Internal restlessness and sleep disorders are symptoms of depression. Mirtazapine can alleviate this: It cushions and helps to come to rest and sleep well restorative. Therefore, this antidepressant is mainly used in depressives with nocturnal restlessness (agitation). Since it acts sleep-inducing, one usually takes the drug before going to bed. Falling asleep with thought and very early awakening are thereby reduced. Nevertheless, side effects are to be considered.
Effect of mirtazapine
Mirtazapine belongs to the class of dual antidepressants: It influences in particular the messenger substance norepinephrine and also serotonin. Therefore, it is called NaSSA antidepressant (Noradrenergic specific serotonergic antidepressant). It belongs to the so-called new generation of antidepressants, a rather young but proven drug group. Mirtazapine enhances the action of the two serotonin and norepinephrine autoimmers in the brain by binding to alpha2 receptors. This blocks it and acts antagonistically, ie opposite to the effect of the substances that usually start there.
Normally, without the activity of mirtazapine, the signaling pathway through the alpha2 receptors would inhibit the release of serotonin and norepinephrine. Thus, as with most other antidepressants, the effects of mirtazapine increase the supply of noradrenaline and serotonin. A deficiency of these is, among other things, blamed for the symptoms and development of depression.
Mirtazapine helps with depression
Psychiatrists often use the antidepressant mirtazapine because it has done well in various international studies. Summarized in the form of an overview, the study results for mirtazapine can be found in the publication "Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatment meta-analysis" in the Lancet 2009; 373: 746-58. Twelve different antidepressants were compared in terms of their effects and tolerability. Above all, mirtazapine showed good efficacy and was tolerated relatively well by most patients.
Citalopram, an antidepressant that could be used for another type of depression as a drug with other side effects, also achieved good results. It is not given in restless, agitated depression, but in the also widespread form that is accompanied by sadness and lack of drive. Because it is a drive-enhancing antidepressant.
Dosage of mirtazapine
The drug mirtazapine is usually taken orally in the form of orodispersible tablets. Alternatively, it is in solution for administration in drop form and as a concentrate for intravenous infusions on the market. Preferably, this antidepressant should be taken late in the evening, as mirtazapine acts as an inducer of sleep. The drug is in Germany pharmacy and prescription. The daily dose for maintenance therapy for depression is 30-45mg per day.
Side effects of mirtazapine
The main side effects of mirtazapine are fatigue, dizziness and headache. Ingestion of the drug may generally cause a feeling of light-headedness, which may be due to the antihistaminergic activity of mirtazapine. Also, it often leads to side effects such as loss of appetite, weight gain and water retention (edema).
Rarely, patients with appropriate predisposition to side effects such as circulatory problems with low blood pressure, involuntary tremor (tremor), skin rash (exanthema), seizures, muscle and joint pain, reduced blood formation, increase in liver function and nightmares (worsening of psychotic symptoms).
Interactions of mirtazapine
In general, mirtazapine has little interaction with other drugs. In combination with the likewise antidepressive lithium, however, it may lead to an increase in the effects and side effects. In addition, mirtazapine can intensify the sleep-inducing effects of other concomitant drugs such as benzodiazepines or alcohol.
In combination with carbamazepine and phenytoin there may be an accelerated degradation of mirtazapine in the body and a possible dose adjustment may be necessary.
Information on the active substance mirtazapine
- Good effective antidepressant, yet discuss the dosage and use with the psychiatrist, do not discontinue self-reliant on improvement of symptoms.
- Do not exceed recommended maximum level of mirtazapine.
- Do not use mirtazapine in combination with MAO inhibitors and if known intolerance.
- Relative contraindications to use are severe liver and kidney dysfunction, urinary retention and a green cataract (glaucoma)
- For prolonged ingestion have regular blood count checks performed by the doctor to detect disorders of blood formation early.