In this video, we review the popular antidepressant, mirtazapine. Mirtazapine is indicated for depression but may also be used in PTSD, OCD and insomnia. Mirtazapine has a unique mechanism of action that gives it an interesting side effect profile – drowsiness and weight gain are common while sexual dysfunction and nausea are rare. A large network meta analysis found that mirtazapine stacks up favourably compared to other antidepressants in terms of efficacy and acceptability. In my opinion, Mirtazapine is best suited for those with depression and insomnia who do not mind gaining a bit of weight.
All right isaac wade doctor of pharmacy let’s talk about mirtazapine mirtazapine this is one of my all-time favorite molecules and it’s a type of antidepressant that’s unlike any of the other antidepressants on the market on one hand this makes mirtazapine a really useful solution for a lot of individuals but on the other hand there are some unique side effects to
Consider so in this video i’m going to be breaking down all of the information that i think you should know about mirtazapine so that you can make a more informed decision about your health as always i’ll be talking about how it works i’ll be talking about what kind of side effects to expect and i’ll be talking about how it compares to other types of antidepressants
So without further ado let’s get into the video as always this video is not medical advice this video is for informational purposes only always speak with your healthcare provider before making any changes to any of your medications mirtazapine is usually used for depression but it can also be used for anxiety ptsd obsessive compulsive disorder and insomnia as well
The mechanism of action of mirtazapine is very complicated but essentially it blocks receptors it blocks certain serotonin receptors it blocks the alpha ii adrenergic receptor and it also blocks the histamine h1 receptor if you’re interested in learning more about the mechanism of action of mirtazapine i’ve linked an interesting paper in the description below in
Terms of administration mirtazapine is taken once per day at bedtime because it is very sedating mirtazapine can be taken with or without food it honestly doesn’t matter but if you’re taking the orally disintegrating tablet make sure to leave the tablet in the foil until you’re ready to take it if the tablet is outside of the foil wrap it is not going to be stable
For a very long time in terms of dosage most people start at a dose of about 15 milligrams and increase their dose slowly to a maximum dose of 45 milligrams if you plan on discontinuing mirtazapine make sure to taper off the medication slowly over a couple weeks because there is a pretty nasty discontinuation syndrome that is associated with this agent in terms
Of onset like other antidepressants mirtazapine doesn’t start working right away you’re going to have to wait a couple weeks for the effects of mirtazapine to kick in however side effects might appear before the beneficial effects occur just like any other drug mirtazapine has the potential of causing side effects some of the most common side effects associated
With mirtazapine include weight gain fatigue dry mouth constipation and drowsiness drowsiness occurs in almost everyone who takes mirtazapine and on one hand it can help you with sleep like if you’re an individual with depression and insomnia drowsiness might actually be a good thing but on the other hand you got to be careful if you’re going to be driving if
You’re going to be using heavy machinery or if you’re going going to be combining mirtazapine with other types of sedating drugs like alcohol and cannabis weight gain is a really big side effect that’s caused by mirtazapine and it seems to happen in a really really high frequency in fact one study found that mirtazapine caused weight gain in up to 77 percent of
Individuals that use the medication overly long term mirtazapine causes a whole bunch of other side effects i’m just going to flash them on the screen for you now so that you can take a look and then we can move on there are some side effects that are caused by other antidepressants that mirtazapine doesn’t seem to cause one of them includes nausea and vomiting it
Doesn’t seem to cause that and another side effect includes sexual dysfunction doesn’t seem to cause that either in terms of more serious side effects mirtazapine like other types of antidepressants can increase suicidal ideation and this is especially prevalent in young adults and also in youth as well so if you fall into that age category just make sure that you
Are being monitored while you are taking mirtazapine you should also be aware of the serotonin syndrome which is a serotonin toxicity that can also be caused by mirtazapine it’s more common if you’re combining mirtazapine with other types of search energy drugs like amphetamine like cocaine like mdma so just if you’re going to combine mirtazapine with any other types
Of agents just make sure that you talk to your healthcare provider before doing that now there’s like a million other things i could talk about if you want to learn more about mirtazapine i’ve linked the product monograph in the description box below so i’d encourage you to take a look at that so we’ve talked about some of the general properties of mirtazapine but
How does mirtazapine compare to other antidepressants like i said before it’s really difficult to compare certain drugs if they’re being studied in different trials however if you were to do so the best way to do it would be to do to a network meta-analysis and these are results that i’m going to show you right now that were from a network meta-analysis in terms of
Efficacy and depression you can see how mirtazapine compares to some of the other antidepressants in this graph here in this graph being higher up on the graph is associated with better efficacy compared to being lower on the graph and in this study efficacy was measured as how many individuals got a 50 reduction in depressive symptoms during an eight week period
You can see mercstazzapine stacks up a very favorably compared to the other antidepressants with only amitriptyline ranking higher than mirtazapine let’s take a look at acceptability in terms of acceptability and depression you can see how mertazapine compares to other types of antidepressants again being higher up on this graph is better than being lower and
Acceptability is being measured as the dropout rates among individuals taking each of these antidepressants you can see mirtazapine land somewhere in the middle and on i’d like to point out that there’s no difference between mirtazapine and placebo in terms of acceptability which means that if you’re taking mirtazapine your chances of discontinuing mirtazapine due
To side effects or due to lack of efficacy are just as much as your chances of discontinuing a placebo because of side effects or because of lack of efficacy so that’s all i have to talk about when it comes to mirtazapine again really really interesting antidepressant in a future video i’m probably going to be breaking mirtazapine down in terms of its mechanism
Of action it’s you know super interesting thank you guys for watching and i’ll see you in the next video
Transcribed from video
Doctor of Pharmacy Reviews Mirtazapine, Remeron, Antidepressant By Isaac Wade PharmD