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Depression
Published in Henry J. Woodford, Essential Geriatrics, 2022
Venlafaxine is associated with a higher rate of nausea (30%). Paroxetine, sertraline and mirtazapine have a higher rate of sexual-type side effects. Mirtazapine is associated with the greatest amount of weight gain (an average of 2 kg over an eight-week period).24 This effect is probably mediated by a histamine receptor-blocking action. It could be a good choice for people with reduced appetite. TCAs have the most anticholinergic effects (see page 47). Of the SSRIs, paroxetine is thought to be more anticholinergic.
Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Most of these large studies do not differentiate between antidepressants and include the SNRIs and other antidepressants as a group. However, when looking at the data for the SNRIs (venlafaxine and duloxetine) separately, most studies have found either a small increased risk, similar to the SSRIs [82] or no increased risk of malformations [83]. Most studies looking at the safety of mirtazapine have not found an association with an increased risk of neonatal malformations [84]. Other studies have found that it may carry a small risk similar to the SSRIs [85].
Pharmaceutical interventions
Published in Jane Hanley, Mark Williams, Fathers and Perinatal Mental Health, 2019
Mirtazapine, an atypical antidepressant, however, was associated most with the weight gain. Mirtazapine tends only to be prescribed to people who are unable to take other, more widely used, antidepressants as weight gain is known to be a common side effect of this drug. Consideration may be given to the addition of a second antidepressant or another type of medication, which can counter the side effects, for example, Sildenafil (Viagra).
Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions
Published in Expert Review of Neurotherapeutics, 2023
Harry A. Fagan, David S. Baldwin
There is evidence to support the efficacy of agomelatine (2 RCTs) and mirtazapine (10 RCTs) in the treatment of GAD, although all RCTs with mirtazapine were conducted and published in China [18]. Agomelatine exerts agonist effects at melatonin 1 and 2 receptors and antagonism at 5-HT2C receptors [27]. It is relatively well tolerated but associated adverse effects include nausea, dizziness, sedation (likely secondary to melatonin agonism), gastrointestinal upset and, rarely, abnormal liver function tests and hepatotoxicity (necessitating regular liver function test monitoring throughout treatment) [27]. Mirtazapine exerts antagonist effects across multiple receptor types (including α2-adrenergic, 5-HT2, 5-HT3, and H1 receptors) [28]. The principal adverse effects of mirtazapine are weight gain and sedation (secondary to H1 receptor antagonism), although the latter appears to be less marked at higher treatment doses [28]. Similar support was not found for the newer serotonin-modulating antidepressants vilazodone and vortioxetine [18]. Both vilazodone and vortioxetine inhibit SERT with additional effects on serotonin receptors, with vilazodone demonstrating 5-HT1A partial agonism and vortioxetine demonstrating 5-HT1A full agonism, 5-HT1B partial agonism, and 5-HT1D, 5-HT3, and 5-HT7 antagonism [29,30].
Varenicline (Chantix): The Smoking Cessation Medication Prescribers May Be Avoiding
Published in Issues in Mental Health Nursing, 2022
When any medication carries a stigma like the miasma emanating from varenicline, it is easy to lose sight of our training and education in the scientific foundations of cause and correlation. Once, many years ago, I prescribed mirtazapine (Remeron) to a patient, and a few weeks after starting the medication, the patient was hospitalized with suicidal ideation for the first time ever. For the patient, this was a life-disrupting outcome, and the inpatient providers correctly considered the introduction of mirtazapine as a possible culprit. We will never know if the new medication played a role in the unfortunate developments, but I have certainly not sworn off mirtazapine for all future patients. And a different lens: advanced practice registered nurses prescribe antidepressants to patients younger than 24 years old every single day, aware of the FDA’s black box warning for increased suicide risk in this age group.
When topical therapy of atopic dermatitis fails: a guide for the clinician
Published in Expert Review of Clinical Immunology, 2021
Giuseppe Ingrasci, Zoe M. Lipman, Gil Yosipovitch
Mirtazapine is a selective serotonin-norepinephrine reuptake inhibitor that also has antihistaminergic properties. It has been proven to reduce nocturnal pruritus in AD and many other pruritic disorders due to its sedating tendency, making it particularly well suited for treating AD patients with nocturnal pruritic aggravations [81–83]. While the mechanism of action in lowering itch is unknown, it has been postulated that increased synaptic serotonin and norepinephrine levels may influence the perception of pruritus in the brain [84]. The antipruritic dose of mirtazapine is usually 7.5–15 mg nightly [48]. A synergistic anti-itch effect is achieved when mirtazapine is administered in combination with gabapentinoids (see below), and neural sensitization is minimized. The most common side effects of mirtazapine are increased appetite and weight gain, and it should not be used in children under the age of 10.