a mean elimination half-life of approximately 22 hours, making it suitable for once-daily administration 5, 7.