Mirtazapine

Mirtazapine
Mirtazapine
Systematic (IUPAC) name
(±)-1,2,3,4,10,14b-hexahydro-2-[11C]methylpyrazino(2,1-a)pyrido(2,3-c)(2)benzazepine
Clinical data
Trade names Remeron
AHFS/Drugs.com monograph
MedlinePlus a697009
Pregnancy cat. C
Legal status Prescription only
Routes Oral
Pharmacokinetic data
Bioavailability 50%
Protein binding 85%
Metabolism Liver (enzymes CYP2D6 and CYP3A4)[1]
Half-life 20–40 hours
Excretion Urine (75%), Feces (15%)
Identifiers
CAS number 61337-67-5 YesY
ATC code N06AX11
PubChem CID 4205
DrugBank DB00370
ChemSpider 4060 YesY
UNII A051Q2099Q N
KEGG D00563 YesY
ChEBI CHEBI:6950 N
ChEMBL CHEMBL654 YesY
Synonyms 6-Azamianserin, Org 3770
Chemical data
Formula C17H19N3 
Mol. mass 265.35 g/mol
SMILES eMolecules & PubChem
Physical data
Density 1.22 g/cm³
Melt. point 114–116 °C (237–241 °F)
Boiling point 432 °C (810 °F)
Solubility in water Soluble in methanol and chloroform mg/mL (20 °C)
 N(what is this?)  (verify)

Mirtazapine (Remeron, Avanza, Zispin) is a tetracyclic antidepressant (TeCA) used primarily in the treatment of depression. It is also sometimes used as a hypnotic, antiemetic, and appetite stimulant, and for the treatment of anxiety, among other indications. Along with its close analogues mianserin and setiptiline, mirtazapine is one of the few noradrenergic and specific serotonergic antidepressants (NaSSAs).

Esmirtazapine, the (S)-(+)-enantiomer of mirtazapine, is currently under development for the treatment of insomnia and menopausal symptoms by the same company that produced mirtazapine.[2]

Contents

Medical uses

Mirtazapine's primary use is the treatment of major depressive disorder.[3] Mirtazapine has been found to be useful in the treatment of generalized anxiety disorder,[4] social anxiety disorder,[5] obsessive-compulsive disorder,[6] panic disorder,[7][8][9] post-traumatic stress disorder,[10][11] seasonal affective disorder,[12] insomnia,[13][14][15] nausea and vomiting,[14][16][17][18][19][20][21] diminished appetite and associated weight loss,[20][22][23] and itching[24][25][26][27] as well, and it may be prescribed off-label for these conditions.

Efficacy and tolerability

Mirtazapine has been found to be one of the most effective antidepressants available and has a generally tolerable side effect profile. In a major systematic review published in 2009 which compared the efficacy and tolerability of 12 popular antidepressants, mirtazapine was found to be superior to all of the included SSRIs and SNRIs, reboxetine, bupropion, and mianserin in terms of antidepressant efficacy, while it was average in regards to tolerability.[28][29][30] Mirtazapine has been demonstrated to be superior to trazodone as well.[31] Mirtazapine has also been shown to be equal in efficacy to many of the TCAs, including amitriptyline, doxepin, and clomipramine, but with a much improved tolerability profile.[28][32] However, two other studies found mirtazapine inferior to the TCA imipramine.[33][34] One study compared the combination of venlafaxine and mirtazapine versus the MAOI tranylcypromine and found them to be equally effective, though the MAOI was much less tolerable in terms of side effects and drug interactions.[35]

Adverse effects

Common side effects of mirtazapine: dizziness, blurred vision, sedation, somnolence, malaise/lassitude, increased appetite and subsequent weight gain, dry mouth, constipation, and vivid, bizarre, lucid dreams or nightmares,[citation needed] joint pain (arthralgia), muscle pain (myalgia) and back pain.[citation needed]

Rarer side effects: agitation/restlessness, irritability, aggression, apathy and/or anhedonia (i.e., inability to experience pleasurable emotions), loss of interest in previously enjoyed activities, excessive mellowness or calmness, difficulty swallowing, shallow breathing, decreased body temperature, miosis, nocturnal emissions, spontaneous orgasm, loss of balance, and restless legs syndrome.[28][36][37][38]

Very rare, potentially serious adverse reactions may include allergic reaction, edema, fainting, seizures, bone marrow suppression, myelodysplasia,[38] and agranulocytosis.[39]

Mirtazapine has a lower risk to cause many of the side effects encountered with other antidepressants, such as decreased appetite, insomnia, nausea and vomiting, diarrhea, urinary retention, increased body temperature, increased perspiration/sweating, mydriasis, and sexual dysfunction (consisting of loss of libido and anorgasmia).[28][32]

In general, some antidepressants may have the capacity to exacerbate some patients' depression or anxiety or cause suicidal ideation, particularly early in the treatment. It has been proven that mirtazapine has a faster onset of antidepressant action compared to SSRIs.[40]

Discontinuation

Mirtazapine and other antidepressants may cause a withdrawal syndrome upon discontinuation.[28][41][42][43] It should be noted that withdrawal effects from most psychoactive drugs (such as antidepressants) are common; but may be less severe than seen with some benzodiazepines.[44] A gradual and slow reduction in dose is recommended in order to minimize withdrawal symptoms.[45] Effects of sudden cessation of treatment with mirtazapine may include depression, anxiety, panic attacks, vertigo, restlessness, irritability, decreased appetite, insomnia, diarrhea, nausea and vomiting, flu-like symptoms such as allergies and pruritus, headache, and sometimes hypomania/mania.[41][42][46][47][48]

Interactions

Concurrent use with inhibitors or inducers of CYP1A2, CYP2D6, or CYP3A4 may result in higher or lower concentrations of mirtazapine, respectively. Mirtazapine has dangerous interactions with benzodiazepines and ethanol. According to the prescribing information, mirtazapine must not be started within two weeks of any MAOI usage; similarly, MAOIs cannot be administered within two weeks of mirtazapine.[49] Contradictorily, a single study regarding the combination reported that it does not result in any incidence of serotonin-related toxicity.[50] A case report claimed that mirtazapine can be used to treat serotonin syndrome.[51] Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is safe and is often used therapeutically.[32][35][52][53][54]A case report described mirtazapine as inducing hypertension in a clonidine-treated patient.[55]

Overdose

Mirtazapine is relatively safe if an overdose is taken.[56] Unlike the TCAs, mirtazapine shows no significant cardiovascular adverse effects at 7 to 22 times the maximum recommended dose.[32] Case reports of overdose with as much as 30 to 50 times the standard dose described the drug as relatively non-toxic, compared to TCAs.[57][58]

12 fatalities have been attributed to mirtazapine overdose in literature.[59][60] However, the fatal toxicity index (FTI: deaths per million prescriptions) for mirtazapine is only 3.1 (95% CI: 0.1 to 17.2). This is similar to that observed with SSRIs.[61]

Pharmacology

Pharmacodynamics

Mirtazapine is an antagonist/inverse agonist at the following receptors:[62][63]

As well as an inhibitor of the following transporters:

All affinities listed were assayed using human materials except those for α1-adrenergic and mACh which are for rat tissues, due to human values being unavailable.[62][63] Though not known to have ever been screened, mirtazapine may act on the 5-HT6 and α2B-adrenergic receptors as well. Notably, mianserin (which is 6-desazamirtazapine) has been shown to have high affinity for 5-HT6 and does not produce cAMP accumulation (indicating it is an antagonist).[66]

Antagonization of the α2-adrenergic receptors which function largely as autoreceptors and heteroreceptors enhances adrenergic and serotonergic neurotransmission, notably central 5-HT1A receptor-mediated transmission in the dorsal raphe nucleus and hippocampus. Indirect α1-adrenoceptor-mediated enhancement of 5-HT cell firing and direct blockade of inhibitory α2-heteroreceptors located on 5-HT terminals are held responsible for the increase in extracellular 5-HT.[3][28][67][68][69] Because of this, mirtazapine has been said to be a functional "indirect agonist" of the 5-HT1A receptor.[68] Increased activation of the central 5-HT1A receptor is thought to be a major mediator of efficacy of most antidepressant drugs.[70] Unlike most conventional antidepressants, however, mirtazapine is not a reuptake inhibitor and has no appreciable affinity for the serotonin, norepinephrine, or dopamine transporters, nor is it an MAOI or have any efficacy at inhibiting/inducing any other enzyme for that matter.[citation needed]

Antagonism to 5-HT2C receptors appears to provide a mechanism for the treatment of depressive states.[71] In a study mirtazapine's properties in rats were likely to be mediated by its blockade of serotonin receptors, notably 5-HT2C.[72]

In a study the 5-HT2C receptor worked to inhibit the release of the neurotransmitters dopamine and norepinephrine in various parts of the rat brain, notably in the pleasure centers such as the ventral tegmental area (VTA) in rats.[73][74] In a study, by blocking the alpha-2-adrenergic receptors and 5-HT2C receptors, mirtazapine disinhibited dopamine and norepinephrine activity in these areas in rats.[75]

Mirtazapine's antagonism of the 5-HT2A and 5-HT2C receptors has beneficial effects on anxiety, sleep and appetite, as well as sexual function regarding the latter receptor.[28][32]

Additionally, antagonism of the 5-HT3 receptor, the mechanism of action of antiemetic ondansetron, significantly improves pre-existing symptoms of nausea, vomiting, diarrhea, and general irritable bowel syndrome in afflicted individuals.[76] Mirtazapine may be used as an inexpensive antiemetic alternative to ondansetron.[17] Blockade of the 5-HT3 receptors has also shown to improve anxiety and to be effective in the treatment of drug addiction in several studies.[77] Mirtazapine appears to enhance memory function in rats as well and reverses scopolamine-induced memory deficits in mice and rats,[78] effects which may be attributed to 5-HT3 antagonism.[79] In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors, leading to a host of negative changes and side effects, the most prominent of which include anorexia, insomnia, sexual dysfunction (impaired libido and anorgasmia), nausea, and diarrhea, among others. As a result, mirtazapine is often used in conjunction with these drugs to reduce their side effect profile and to produce a stronger antidepressant effect.[32][35][52][53][54][80]

Mirtazapine is a very strong H1 receptor antagonist and as a result, it can cause powerful sedative and hypnotic effects.[citation needed] After a short period of chronic treatment, however, the H1 receptor tends to sensitize and the antihistamine effects become more tolerable. Many patients may also dose at night to avoid the effects and this appears to be an effective strategy for combating them. Blockade of the H1 receptor may improve pre-existing allergies, pruritus, nausea, and insomnia in afflicted individuals; hence, this may actually be a positive thing for some. It may also contribute to weight gain, however.[citation needed] Mirtazapine has very low affinity for the muscarinic acetylcholine receptors and therefore lacks significant anticholinergic properties at clinically used doses.[citation needed]

Similarly to many other antidepressants, mirtazapine has been found to have antinociceptive properties in mice and reduces the intensity of painful stimuli in mice, and it has been suggested that this may contribute to its antidepressant efficacy in mice.[citation needed][81] Unlike with SSRIs and similar antidepressants, however, these effects in mice may be produced through different pathways and appear to result from downstream modulation of μ- and κ3-opioid receptors, an indirect action possibly related to its antagonism of the α2-adrenergic receptor.[81]

Mirtazapine 30 mg tablets.

Pharmacokinetics

Mirtazapine is typically prescribed in doses ranging from 15 mg to 45 mg. However, in severely depressed individuals, doses as high as 120 mg have been used with success.[citation needed] Mirtazapine has a half-life of approximately 20–40 hours. Like most other antidepressants, because of the therapeutic-latency mirtazapine may require as long as 2–4 weeks until the therapeutic benefits of the drug become evident.[citation needed]

Chemistry

The racemic mixture of enantiomers

Mirtazapine is a racemic mixture of enantiomers and the (S)-(+)-enantiomer is known as esmirtazapine.

A four step chemical synthesis of mirtazapine has been published.[82][83]

History

Mirtazapine was introduced by Organon International in the United States in 1990 for the treatment of depression.[citation needed]

Research

Mirtazapine has had literature published on its efficacy (or lack thereof) in the following areas: for the treatment of sleep apnea/hypopnea syndrome,[84][85][86][87][88] headaches such as migraines,[89][90] tension headaches,[91][92][93] post-dural puncture headaches[94] and cluster headaches,[95] hyperemesis gravidarum,[96][97][98] irritable bowel syndrome,[99][100] gastroparesis,[101] dysgeusia,[citation needed] undifferentiated somatoform disorder,[102] autism and other pervasive developmental disorders,[103][104][105][106][107] and neuroleptic-induced akathisia.[108][109][109][110][111][112][113]

