Inner restlessness and  sleep disturbances  are symptoms of  depression . Mirtazapine can alleviate this: It helps to calm down and get a good night’s sleep again. Therefore, this antidepressant is mainly used in depressives with nocturnal restlessness (agitation). Since it has a sleep-inducing effect, the drug is usually taken before going to bed. Difficulties falling asleep with circles of thought and very early awakening are thereby reduced. However, side effects should be taken into account.

effect of mirtazapine

Mirtazapine belongs to the class of dual antidepressants: It particularly affects the neurotransmitters norepinephrine and  serotonin . That is why it is called the  NaSSA antidepressant  (Noradrenergic specific serotonergic antidepressant). It belongs to the so-called new generation of antidepressants, a relatively young but proven group of drugs.

Mirtazapine increases the effect of the two signal generators serotonin and noradrenaline in the brain by binding to alpha2 receptors. This blocks the drug and has an  antagonistic effect, i.e.  opposite to the effect of the substances that normally act there.

Normally or without the activity of mirtazapine, the signaling pathway via the alpha2 receptors would inhibit the release of serotonin and norepinephrine. As with most other antidepressants, the effect of mirtazapine leads to an increased supply of the messenger substances norepinephrine and serotonin. A lack of these substances is held responsible, among other things, for the symptoms and development of depression.

Mirtazapine helps with depression

The antidepressant mirtazapine is often used by psychiatrists because it has performed well in various international studies. For example, a  meta-analysis  compared twelve different antidepressants in terms of their effectiveness and tolerability and showed that mirtazapine was particularly effective and was relatively well tolerated by most patients.

Citalopram , an antidepressant drug that can be used to treat another form of depression with other side effects, also achieved good results  . Due to its drive-increasing effect, it is administered for depressions that are primarily characterized by sadness and a lack of drive.

Dosage of Mirtazapine

The drug mirtazapine is usually taken orally in the form of orodispersible tablets. Alternatively, it is marketed in solution for administration in drop form and as a concentrate for intravenous infusions.

The antidepressant should preferably be taken  late in the evening  , as mirtazapine has a sleep-inducing effect. The preparation is available in pharmacies and requires a prescription in Germany. The daily dose for maintenance therapy for depression is  30 to 45 milligrams  per day.

Side Effects of Mirtazapine

The main and  most common side effects  of mirtazapine are:

  • fatigue
  • dizziness
  • headache

A general feeling of  lightheadedness  may occur while taking the drug, which is sometimes due to the antihistaminergic activity of mirtazapine. It also often leads to side effects such as increased appetite and weight gain as well as water retention (edema).

Rarely  , patients with a corresponding disposition experience side effects such as

Interactions of Mirtazapine

In general, there are hardly any interactions with other medications with mirtazapine.

In combination with lithium, which also has an antidepressant effect, the effects and side effects can be increased. In addition, mirtazapine can intensify the sleep-inducing effect of other drugs taken at the same time, such as benzodiazepines or alcohol.

In combination with carbamazepine and phenytoin, the degradation of mirtazapine in the body may be accelerated and a dose adjustment may be necessary.

Notes on the active ingredient mirtazapine

Below is some general advice to keep in mind when using mirtazapine.

  • Effective antidepressant, however dosage and use must be discussed with a psychiatrist.
  • If the symptoms improve, the drug must not be discontinued independently.
  • The maximum recommended amount of mirtazapine should not be exceeded.
  • Do not use mirtazapine in combination with MAO inhibitors and if you have a known intolerance.
  • Relative contraindications to use are severe liver and kidney dysfunction, urinary retention and  glaucoma  .
  • If you take it for a long time, it is advisable to have regular blood count checks carried out by a doctor in order to be able to detect blood formation disorders at an early stage.


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