Mitrazapine

Mirtazapine is a tetracyclic antidepressant (TeCA) used primarily in the treatment of major depressive disorder (MDD). It functions by enhancing the central noradrenergic and serotonergic activity.

Indications

-Major Depressive Disorder (MDD) -Anxiety disorders -Insomnia (off-label) -PTSD (off-label)

Dosage

-Adults: Start with 15 mg once daily, preferably in the evening before sleep. The dose may be increased to a maximum of 45 mg/day depending on patient response and tolerability. -Elderly: Doses are typically lower and increased more gradually. -Children and adolescents: Safety and efficacy not established.

Contra-Indications

-Hypersensitivity to mirtazapine or any of its components. -Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs. -Severe liver or kidney impairment without medical supervision.

Special Precautions

-Monitor for worsening of depression and emergence of suicidal thoughts, particularly during the initial few months of therapy or at times of dose changes. -Caution in patients with a history of seizures. -Use cautiously in patients with a history of mania/hypomania. -May cause weight gain and increased cholesterol levels. -Avoid alcohol consumption due to enhanced sedative effects.

Side Effects

-Common: Increased appetite, weight gain, dry mouth, constipation, sedation, dizziness. -Less common: Blood dyscrasias, including agranulocytosis, elevated liver enzymes, orthostatic hypotension. -Rare: Serotonin syndrome, especially when used in combination with other serotonergic drugs.

Drug Interactions

-Increased sedation with CNS depressants including alcohol, benzodiazepines. -Enhanced serotonergic effects with SSRIs, SNRIs, and other antidepressants. -Risk of hypertensive crisis with MAOIs. -Potential interaction with warfarin and other anticoagulants.