Mirtazepine: Heir apparent to amitriptyline?

Abstract

"What's new in therapeutics?" will examine and evaluate drugs that may have a place in hospice, palliative, and long-term care. Mirtazepine will be examined and evaluated. Mirtazepine is a potential alternative anti-depressant with multiple additional benefits. It is an atypical anti-depressant, which has both noradrenergic and specific serotonergic receptor antagonism (NaSSa), and a unique pharmacological profile. Mirtazepine appears to be a "designer drug" for palliative medicine with a number of benefits, but cost may be a drawback.

Sleep Disturbance in Supportive Care of Cancer: A Review

“…It is sedating and stimulates appetite, and is gaining increased use among palliative care practitioners. [75][76][77][78][79] It remains expensive compared to tricyclics, but improved safety and side effect profiles make it attractive, as does the fact that the starting dose at 15 mg is effective antidepressant dosing. 76 Another group of drugs frequently used for insomnia but poorly studied for this indication are the antihistamines.…”

The psychiatric management of end-of-life pain and associated psychiatric comorbidity

“…Psychosocial interventions also are recommended in addition to medication and psychotherapy. Other psychotropic medications mentioned in the recent literature that potentially improve the quality of life for patients near the end of their lives who suffer from depression disorders, psychoses, or pain include methylphenidate [31,32] and modafinil [33] to relieve fatigue and depression and provide more energy for some patients, mirtazepine [34,35] and venlafaxine [36] to address depressive and pain-related problems, and olanzapine [37] and risperidone [38] to address delirium and psychoses-related behaviors.…”

Elements toward novel therapeutic targeting of the adrenergic system

“…For instance, clonidine, an a2-AR agonist, is used as an anti-hypertensive agent that acts on cardiovascular regulatory centers in the brainstem (Yamazato et al, 2001). In psychiatry, other a2-AR agonists are used as antidepressants (Davis et al, 2001) including mirtazapine which is an a2-AR, 5 HT2 and 5-HT3 serotoninergic receptors' agonist (Sanders et al, 2011) used to treat social phobia (Mrakotsky et al, 2008) and to improve cognitive functions (Arnsten et al, 1996;Franowicz and Arnsten, 1999;Franowicz et al, 2002). Guanfacine, an a2A-AR selective agonist, has been used to treat patients suffering from attention deficit hyperactivity disorder (ADHD) (Sallee et al, 2009) and other psychiatric disorders (Faraone and Glatt, 2010;Sallee and Eaton, 2010;Taylor and Russo, 2001).…”