Mirtazapine Treatment of a Severe Depressive Episode and Resolution of Elevated Inflammatory Markers
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Abstract:
Depression has been shown to be associated with systemic inflammatory activity and the mode of action of several antidepressants appears to involve immunomodulation. Effects on immune system activity have also recently been observed in correlation with therapeutic response to mirtazapine in cardiac patients with depression, but no study has yet examined these effects in otherwise physically healthy depressed patients treated with mirtazapine. This report describes an association between a clinical antidepressant response and a decrease in markers of systemic inflammation observed during pharmacotherapy with mirtazapine in a severely depressed but physically well patient. This observation adds to the evidence that changes in inflammatory responses may be implicated in the mode of action of antidepressants. Further studies of antidepressant responses to mirtazapine and levels of inflammatory markers in depressed patients without medical comorbidity can help elucidate the role of the immune system in the pathophysiology of depression, and hence contribute to the development of novel antidepressant therapies.Keywords:
Mirtazapine
Depression
Pathophysiology
Pharmacotherapy
Mianserin
Two cases of restless legs syndrome in association with mirtazapine treatment of 5–6 weeks are presented. Rather than akathisia related to serotonine reuptake inhibitors, which usually emerges during the first weeks of treatment, our cases resemble previously described mianserin-induced RLS cases. This suggests that although blockade of 5-HT2 receptors by mirtazapine may be protective against acute akathisia, it does not protect against slowly developing restless legs syndrome similar to that induced by mianserin. © 1997 John Wiley & Sons, Ltd.
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Summary Objective. The aim of our work is to describe the first two cases of arthralgia associated with the antidepressant drug mirtazapine. Method. Descriptive analysis of two iatrogenic cases. The review of the literature was achieved by the traditional electronic methods. The French database of iatrogenic cases was consulted. Results. A 53-year-old man presented with gonalgia after some weeks of mirtazapine treatment. The intensity of the arthralgia was correlated with the dosage and the adverse effect rapidly disappeared after the antidepressant therapy was stopped. A 38-year-old woman received mirtazapine for 3 months and complained of arthralgia and myalgia. This clinical picture was suspended as the drug was stopped and a positive reintroduction was observed. No other cause was found in these two patients. Discussion. No similar case has been reported in the international literature, but several observations of arthralgia with mianserin are mentioned. As mirtazapine is the 6-aza derivative of the tetracyclic antidepressant mianserin, the similarities of their chemical structures begs the responsibility of mirtazapine for arthralgia.
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Two cases of restless legs syndrome in association with mirtazapine treatment of 5–6 weeks are presented. Rather than akathisia related to serotonine reuptake inhibitors, which usually emerges during the first weeks of treatment, our cases resemble previously described mianserin-induced RLS cases. This suggests that although blockade of 5-HT2 receptors by mirtazapine may be protective against acute akathisia, it does not protect against slowly developing restless legs syndrome similar to that induced by mianserin. © 1997 John Wiley & Sons, Ltd.
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Restless Legs Syndrome
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The paper systematizes the history of studying the neurochemical activity of mianserin and mirtazapine. The concept of the development of the antidepressant effect of these drugs, by stimulating the release of norepinephrine into the synaptic cleft, is shown to have gained unanimously acceptance. The data on manifestation of their thymoleptic effect due to stimulation of the release of serotonin into the synaptic cleft have been disputed. Other neurochemical theories of the development of the antidepressant activity of mianserin and mirtazapine have been unproven or rejected. The history of identifying the position of mianserin and mirtazapine in the classification of antidepressants has been generalized. The paper shows the ambiguity of approaches to this issue. As turned out, the legality of using the term «noradrenalinergic and specific serotonergic antidepressant» has been criticized. Analysis of historical facts has identified that it is rational to assign mianserin and mirtazapine to one neurochemical group and its designation by the term «norepinephrine and (presumably) serotonin release stimulators – α 2 -adrenergic receptor and serotonin 5-HT2 receptor blockers».
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Mianserin
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Depression
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Mirtazapine Treatment of a Severe Depressive Episode and Resolution of Elevated Inflammatory Markers
Depression has been shown to be associated with systemic inflammatory activity and the mode of action of several antidepressants appears to involve immunomodulation. Effects on immune system activity have also recently been observed in correlation with therapeutic response to mirtazapine in cardiac patients with depression, but no study has yet examined these effects in otherwise physically healthy depressed patients treated with mirtazapine. This report describes an association between a clinical antidepressant response and a decrease in markers of systemic inflammation observed during pharmacotherapy with mirtazapine in a severely depressed but physically well patient. This observation adds to the evidence that changes in inflammatory responses may be implicated in the mode of action of antidepressants. Further studies of antidepressant responses to mirtazapine and levels of inflammatory markers in depressed patients without medical comorbidity can help elucidate the role of the immune system in the pathophysiology of depression, and hence contribute to the development of novel antidepressant therapies.
Mirtazapine
Depression
Pathophysiology
Pharmacotherapy
Mianserin
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Milnacipran
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