Robert L. Barkin, MBA, PharmD; Philip N. Chor, MD; Bennett G. Braun, MD; and William A. Schwer, MD
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Background: Mirtazapine, a noradrenergic and
specific serotonergic antidepressant (NaSSA), is characterized by
a unique receptor-specific pharmacologic profile and tolerable
side-effect profile in comparison to other antidepressants. It
has been reported to have a low incidence of agitation, anxiety,
and insomnia, which may be due to blockade of 5-HT2 and 5-HT3 receptors. This unique
multireceptor-mediated clinical pharmacologic profile may reduce
the need for polypharmacy in selected patients.
Case reports: Three cases are presented. In case
1, mirtazapine was able to rapidly treat anxiety and agitation in
a 90-year-old woman. This was confirmed with 3 consecutive
challenges with mirtazapine. In case 2, both a mood disorder and
insomnia were successfully treated with rapid resolution in a
patient by using mirtazapine. In case 3, the patient experienced
sexual dysfunction while receiving sertraline and developed
insomnia with the addition of bupropion. The addition of
mirtazapine and the discontinuation of sertraline and bupropion
resolved the sexual dysfunction and insomnia. Polypharmacy
interventions were decreased in these patients through
receptor-specific events from mirtazapine.
Conclusion: The new antidepressant
mirtazapine appears to be an effective strategy for treating
anxiety, agitation, and insomnia and for diminishing SSRI-related
sexual dysfunction without compromising the patient's therapeutic
response to the medication while decreasing the need for
additional pharmacotherapies. More than 70% of patients with
major depression will have anxiety symptoms. The 5-HT2 receptor seems to play a major role in the regulation of anxiety.
The anxiolytic properties of mirtazapine may be due to its
antagonism of 5-HT2 receptors and can appear as early
as the first week of treatment.
Prim Care Companion J Clin Psychiatry 1999;1(5):142-145
https://doi.org/10.4088/PCC.v01n0502
© Copyright 1999 Physicians Postgraduate Press, Inc.