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Re: NE alpha-2 antagonism + reuptake inhibitors = AD++ King Vultan

Posted by SLS on September 2, 2004, at 6:38:32

In reply to Re: NE alpha-2 antagonism + reuptake inhibitors = AD++ SLS, posted by King Vultan on September 1, 2004, at 23:19:50

> > This provides a nice pharmacological rationale for the use of Remeron or Buspar (with its 1-PP metabolite) as augmentors.

> As for Remeron, Stahl in "Essential Psychopharmacology" states "The therapeutic actions of mirtazapine are thought to be mainly mediated through its alpha 2 antagonist properties."

So, is he discounting 5-HT2a antagonism as being contributory?

> However, mirtazapine has other things going for it; the selective alpha-2 antagonists such as yohimbine and idazoxan are rather one dimensional in comparison and have not really demonstrated any kind of robust AD effects. Remeron, OTOH, apparently does, to a large enough extent to at least be classified as an antidepressant, and demonstrating AD efficacy in many cases just being used by itself.

The multiple actions of Remeron probably confer its superior antidepressant properties, but I thought it was interesting to see how the isolation of NE alpha-2 antagonism itself specifically potentiated the effects that the monoamine reuptake inhibitors have on neurotransmitter levels in frontal cortical areas of the brain. It represents a discreet building block in understanding the synergies that multiple actions can have.

- Scott




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