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Pharmacological management of depression in older people
Published in Stephen Curran, John P Wattis, Practical Management of Affective Disorders in Older People, 2018
Stephen Curran, Andrew Byrne, John P Wattis
Mianserin and mirtazapine are both potent antagonists at α2-autoreceptors. This leads to an increase in noradrenaline release. These drugs have low affinity for muscarinic, cholinergic and dopamine receptors, resulting in reduced side-effects. Mianserin has fallen out of favour over the past 10 years or so because of the small risk of agranulocytosis necessitating blood monitoring. There is very little published data in older people with depression. Mirtazapine has effects on both the noradrenergic and serotonergic systems. It enhances central noradrenergic and 5HT1-receptor mediated serotonergic neurotransmission. It is also an antagonist at α2 presynaptic autoreceptors and also blocks 5HT2 and 5HT3 receptors, resulting in increased noradrenergic release. Changes in pharmacokinetics with age are considered minor.45 The main side-effects of mirtazapine include sedation and weight gain and less commonly mania, convulsions, paraesthesia and reversible agranulocytocis.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
65 Costa D, Mogos I, Toma T. Efficacy and safety of mianserin in the treatment of depression of women with cancer. Acta Psychiatr Scand Suppl 1985;320:85-92. 66 van Heeringen K, Zivkov M. Pharmacological treatment of depression in cancer patients. A placebo-controlled study of mianserin. Br JPsychiatry 1996; 169:440-443
Treating Depression in Elderly People
Published in José León-Carrión, Margaret J. Giannini, Behavioral Neurology in the Elderly, 2001
José M. González Infantes, José I. Ramírez Benítez, Pilar Moya Corral
The tetracyclic antidepressants used are mianserin and maprotyline. Mianserin is widely used in older adults. It is characterized by a lack of anticholinergic and sedative effects and is used to treat depressed elderly people suffering from cardiovascular disease. Maprotyline is a noradrenaline reuptake inhibitor and is characterized by its sedative action. It is used in cases of anxious–agitated depressions when anticholinergic drugs are not tolerated. Arterial hypotension and the appearance of some cases of agranulocytosis are noteworthy among the described adverse reactions from mianserin. The most notable adverse reaction in the case of maprotyline is the production of epileptic crises with greater frequency than with other antidepressants.
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Mianserin showed either proconvulsant or anticonvulsant properties depending on a type of seizure model and protocol of administration. Acute and subchronic treatment with mianserin mitigated amygdala-kindled seizures in rats and rabbits [63,64]. Chronic administration of this antidepressant resulted, however, in the intensification of electroconvulsions in rats. Similarly, acute mianserin (30–40 mg/kg) increased the electroconvulsive threshold in mice, while chronic treatment led to just the opposite effect. Moreover, a single application of this antidepressant at subthreshold doses enhanced the anti-electroshock action of carbamazepine, valproate, and phenytoin, but not that of phenobarbital. In contrast, chronic treatment reduced the effect of carbamazepine and phenobarbital against MES. All revealed interactions seemed to have a pharmacodynamic nature [65].