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Mirtazapine, sold under the brand name Remeron among others, is an atypical tetracyclic antidepressant, and as such is used primarily to treat depression. [11] [12] Its effects may take up to four weeks but can also manifest as early as one to two weeks. [12] [13] It is often used in cases of depression complicated by anxiety or insomnia.
Chemical structure of the prototypical NaSSA mirtazapine (original brand name Remeron). Noradrenergic and specific serotonergic antidepressants (NaSSAs) are a class of psychiatric drugs used primarily as antidepressants. [1]
[8] [9] [10] There is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults. [11] Discontinuation syndrome , which resembles recurrent depression in the case of the SSRI class, may occur after stopping the intake of any antidepressant, having effects which may be permanent and irreversible.
The TCAs are used primarily in the clinical treatment of mood disorders such as major depressive disorder (MDD), dysthymia, and treatment-resistant variants. They are also used in the treatment of a number of other medical disorders, including cyclic vomiting syndrome (CVS) and anxiety disorders such as generalized anxiety disorder (GAD), social phobia (SP) also known as social anxiety ...
[38] [39] The condition has however occurred in surprising clinical situations, and because of phenotypic variations among individuals, it has been associated with unexpected drugs, including mirtazapine. [40] [41] The relative risk and severity of serotonergic side effects and serotonin toxicity, with individual drugs and combinations, is complex.
Mirtazapine was developed by the same team of organic chemists and differs via addition of a nitrogen atom in one of the rings. [43] [44] (S)-(+)-Mianserin is approximately 200–300 times more active than its enantiomer (R)-(−)-mianserin; hence, the activity of mianserin lies in the (S)-(+) isomer. [citation needed]
Besides mirtazapine, they also block the α 1-adrenergic receptor [citation needed]. Conversely, whereas TCAs have relatively low affinity for the α 2 -adrenergic receptor , mianserin and mirtazapine potently antagonize this receptor, and this action is thought to be involved in their antidepressant effects [ citation needed ] .
Mood disturbances such as dysphoria, anxiety, or agitation are also reported, as are cognitive disturbances such as confusion and hyperarousal. In cases associated with sudden discontinuation of MAO inhibitors, acute psychosis has been observed. [2] [11] [12] Over fifty symptoms have been reported. [13]