References

  1. ^ Timmer, Cees J.; Ad Sitsen, J.M.; Delbressine, Leon P. (2000). "Clinical Pharmacokinetics of Mirtazapine". Clinical Pharmacokinetics 38 (6): 461–74. doi:10.2165/00003088-200038060-00001. PMID 10885584. 
  2. ^ "Future Treatments for Depression, Anxiety, Sleep Disorders, Psychosis, and ADHD -- Neurotransmitter.net". http://www.neurotransmitter.net/newdrugs.html. [unreliable medical source?]
  3. ^ a b Gorman, JM (1999). "Mirtazapine: Clinical overview". The Journal of clinical psychiatry 60 Suppl 17: 9–13; discussion 46–8. PMID 10446735. 
  4. ^ Goodnick, Paul J.; Puig, Alina; Devane, C. Lindsay; Freund, Blanche V. (1999). "Mirtazapine in Major Depression with Comorbid Generalized Anxiety Disorder". The Journal of Clinical Psychiatry 60 (7): 446–8. doi:10.4088/JCP.v60n0705. PMID 10453798. [unreliable medical source?]
  5. ^ Mortberg, E. (2006). "Mirtazapine reduces social anxiety and improves quality of life in women with social phobia". Evidence-Based Mental Health 9 (3): 75. doi:10.1136/ebmh.9.3.75. PMID 16868194. [unreliable medical source?]
  6. ^ Koran, Lorrin M.; Quirk, Thomas; Lorberbaum, Jeffrey P.; Elliott, Michael (2001). "Mirtazapine Treatment of Obsessive-Compulsive Disorder". Journal of Clinical Psychopharmacology 21 (5): 537–9. doi:10.1097/00004714-200110000-00016. PMID 11593084. [unreliable medical source?]
  7. ^ Carpenter, Linda; Leon, Zelko; Yasmin, Sarah; Price, Lawrence (1999). "Clinical Experience with Mirtazapine in the Treatment of Panic Disorder". Annals of Clinical Psychiatry 11 (2): 81–6. doi:10.3109/10401239909147053. PMID 10440525. [unreliable medical source?]
  8. ^ Carli, V.; Sarchiapone, M; Camardese, G; Romano, L; Derisio, S (2002). "Mirtazapine in the Treatment of Panic Disorder". Archives of General Psychiatry 59 (7): 661–2. doi:10.1001/archpsyc.59.7.661. PMID 12090820. [unreliable medical source?]
  9. ^ Ribeiro, L.; Busnello, J.V.; Kauer-Sant'Anna, M.; Madruga, M.; Quevedo, J.; Busnello, E.A.D.; Kapczinski, F. (2001). "Mirtazapine versus fluoxetine in the treatment of panic disorder". Brazilian Journal of Medical and Biological Research 34 (10): 1303–7. doi:10.1590/S0100-879X2001001000010. PMID 11593305. [unreliable medical source?]
  10. ^ Alderman, C. P; Condon, J. T; Gilbert, A. L (2009). "An Open-Label Study of Mirtazapine as Treatment for Combat-Related PTSD". Annals of Pharmacotherapy 43 (7): 1220–6. doi:10.1345/aph.1M009. PMID 19584388. [unreliable medical source?]
  11. ^ Lewis, J. D. (2002). "Mirtazapine for PTSD Nightmares". American Journal of Psychiatry 159 (11): 1948–9. doi:10.1176/appi.ajp.159.11.1948-a. PMID 12411239. [unreliable medical source?]
  12. ^ Hesselmann, B.; Habeler, A.; Praschak-Rieder, N.; Willeit, M.; Neumeister, A.; Kasper, S. (1999). "Mirtazapine in seasonal affective disorder (SAD): A preliminary report". Human Psychopharmacology 14: 59–62. doi:10.1002/(SICI)1099-1077(199901)14:1<59::AID-HUP67>3.0.CO;2-6. [unreliable medical source?]
  13. ^ Winokur, Andrew; Demartinis, Nicholas A.; McNally, Daniel P.; Gary, Ellen M.; Cormier, Jennifer L.; Gary, Keith A. (2003). "Comparative Effects of Mirtazapine and Fluoxetine on Sleep Physiology Measures in Patients with Major Depression and Insomnia". The Journal of Clinical Psychiatry 64 (10): 1224–9. doi:10.4088/JCP.v64n1013. PMID 14658972. [unreliable medical source?]
  14. ^ a b Kim, Sung-Wan; Shin, Il-Seon; Kim, Jae-Min; Kim, Young-Chul; Kim, Kyu-Sik; Kim, Ki-Min; Yang, Su-Jin; Yoon, Jin-Sang (2008). "Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression". Psychiatry and Clinical Neurosciences 62 (1): 75–83. doi:10.1111/j.1440-1819.2007.01778.x. PMID 18289144. [unreliable medical source?]
  15. ^ Cankurtaran, Eylem Sahin; Ozalp, Elvan; Soygur, Haldun; Akbiyik, Derya Iren; Turhan, Levent; Alkis, Necati (2008). "Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: Superiority over imipramine". Supportive Care in Cancer 16 (11): 1291–8. doi:10.1007/s00520-008-0425-1. PMID 18299900. [unreliable medical source?]
  16. ^ Pae, Chi-Un (2006). "Low-dose mirtazapine may be successful treatment option for severe nausea and vomiting". Progress in Neuro-Psychopharmacology and Biological Psychiatry 30 (6): 1143–5. doi:10.1016/j.pnpbp.2006.03.015. PMID 16632163. [unreliable medical source?]
  17. ^ a b Kast, R.E.; Foley, K.F. (2007). "Cancer chemotherapy and cachexia: Mirtazapine and olanzapine are 5-HT3 antagonists with good antinausea effects". European Journal of Cancer Care 16 (4): 351–4. doi:10.1111/j.1365-2354.2006.00760.x. PMID 17587360. 
  18. ^ Chen, Chien-Chuan; Lin, Chia-Shiang; Ko, Yuan-Pi; Hung, Yu-Chun; Lao, Hsuan-Chih; Hsu, Yung-Wei (2008). "Premedication with Mirtazapine Reduces Preoperative Anxiety and Postoperative Nausea and Vomiting". Anesthesia & Analgesia 106 (1): 109–13, table of contents. doi:10.1213/01.ane.0000289636.09841.bc. PMID 18165563. [unreliable medical source?]
  19. ^ Teixeira, Fabio V.; Novaretti, Tânia M.S.; Pilon, Benedito; Pereira, Priscila G.; Breda, Maria Fernanda C.L. (2005). "Mirtazapine (Remeron™) as Treatment for Non-Mechanical Vomiting after Gastric Bypass". Obesity Surgery 15 (5): 707–9. doi:10.1381/0960892053923923. PMID 15946465. [unreliable medical source?]
  20. ^ a b Ito, T; Okubo, Y; Roth, A (2009). "Efficacy of mirtazapine for appetite loss and nausea of the cancer patient--from clinical experience in Memorial Sloan-Kettering Cancer Center". Gan to kagaku ryoho. Cancer & chemotherapy 36 (4): 623–6. PMID 19381036. [unreliable source?]
  21. ^ Thompson, D. S. (2000). "Mirtazapine for the Treatment of Depression and Nausea in Breast and Gynecological Oncology". Psychosomatics 41 (4): 356–9. doi:10.1176/appi.psy.41.4.356. PMID 10906359. [unreliable medical source?]
  22. ^ Mattox, T. W. (2005). "Treatment of Unintentional Weight Loss in Patients with Cancer". Nutrition in Clinical Practice 20 (4): 400–10. doi:10.1177/0115426505020004400. PMID 16207680. 
  23. ^ Fox, Carol B; Treadway, Angela K; Blaszczyk, Amie T; Sleeper, Rebecca B (2009). "Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the Elderly". Pharmacotherapy 29 (4): 383–97. doi:10.1592/phco.29.4.383. PMID 19323618. 
  24. ^ Davis, Mellar P; Frandsen, Jan L; Walsh, Declan; Andresen, Steven; Taylor, Sandy (2003). "Mirtazapine for Pruritus". Journal of Pain and Symptom Management 25 (3): 288–91. doi:10.1016/S0885-3924(02)00645-0. PMID 12614964. [unreliable medical source?]
  25. ^ Hundley, J; Yosipovitch, G (2004). "Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: A pilot study". Journal of the American Academy of Dermatology 50 (6): 889–91. doi:10.1016/j.jaad.2004.01.045. PMID 15153889. [unreliable medical source?]
  26. ^ Demierre, M; Taverna, J (2006). "Mirtazapine and gabapentin for reducing pruritus in cutaneous T-cell lymphoma". Journal of the American Academy of Dermatology 55 (3): 543–4. doi:10.1016/j.jaad.2006.04.025. PMID 16908377. [unreliable medical source?]
  27. ^ Sheen, M. J.; Ho, S.-T.; Lee, C.-H.; Tsung, Y.-C.; Chang, F.-L.; Huang, S.-T. (2008). "Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus". British Journal of Anaesthesia 101 (5): 711–5. doi:10.1093/bja/aen241. PMID 18713761. [unreliable medical source?]
  28. ^ a b c d e f g Anttila, Sami A. K.; Leinonen, Esa V. J. (2006). "A Review of the Pharmacological and Clinical Profile of Mirtazapine". CNS Drug Reviews 7 (3): 249–64. doi:10.1111/j.1527-3458.2001.tb00198.x. PMID 11607047. 
  29. ^ Cipriani, Andrea; Furukawa, Toshiaki A; Salanti, Georgia; Geddes, John R; Higgins, Julian PT; Churchill, Rachel; Watanabe, Norio; Nakagawa, Atsuo et al. (2009). "Comparative efficacy and acceptability of 12 new-generation antidepressants: A multiple-treatments meta-analysis". The Lancet 373 (9665): 746–58. doi:10.1016/S0140-6736(09)60046-5. 
  30. ^ Croom, Katherine F.; Perry, Caroline M.; Plosker, Greg L. (2009). "Mirtazapine". CNS Drugs 23 (5): 427–52. doi:10.2165/00023210-200923050-00006. PMID 19453203. 
  31. ^ Van Moffaert, M.; De Wilde, J.; Vereecken, A.; Dierick, M.; Evrard, J. L.; Wilmotte, J.; Mendlewicz, J. (1995). "Mirtazapine is more effective than trazodone". International Clinical Psychopharmacology 10 (1): 3–9. doi:10.1097/00004850-199503000-00001. PMID 7622801. 
  32. ^ a b c d e f Fawcett, Jan; Barkin, Robert L (1998). "Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression". Journal of Affective Disorders 51 (3): 267–85. doi:10.1016/S0165-0327(98)00224-9. PMID 10333982. 
  33. ^ Bruijn, J. A.; Broek, W. W.; Hulst, A. M.; Mast, R. C.; Wetering, B. J. M.; Moleman, P.; Mulder, P. G. H. (1996). "A double-blind, fixed blood-level study comparing mirtazapine with imipramine in depressed in-patients". Psychopharmacology 127 (3): 231–7. doi:10.1007/BF02246131. PMID 8912401. 
  34. ^ Bruijn, J.; Moleman, P.; Mulder, P.; Van Den Broek, W. (2007). "Depressed In-Patients Respond Differently to Imipramine and Mirtazapine". Pharmacopsychiatry 32 (3): 87–92. doi:10.1055/s-2007-979200. PMID 10463374. 
  35. ^ a b c McGrath, P. J.; Stewart, J. W.; Fava, M.; Trivedi, M. H.; Wisniewski, S. R.; Nierenberg, A. A.; Thase, M. E.; Davis, L. et al. (2006). "Tranylcypromine Versus Venlafaxine Plus Mirtazapine Following Three Failed Antidepressant Medication Trials for Depression: A STAR*D Report". American Journal of Psychiatry 163 (9): 1531–41; quiz 1666. doi:10.1176/appi.ajp.163.9.1531. 
  36. ^ Kim, Sung-Wan; Shin, Il-Seon; Kim, Jae-Min; Park, Kee-Hyung; Youn, Tak; Yoon, Jin-Sang (2008). "Factors potentiating the risk of mirtazapine-associated restless legs syndrome". Human Psychopharmacology: Clinical and Experimental 23 (7): 615–20. doi:10.1002/hup.965. PMID 18756499. [unreliable medical source?]
  37. ^ Montgomery, SA (1995). "Safety of mirtazapine: A review". International clinical psychopharmacology 10 Suppl 4: 37–45. PMID 8930008. 
  38. ^ a b Biswas, P. N.; Wilton, L. V.; Shakir, S. A. W. (2003). "The pharmacovigilance of mirtazapine: Results of a prescription event monitoring study on 13 554 patients in England". Journal of Psychopharmacology 17 (1): 121–6. doi:10.1177/0269881103017001716. PMID 12680749. [unreliable medical source?]
  39. ^ Hartmann, PM (1999). "Mirtazapine: A newer antidepressant". American family physician 59 (1): 159–61. PMID 9917581. 
  40. ^ Thase, Michael E.; Nierenberg, Andrew A.; Vrijland, Peter; Van Oers, Helga J.J.; Schutte, Albert-Jan; Simmons, John H. (2010). "Remission with mirtazapine and selective serotonin reuptake inhibitors: A meta-analysis of individual patient data from 15 controlled trials of acute phase treatment of major depression". International Clinical Psychopharmacology 25 (4): 189–98. doi:10.1097/YIC.0b013e328330adb2. PMID 20531012. 
  41. ^ a b Benazzi, F (1998). "Mirtazapine withdrawal symptoms". Canadian journal of psychiatry. Revue canadienne de psychiatrie 43 (5): 525. PMID 9653542. [unreliable medical source?]
  42. ^ a b Berigan, Timothy R. (2001). "Mirtazapine-Associated Withdrawal Symptoms: A Case Report". Primary Care Companion to the Journal of Clinical Psychiatry 3 (3): 143. PMC 181176. PMID 15014614. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=181176. [unreliable medical source?]
  43. ^ Blier, P (2001). "Pharmacology of rapid-onset antidepressant treatment strategies". The Journal of clinical psychiatry 62 Suppl 15: 12–7. PMID 11444761. 
  44. ^ Van Broekhoven, Frank; Kan, Cornelis C; Zitman, Frans G (2002). "Dependence potential of antidepressants compared to benzodiazepines". Progress in Neuro-Psychopharmacology and Biological Psychiatry 26 (5): 939–43. doi:10.1016/S0278-5846(02)00209-9. PMID 12369270. 
  45. ^ Vlaminck, JJ; Van Vliet, IM; Zitman, FG (2005). "Onttrekkingsverschijnselen bij stoppen met antidepressiva [Withdrawal symptoms of antidepressants]" (in Dutch). Nederlands Tijdschrift voor Geneeskunde 149 (13): 698–701. PMID 15819135. 
  46. ^ Klesmer, J; Sarcevic, A; Fomari, V (2000). "Panic attacks during discontinuation of mirtazepine". Canadian journal of psychiatry. Revue canadienne de psychiatrie 45 (6): 570–1. PMID 10986577. [unreliable medical source?]
  47. ^ MacCall, C.; Callender, J. (1999). "Mirtazapine withdrawal causing hypomania". The British Journal of Psychiatry 175 (4): 390a. doi:10.1192/bjp.175.4.390a. PMID 10789310. [unreliable medical source?]
  48. ^ Ali, S; Milev, R (2003). "Switch to mania upon discontinuation of antidepressants in patients with mood disorders: A review of the literature". Canadian journal of psychiatry. Revue canadienne de psychiatrie 48 (4): 258–64. PMID 12776393. 
  49. ^ Mirtazapine monograph
  50. ^ Gillman, P. Ken (2006). "A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug Action". Biological Psychiatry 59 (11): 1046–51. doi:10.1016/j.biopsych.2005.11.016. PMID 16460699. 
  51. ^ Hoes, M.; Zeijpveld, JH (2007). "Mirtazapine as Treatment for Serotonin Syndrome". Pharmacopsychiatry 29 (2): 81. doi:10.1055/s-2007-979550. PMID 8741027. [unreliable medical source?]
  52. ^ a b Sennef, C.; Timmer, C. J.; Sitsen, J. M. A. (2003). "Mirtazapine in combination with amitriptyline: A drug-drug interaction study in healthy subjects". Human Psychopharmacology: Clinical and Experimental 18 (2): 91–101. doi:10.1002/hup.441. PMID 12590402. [unreliable medical source?]
  53. ^ a b de la Gándara Martín, J; Agüera Ortiz, L; Ferre Navarrete, F; Rojo Rodés, E; Ros Montalbán, S; Grupo Geaa (Grupo De Estudio De Las Asociaciones De Antidepresivos), Spain (2002). "Eficacia y seguridad de la asociación de antidepresivos [Tolerability and efficacy of combined antidepressant therapy]" (in Spanish). Actas Españolas de Psiquiatría 30 (2): 75–84. PMID 12028939. http://www.psiquiatria.com/articulos/atprimaria_y_sm/15413/. 
  54. ^ a b Lavindran, Lakshmi N; Eisfeld, Beata S.; Kennedy, Sidney H. (2008). "Combining Mirtazapine and Duloxetine in Treatment-Resistant Depression Improves Outcomes and Sexual Function". Journal of Clinical Psychopharmacology 28 (1): 107–8. doi:10.1097/JCP.0b013e318160d609. PMID 18204355. [unreliable medical source?]
  55. ^ Abo-Zena, Reem A.; Bobek, Mary Beth; Dweik, Raed A. (2000). "Hypertensive Urgency Induced by an Interaction of Mirtazapine and Clonidine". Pharmacotherapy 20 (4): 476–8. doi:10.1592/phco.20.5.476.35061. PMID 10772378. [unreliable medical source?]
  56. ^ Velazquez, C; Carlson, A; Stokes, KA; Leikin, JB (2001). "Relative safety of mirtazapine overdose". Veterinary and human toxicology 43 (6): 342–4. PMID 11757992. [unreliable medical source?]
  57. ^ Holzbach, Rüdiger; Jahn, Holger; Pajonk, Frank-Gerald; Mähne, Christiane (1998). "Suicide attempts with mirtazapine overdose without complications". Biological Psychiatry 44 (9): 925–6. doi:10.1016/S0006-3223(98)00081-X. PMID 9807651. [unreliable medical source?]
  58. ^ Retz, W.; Maier, S.; Maris, F.; Rösler, M. (1998). "NON-fatal mirtazapine overdose". International Clinical Psychopharmacology 13 (6): 277–9. doi:10.1097/00004850-199811000-00007. PMID 9861579. [unreliable medical source?]
  59. ^ Nikolaou, P.; Dona, A.; Papoutsis, I.; Spiliopoulou, C.; Maravelias, C.. Death Due to Mirtazapine Overdose.  in "Abstracts of the XXIX International Congress of the European Association of Poison Centres and Clinical Toxicologists, May 12–15, 2009, Stockholm, Sweden". Clinical Toxicology 47 (5): 436. 2009. doi:10.1080/15563650902952273. 
  60. ^ Baselt, Randall C. (2008). Disposition of Toxic Drugs and Chemicals in Man (8th ed.). Foster City, CA: Biomedical Publications. pp. 1045–7. ISBN 978-0-9626523-7-0. 
  61. ^ Buckley, Nicholas A.; McManus, Peter R. (2002). "Fatal toxicity of serotoninergic and other antidepressant drugs: Analysis of United Kingdom mortality data". BMJ 325 (7376): 1332–3. doi:10.1136/bmj.325.7376.1332. PMC 137809. PMID 12468481. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=137809. [unreliable medical source?]
  62. ^ a b Fernández, Javier; Alonso, José M.; Andrés, José I.; Cid, José M.; Díaz, Adolfo; Iturrino, Laura; Gil, Pilar; Megens, Anton et al. (2005). "Discovery of New Tetracyclic Tetrahydrofuran Derivatives as Potential Broad-Spectrum Psychotropic Agents". Journal of Medicinal Chemistry 48 (6): 1709–12. doi:10.1021/jm049632c. PMID 15771415. [unreliable medical source?]
  63. ^ a b Deboer, T; Maura, G; Raiteri, M; Devos, C; Wieringa, J; Pinder, R (1988). "Neurochemical and autonomic pharmacological profiles of the 6-aza-analogue of mianserin, org 3770 and its enantiomers". Neuropharmacology 27 (4): 399–408. doi:10.1016/0028-3908(88)90149-9. PMID 3419539. [unreliable medical source?]
  64. ^ De Boer, T (1996). "The pharmacologic profile of mirtazapine". The Journal of clinical psychiatry 57 Suppl 4: 19–25. PMID 8636062. 
  65. ^ Kooyman, A.R.; Zwart, R.; Vanderheijden, P.M.L.; Van Hooft, J.A.; Vijverberg, H.P.M. (1994). "Interaction between enantiomers of mianserin and ORG3770 at 5-HT3 receptors in cultured mouse neuroblastoma cells". Neuropharmacology 33 (3–4): 501–7. doi:10.1016/0028-3908(94)90081-7. PMID 7984289. [unreliable medical source?]
  66. ^ Boess, F.G.; Monsma, F.J.; Carolo, C.; Meyer, V.; Rudler, A.; Zwingelstein, C.; Sleight, A.J. (1997). "Functional and Radioligand Binding Characterization of Rat 5-HT6 Receptors Stably Expressed in HEK293 Cells". Neuropharmacology 36 (4–5): 713–20. doi:10.1016/S0028-3908(97)00019-1. PMID 9225298. [unreliable medical source?]
  67. ^ De Boer, Thijs; Nefkens, Frans; Van Helvoirt, Ad (1994). "The α2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo". European Journal of Pharmacology 253 (1–2): R5–6. doi:10.1016/0014-2999(94)90778-1. PMID 7912194. [unreliable medical source?]
  68. ^ a b Berendsen, H. H. G.; Broekkamp, Chris L. E. (1997). "Indirect in vivo 5-HT 1A -agonistic effects of the new antidepressant mirtazapine". Psychopharmacology 133 (3): 275–82. doi:10.1007/s002130050402. PMID 9361334. 
  69. ^ Nakayama, K; Sakurai, T; Katsu, H (2004). "Mirtazapine increases dopamine release in prefrontal cortex by 5-HT1A receptor activation". Brain Research Bulletin 63 (3): 237–41. doi:10.1016/j.brainresbull.2004.02.007. PMID 15145142. [unreliable medical source?]
  70. ^ Blier, Pierre; Abbott, Frances V. (2001). "Putative mechanisms of action of antidepressant drugs in affective and anxiety disorders and pain". Journal of psychiatry & neuroscience 26 (1): 37–43. PMC 1408043. PMID 11212592. http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-26/issue-1/pdf/pg37.pdf. 
  71. ^ Millan, Mark John (2005). "Le récepteur 5-HT2C comme cible dans le traitement des états dépressifs et anxieux : Nouvelles stratégies thérapeutiques [Serotonin 5-HT2C Receptors as a Target for the Treatment of Depressive and Anxious States: Focus on Novel Therapeutic Strategies]" (in French). Thérapie 60 (5): 441–60. doi:10.2515/therapie:2005065. PMID 16433010. 
  72. ^ Dekeyne, Anne; Millan, Mark J. (2008). "Discriminative stimulus properties of the 'atypical' antidepressant, mirtazapine, in rats: A pharmacological characterization". Psychopharmacology 203 (2): 329–41. doi:10.1007/s00213-008-1259-8. PMID 18709360. [unreliable medical source?]
  73. ^ De Deurwaerdère, Philippe; Navailles, Sylvia; Berg, Kelly A.; Clarke, William P.; Spampinato, Umberto (2004). "Constitutive Activity of the Serotonin2C Receptor Inhibits in Vivo Dopamine Release in the Rat Striatum and Nucleus Accumbens". Journal of Neuroscience 24 (13): 3235–41. doi:10.1523/JNEUROSCI.0112-04.2004. PMID 15056702. [unreliable medical source?]
  74. ^ Bubar, M.J.; Cunningham, K.A. (2007). "Distribution of serotonin 5-HT2C receptors in the ventral tegmental area". Neuroscience 146 (1): 286–97. doi:10.1016/j.neuroscience.2006.12.071. PMC 1939890. PMID 17367945. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1939890. [unreliable medical source?]
  75. ^ Millan, M. J.; Gobert, A.; Rivet, J. -M.; Adhumeau-Auclair, A.; Cussac, D.; Newman-Tancredi, A.; Dekeyne, A.; Nicolas, J. -P. et al. (2000). "Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of α2-adrenergic and serotonin2C receptors: a comparison with citalopram". European Journal of Neuroscience 12 (3): 1079–95. doi:10.1046/j.1460-9568.2000.00982.x. PMID 10762339. 
  76. ^ r., Kast (2001). "Mirtazapine may be useful in treating nausea and insomnia of cancer chemotherapy". Supportive Care in Cancer 9 (6): 469–70. doi:10.1007/s005200000215. PMID 11585276. 
  77. ^ Costall, Brenda; Naylor, Robert J.; Tyers, Michael B. (1990). "The psychopharmacology of 5-HT3 receptors". Pharmacology & Therapeutics 47 (2): 181. doi:10.1016/0163-7258(90)90086-H. 
  78. ^ Nowakowska, Elżbieta; Chodera, Alfons; Kus, Krzysztof (1999). "Behavioral and memory improving effects of mirtazapine in rats". Polish Journal of Pharmacology 51 (6): 463–9. PMID 10817523. http://www.if-pan.krakow.pl/pjp/996_2.htm. [unreliable medical source?]
  79. ^ Roychoudhury, M; Kulkarni, SK (1997). "Effects of ondansetron on short-term memory retrieval in mice". Methods and findings in experimental and clinical pharmacology 19 (1): 43–6. PMID 9098839. 
  80. ^ Caldis, EV; Gair, RD (2004). "Mirtazapine for treatment of nausea induced by selective serotonin reuptake inhibitors". Canadian journal of psychiatry. Revue canadienne de psychiatrie 49 (10): 707. PMID 15560319. 
  81. ^ a b Schreiber, Shaul; Bleich, Avi; Pick, Chaim G. (2002). "Venlafaxine and Mirtazapine". Journal of Molecular Neuroscience 18 (1–2): 143–9. doi:10.1385/JMN:18:1-2:143. PMID 11931344. 
  82. ^ Rao, Divvela V. N. Srinivasa; Dandala, Ramesh; Bharathi, Chalamakuri; Handa, Vijay Kumar; Sivakumaran, Meenakshisunderam; Naidub, Andra (2006). "Synthesis of potential related substances of mirtazapine". Arkivoc 2006 (15): 127–32. http://www.arkat-usa.org/get-file/22868/. 
  83. ^ US patent 4062848, Van der Burg WJ, "Tetracyclic compounds", published 1977-12-13, issued 1977-12-13 
  84. ^ Castillo, José Luis; Menendez, Pedro; Segovia, Luis; Guilleminault, Christian (2004). "Effectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome (SAHS)". Sleep Medicine 5 (5): 507–8. doi:10.1016/j.sleep.2004.06.004. PMID 15341898. 
  85. ^ Carley, David W.; Olopade, Christopher; Ruigt, Ge S.; Radulovacki, Miodrag (2007). "Efficacy of Mirtazapine in Obstructive Sleep Apnea Syndrome". Sleep 30 (1): 35–41. PMID 17310863. http://www.journalsleep.org/Articles/300105.pdf. 
  86. ^ Marshall, NS; Yee, BJ; Desai, AV; Buchanan, PR; Wong, KK; Crompton, R; Melehan, KL; Zack, N et al. (2008). "Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea". Sleep 31 (6): 824–31. PMC 2442407. PMID 18548827. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2442407. 
  87. ^ Brunner, H. (2008). "Success and failure of mirtazapine as alternative treatment in elderly stroke patients with sleep apnea—a preliminary open trial". Sleep and Breathing 12 (3): 281–5. doi:10.1007/s11325-008-0177-7. PMID 18369672. 
  88. ^ Carley, David W.; Radulovacki, Midrag (1999). "Mirtazapine, a Mixed-Profile Serotonin Agonist/Antagonist, Suppresses Sleep Apnea in the Rat". American journal of respiratory and critical care medicine 160 (6): 1824–9. PMID 10588592. http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=10588592. 
  89. ^ Lévy, Emmanuelle; Margolese, Howard C. (2003). "Migraine headache prophylaxis and treatment with low-dose mirtazapine". International Clinical Psychopharmacology 18 (5): 301–3. doi:10.1097/01.yic.0000080803.87368.01. PMID 12920393. 
  90. ^ Brannon, G. E.; Rolland, PD; Gary, JM (2000). "Use of Mirtazapine as Prophylactic Treatment for Migraine Headache". Psychosomatics 41 (2): 153–4. doi:10.1176/appi.psy.41.2.153. PMID 10749956. 
  91. ^ Bendtsen, Lars; Jensen, Rigmor (2004). "Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache". Neurology 62 (10): 1706–11. PMID 15159466. 
  92. ^ Bendtsen, L.; Buchgreitz, L.; Ashina, S.; Jensen, R. (2007). "Combination of low-dose mirtazapine and ibuprofen for prophylaxis of chronic tension-type headache". European Journal of Neurology 14 (2): 187–93. doi:10.1111/j.1468-1331.2006.01607.x. PMID 17250728. 
  93. ^ Martín-Araguz, A; Bustamante-Martínez, C; De Pedro-Pijoán, JM (2003). "Tratamiento de la cefalea tipo tensión crónica con mirtazapina y amitriptilina [Treatment of chronic tension type headache with mirtazapine and amitriptyline]" (in Spanish). Revista de neurologia 37 (2): 101–5. PMID 12938066. http://www.revneurol.com/LinkOut/formMedLine.asp?Refer=2002498&Revista=Revneurol. 
  94. ^ Sheen, Michael J.; Ho, Shung-Tai (2008). "Mirtazapine Relieves Postdural Puncture Headache". Anesthesia & Analgesia 107: 346. doi:10.1213/ane.0b013e3181771074. 
  95. ^ "Letters to the Editor". Headache: the Journal of Head and Face Pain 39 (8): 586–7. 1999. doi:10.1046/j.1526-4610.1999.t01-1-3908586.x. 
  96. ^ Guclu, Serkan; Gol, Mert; Dogan, Erbil; Saygili, Ugur (2005). "Mirtazapine use in resistant hyperemesis gravidarum: Report of three cases and review of the literature". Archives of Gynecology and Obstetrics 272 (4): 298–300. doi:10.1007/s00404-005-0007-0. PMID 16007504. 
  97. ^ Dorn, Christoph; Rohde, Anke; Dembinski, Joerg (2003). "Mirtazapine (Remergil) for treatment resistant hyperemesis gravidarum: Rescue of a twin pregnancy". Archives of Gynecology and Obstetrics 268 (3): 219–21. doi:10.1007/s00404-003-0502-0. PMID 12819986. 
  98. ^ Schwarzer, V.; Heep, A.; Gembruch, U.; Rohde, A. (2007). "Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: Neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine". Archives of Gynecology and Obstetrics 277 (1): 67–9. doi:10.1007/s00404-007-0406-5. PMID 17628816. 
  99. ^ Thomas, Stephanie G. (2000). "Irritable Bowel Syndrome and Mirtazapine". The American journal of psychiatry 157 (8): 1341–2. doi:10.1176/appi.ajp.157.8.1341-a. PMID 10910804. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10910804. 
  100. ^ Thomas, S. G. (2000). "Irritable Bowel Syndrome and Mirtazapine". American Journal of Psychiatry 157 (8): 1341–2. doi:10.1176/appi.ajp.157.8.1341-a. PMID 10910804. 
  101. ^ Kim, S.-w.; Shin, I.-s.; Kim, J.-m.; Kang, H.-c.; Mun, J.-u.; Yang, S.-j.; Yoon, J.-s. (2006). "Mirtazapine for Severe Gastroparesis Unresponsive to Conventional Prokinetic Treatment". Psychosomatics 47 (5): 440–2. doi:10.1176/appi.psy.47.5.440. PMID 16959934. 
  102. ^ Han, C; Pae, CU; Lee, BH; Ko, YH; Masand, PS; Patkar, AA; Joe, SH; Jung, IK (2008). "Venlafaxine versus mirtazapine in the treatment of undifferentiated somatoform disorder: A 12-week prospective, open-label, randomized, parallel-group trial". Clinical drug investigation 28 (4): 251–61. PMID 18345715. 
  103. ^ Posey, David J.; Guenin, Krista D.; Kohn, Arlene E.; Swiezy, Naomi B.; McDougle, Christopher J. (2001). "A Naturalistic Open-Label Study of Mirtazapine in Autistic and Other Pervasive Developmental Disorders". Journal of Child and Adolescent Psychopharmacology 11 (3): 267–77. doi:10.1089/10445460152595586. PMID 11642476. 
  104. ^ Coskun, Murat; Karakoc, Sevcan; Kircelli, Fuat; Mukaddes, Nahit Motavalli (2009). "Effectiveness of Mirtazapine in the Treatment of Inappropriate Sexual Behaviors in Individuals with Autistic Disorder". Journal of Child and Adolescent Psychopharmacology 19 (2): 203–6. doi:10.1089/cap.2008.020. PMID 19364298. 
  105. ^ Coskun, Murat; Mukaddes, Nahit Motavalli (2008). "Mirtazapine Treatment in a Subject with Autistic Disorder and Fetishism". Journal of Child and Adolescent Psychopharmacology 18 (2): 206–9. doi:10.1089/cap.2007.0014. PMID 18439117. 
  106. ^ Albertini, G; Polito, E; Sara, M; Digennaro, G; Onorati, P (2006). "Compulsive Masturbation in Infantile Autism Treated by Mirtazapine". Pediatric Neurology 34 (5): 417–8. doi:10.1016/j.pediatrneurol.2005.10.023. PMID 16648008. 
  107. ^ Nguyen, Mathew; Murphy, Tanya (2001). "Mirtazapine for Excessive Masturbation in an Adolescent with Autism". Journal of the American Academy of Child & Adolescent Psychiatry 40 (8): 868–9. doi:10.1097/00004583-200108000-00004. 
  108. ^ Poyurovsky, Michael; Weizman, A (2001). "Mirtazapine for Neuroleptic-Induced Akathisia". The American journal of psychiatry 158 (5): 819. doi:10.1176/appi.ajp.158.5.819. PMID 11329417. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=11329417. 
  109. ^ a b Poyurovsky, Michael; Epshtein, Svetlana; Fuchs, Camil; Schneidman, Michael; Weizman, Ronit; Weizman, Abraham (2003). "Efficacy of Low-Dose Mirtazapine in Neuroleptic-Induced Akathisia: A Double-Blind Randomized Placebo-Controlled Pilot Study". Journal of Clinical Psychopharmacology 23 (3): 305–8. doi:10.1097/01.jcp.0000084027.22282.16. PMID 12826992. 
  110. ^ Poyurovsky, Michael; Pashinian, Artashes; Weizman, Ronit; Fuchs, Camil; Weizman, Abraham (2006). "Low-Dose Mirtazapine: A New Option in the Treatment of Antipsychotic-Induced Akathisia. A Randomized, Double-Blind, Placebo- and Propranolol-Controlled Trial". Biological Psychiatry 59 (11): 1071–7. doi:10.1016/j.biopsych.2005.12.007. PMID 16497273. 
  111. ^ Hieber, R.; Dellenbaugh, T.; Nelson, L. A. (2008). "Role of Mirtazapine in the Treatment of Antipsychotic-Induced Akathisia". Annals of Pharmacotherapy 42 (6): 841–6. doi:10.1345/aph.1K672. PMID 18460588. 
  112. ^ Ranjan, S.; Chandra, PS; Chaturvedi, SK; Prabhu, SC; Gupta, A (2006). "Atypical Antipsychotic-Induced Akathisia with Depression: Therapeutic Role of Mirtazapine". Annals of Pharmacotherapy 40 (4): 771–4. doi:10.1345/aph.1G561. PMID 16569791. 
  113. ^ Poyurovsky, M.; Weizman, A (2001). "Mirtazapine for Neuroleptic-Induced Akathisia". American Journal of Psychiatry 158 (5): 819. doi:10.1176/appi.ajp.158.5.819. PMID 11329417. 

Further reading

  • Stimmel, GL; Dopheide, JA; Stahl, SM (1997). "Mirtazapine: An antidepressant with noradrenergic and specific serotonergic effects". Pharmacotherapy 17 (1): 10–21. PMID 9017762. 
  • Croom, Katherine F.; Perry, Caroline M.; Plosker, Greg L. (2009). "Mirtazapine". CNS Drugs 23 (5): 427–52. doi:10.2165/00023210-200923050-00006. PMID 19453203. 
  • Anttila, Sami A. K.; Leinonen, Esa V. J. (2006). "A Review of the Pharmacological and Clinical Profile of Mirtazapine". CNS Drug Reviews 7 (3): 249–64. doi:10.1111/j.1527-3458.2001.tb00198.x. PMID 11607047. 
  • Timmer, Cees J.; Ad Sitsen, J.M.; Delbressine, Leon P. (2000). "Clinical Pharmacokinetics of Mirtazapine". Clinical Pharmacokinetics 38 (6): 461–74. doi:10.2165/00003088-200038060-00001. PMID 10885584. 

External links


Wikimedia Foundation. 2010.

Игры ⚽ Нужна курсовая?

Look at other dictionaries:

  • Mirtazapine — Énantiomère R de la mirtazapine (en haut) et S mirtazapine (en bas) Général …   Wikipédia en Français

  • mirtazapine — noun A tetracyclic antidepressant drug …   Wiktionary

  • mirtazapine — mir·taz·a·pine (mir″taz ə pēn) an antidepressant compound unrelated to any of the classes of antidepressants; administered orally …   Medical dictionary

  • mirtazapine — A drug used to treat depression. It belongs to the family of drugs called antidepressant agents. Also called Remeron …   English dictionary of cancer terms

  • 61337-67-5 — Mirtazapine Mirtazapine Général Nom IUPAC (±) 1,2,3,4,10,14b Hexahydro 2 méthylpyrazino(2,1 a)pyrido(2,3 c)benzazépine …   Wikipédia en Français

  • C17H19N3 — Mirtazapine Mirtazapine Général Nom IUPAC (±) 1,2,3,4,10,14b Hexahydro 2 méthylpyrazino(2,1 a)pyrido(2,3 c)benzazépine …   Wikipédia en Français

  • Norset — Mirtazapine Mirtazapine Général Nom IUPAC (±) 1,2,3,4,10,14b Hexahydro 2 méthylpyrazino(2,1 a)pyrido(2,3 c)benzazépine …   Wikipédia en Français

  • Remeron — Mirtazapine Mirtazapine Général Nom IUPAC (±) 1,2,3,4,10,14b Hexahydro 2 méthylpyrazino(2,1 a)pyrido(2,3 c)benzazépine …   Wikipédia en Français

  • Mirtazapin — Strukturformel (R) Enantiomer (oben) und (S) Enantiomer (unten) Allgemeines …   Deutsch Wikipedia

  • Antidepressant — Fluoxetine (Prozac), an SSRI The chemical structure of …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”