Mirtazapine: clinical overview.
There is currently available evidence that suggests that drugs combining 2 synergistic mechanisms of action (e.g., enhancement of both noradrenergic and serotonergic neurotransmission) may yield superior therapeutic efficacy compared with a single therapeutic mechanism of highly selective agents such as selective serotonin reuptake inhibitors (SSRIs). The differences in antidepressant efficacy favoring dual-acting drugs may exist in particular for 3 difficult-to-treat groups of patients: those with endogenous depression, those with severe depression, or hospitalized depressed patients. Mirtazapine differs from other new dual-acting antidepressants by not being a reuptake inhibitor. Its antidepressant activity may be related to a direct enhancement of noradrenergic neurotransmission by blockade of alpha2-autoreceptors. The rapid increase in serotonin (5-HT) synaptic levels by blockade of alpha2-heteroreceptors indirectly enhances 5-HT1A-mediated neurotransmission since 5-HT2 and 5-HT3 are blocked by mirtazapine. The antidepressant efficacy of mirtazapine was established in several placebo-controlled trials. Currently available evidence suggests that mirtazapine is effective in all levels of severity of depressive illness, as well as is in a broad range of symptoms associated with depression.
Gorman
J M
JM
Department of Psychiatry, Columbia University, New York, NY 10032, USA.
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000494:pharmacology / Q000627:therapeutic use*; D002997:Clomipramine / Q000494:pharmacology / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003511:Cyclohexanols / Q000494:pharmacology / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D008803:Mianserin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D010919:Placebos; D011985:Receptors, Serotonin / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D000317:Adrenergic alpha-Antagonists; D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine; D003511:Cyclohexanols; D008803:Mianserin; D000078785:Mirtazapine; D010919:Placebos; D011985:Receptors, Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride