mirtazapine_flashcards
What type of medication is Mirtazapine?
An antidepressant
How does Mirtazapine work?
By blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters
Why is Mirtazapine useful in older people?
It has fewer side effects and interactions than many other antidepressants
What are two beneficial side effects of Mirtazapine for older people?
Sedation and increased appetite, which can help with insomnia and poor appetite
When is Mirtazapine generally taken and why?
In the evening, because it can be sedative
What receptors does Mirtazapine block?
Alpha2-adrenergic receptors
summarise mirazapine
Mirtazapine
Mirtazapine is an antidepressant that works by blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters.
Mirtazapine has fewer side effects and interactions than many other antidepressants and so is useful in older people who may be affected more or be taking other medications. Two side effects of mirtazapine, sedation and an increased appetite, can be beneficial in older people that are suffering from insomnia and poor appetite.
It is generally taken in the evening as it can be sedative.
A 35-year-old woman comes to see you due to depression. She describes a 6-month history of low mood, tearfulness, reduced appetite and insomnia. Her insomnia is causing difficulties with attending work as a teacher. You have previously referred her for cognitive behavioural therapy but she felt there was a limited improvement. She is keen to start anti-depressant medication which will also help with her sleep.
What is the most appropriate management?
Duloxetine
Escitalopram
Mirtazapine
Nortriptyline
Venlafaxine
Mirtazapine
Mirtazapine may be prescribed due to useful side effects (sedation and increased appetite)
Although SSRIs are first line, alternative medications can be used for their side effect profile. In this case, mirtazapine is the most appropriate medication as it can cause sedation and increased appetite as side effects. The patient describes a reduced appetite and is also seeking help for her insomnia which is starting to affect her work.
The remaining options are not first-line anti-depressant medications for depression.
Duloxetine and escitalopram can cause insomnia as a recognised side effect.
Whilst nortriptyline can have sedating effects, it is not the first line for depression.
Venlafaxine can have various side effects including sedation or insomnia. However, it is not routinely used first-line and is associated with a greater risk of death from an overdose compared with other equally efficacious antidepressants.
You are reviewing a 21-year-old male with depression, who has previously tried several antidepressants and counselling with little success. You decide to commence him on a trial of mirtazapine.
Which of the following can you inform him is a characteristic side effect of this antidepressant?
The tyramine cheese reaction
Tardive dyskinesia
Headache
Increase in appetite
Agranulocytosis
Increase in appetite
Mirtazapine - increased appetite is a characteristic side effect
Mirtazapine is an effective antidepressant which is an alpha-2 receptor antagonist, but is often not tolerated by patients as it commonly causes increased appetite and sedation.
The tyramine cheese reaction is a classic side effect of MAOI (monoamine oxidase inhibitor) antidepressants, such as phenelzine. Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis.
Tardive dyskinesia is a movement disorder than is characteristically caused by typical antipsychotics, though very rarely can be a result of some antidepressants also.
Headache is a common withdrawal symptom of mirtazapine, not a side effect during its administration.
Agranulocytosis is a side effect monitored for in clozapine, an antipsychotic.
