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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 ] .
A small 2011 study found that consuming 20 grams of casein (a milk protein) or pea protein before a meal led to eating less at that meal. This was compared to drinking water before a meal.
[8] [1] Unlike low-dose mirtazapine, the half life (10 hours) is short enough that next-day sedation may be manageable, however, for people with CYP2D6 polymorphisms, which constitute a sizable fraction of the population, the half-life is expected to be quite a bit longer. Merck researchers claimed that the incidence of next-day sedation was ...
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]
For example, venlafaxine works alongside its primary metabolite O-desmethylvenlafaxine to strongly inhibit serotonin and norepinephrine reuptake in the brain. The evidence also suggests that dopamine and norepinephrine behave in a co-transportational manner, due to the inactivation of dopamine by norepinephrine reuptake in the frontal cortex ...
Mirtazapine has also been used in the treatment of the motility disorder gastroparesis due to its anti-emetic effects. [27] Olanzapine , an atypical antipsychotic with anti-emetic properties similar to those of mirtazapine, also shows promise in treating chemotherapy-induced nausea and vomiting.
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