Remeron (Mirtazapine)

Generic name: Mirtazapine
Trade names: Avanza, Remeron, Remeron Soltab, Zispin
Pharmacologic category: Noradrenergic and specific serotonergic antidepressant, tetracyclic piperazino-azepine
FDA approved: 1996
Manufacturer: Organon International
Habit forming? No
Pregnancy risk factor: C

Medical uses

Remeron is an antidepressant used for the treatment of mild to severe depression. Remeron is effective in all levels of severity of depressive illness, as well as is in a broad range of symptoms associated with depression.

Although mirtazapine has a tetracyclic chemical structure it is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). This medication may be used in preference to an SSRI due to the fact that it causes fewer sexual dysfunction problems, that are a relatively common side effects of SSRIs. Due to its unique pharmacologic profile, mirtazapine is virtually devoid of anticholinergic, adrenolytic, and serotonin-related side effects. Remeron is relatively safe if it is overdosed.

Pharmacological characteristics

Elimination half-life: 20 to 40 h
Metabolism: extensively metabolized by demethylation and hydroxylation followed by glucuronide conjugation. CYP2D6 and CYP1A2 are involved in formation of an 8-hydroxy metabolite. CYP3A is responsible for formation of N-desmethyl and N-oxide metabolites.
Excretion: Primary route of elimination is urine (75%) and feces (15%).

Benefits

Effective for depression
Possibly effective for anxiety at a low dose

Concerns

Approximately half of the patients who take Remeron (mirtazapine) develop noticeable sleepiness and sedation.
Increased appetite, cravings for sweets and carbohydrates.
Weight gain.

Unlabeled uses

Anxiety
Bipolar depression
Fibromyalgia

Mechanism of action

Although the precise mechanism of action of Remeron is not known, it increases the amount of norepinephrine and serotonin in the brain. Norepinephrine and serotonin are neurotransmitters, chemicals that nerves use to communicate with each other.

Mirtazapine blocks histamine-1 receptor, so it acts as an antihistamine similar to diphenhydramine (Benadryl).

Mirtazapine also blocks the alpha-2 adrenergic receptor (like yohimbine).

Last modified: October, 2011

Mirtazapine

Remeron is a new antidepressant that enhances both noradrenergic and serotonergic activity and is currently the only member of the noradrenergic and specific serotonergic antidepressant (NaSSA) class.
There is evidence that Remeron can be used to treat panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD).
Remeron is thought to be effective in the prophylactic treatment of chronic headache.
Remeron, a dual-action antidepressant, has demonstrated an earlier onset of action compared with SSRIs.
Despite having good efficacy, Remeron has not become a first-line treatment for depression in most clinical situations because of 2 limiting side effects in a number of patients: weight gain and sedation.