Summary NR546 Antidepressant and Mood Stabilizer Medication Table

Mirtazapine (Remeron) serotonin, norepinephrine receptor antagonist (SN-RAn) Commonly Prescribed for Major depressive disorder Panic disorder Generalized anxiety disorder Posttraumatic stress disorder How the Drug Works Boosts neurotransmitters serotonin and norepinephrine/noradrenaline Blocks alpha 2 adrenergic presynaptic receptor, thereby increasing norepinephrine neurotransmission Blocks alpha 2 adrenergic presynaptic receptor on serotonin neurons (heteroreceptors), thereby increasing serotonin neurotransmission. Treatment most often reduces or even eliminates symptoms, but not a cure since symptoms Half-life 20–40 hours Substrate for CYP450 2D6, 3A4, and possibly also CYP450 1A2 Notable Side Effects: Dry mouth, constipation, increased appetite, weight gain Sedation, dizziness, abnormal dreams, confusion Flu-like symptoms (may indicate low white blood cell or granulocyte count) Change in urinary function. Hypotension Life-Threatening or Dangerous Side Effects Rare seizures Rare induction of mania Rare activation of suicidal ideation and behavior (suicidality) (short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo beyond age 24) Other Warnings/Precautions Drug may lower white blood cell count (rare; may not be increased compared to other antidepressants but controlled studies lacking; not a common problem reported in post marketing surveillance) Drug may increase cholesterol May cause photosensitivity Avoid alcohol, which may increase sedation and cognitive and motor effects Use with caution in patients with history of seizures Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent