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How it works is not clear, but it may involve blocking certain adrenergic and serotonin receptors. [11] [12] Chemically, it is a tetracyclic antidepressant, [12] and is closely related to mianserin. It also has strong antihistaminergic effects. [11] [12] Mirtazapine came into medical use in the United States in 1996. [12]
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]
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 ] .
Paroxetine was the first drug to be approved for social anxiety disorder and it is considered effective for this disorder; sertraline and fluvoxamine were later approved for it as well. Escitalopram and citalopram are used off-label with acceptable efficacy, while fluoxetine is not considered to be effective for this disorder. [ 22 ]
The tetracyclic antidepressants mianserin and mirtazapine are α 2 blockers, although their efficacy as antidepressants may come from their activity at other receptor sites. [citation needed] Mechanistically, α 2 blockers increase adrenergic, dopaminergic and serotonergic neurotransmitters and induce insulin secretion, decreasing blood sugar ...
Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed . Find sources: "Serotonin antagonist and reuptake inhibitor" – news · newspapers · books · scholar · JSTOR ( September 2015 )
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A literature review by Castagna, et. al from 2023 shows indications of efficacy treating pediatric generalized anxiety disorder. Currently, Duloxetine, an SNRI, is the only FDA-approved medication for pediatric GAD, despite the fact that SSRIs are typically first-line treatment.
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