Dr. Bob's Psychopharmacology Tips

Mirtazapine effects

Subject: Mirtazapine press release
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Fri, 13 Sep 1996 23:49:00 -0640

Here's a press release on mirtazapine I found:

West Orange, N.J., June 19, 1996 -- Organon today announced that the U.S. Food and Drug Administration (FDA) cleared for marketing Remeron (mirtazapine) for the treatment of depression...

"Remeron's ability to specifically target serotonin receptors is critical, since it minimizes common side effects patients typically find undesirable with most other agents, such as decreased sexual drive, nervousness and insomnia," said Dr. Paul Lammers, Medical Director at Organon...

Clinical Trial Data

The FDA clearance of Remeron is based on efficacy data from clinical trials involving approximately 3,000 people. Results from placebo and amitriptyline-controlled clinical trials supported the conclusion that Remeron provides effective relief of depression...

Side Effect Profile

Side effects observed in clinical trials were mostly mild and generally have not caused patients to stop taking Remeron. The commonly reported drug-related side effects were somnolence, increased appetite, weight gain and dizziness...

Date: 14 Aug 96 08:36:19 EDT
From: "Furey A. Lerro" <71544.3434@compuserve.com>
Subject: Mirtazapine effects

At the APA this year, Preskorn's group reported a double blind crossover study on this 5HT2 antagonist. The study was done in three groups of patients. Two had not responded to placebo and amitriptyline, respectively, after 6 weeks; after being switched to mirtazapine for eight weeks, 71% of placebo group and 59% of amitriptyline group responded. Additionally, with the third group (made up of mirtazapine nonresponders), eight weeks of amitriptyline yielded a 55% response rate.

Date: Sun, 18 Aug 1996 23:56:57 +0300 (EET DST)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Mianserin effects

Mirtazapine resembles closely mianserin, which has been marketed in this country since the begining of the 80s... Here mianserin is used mainly for older people and very agitated depressives.

An interesting possibility is the use of mirtazapine together with moclobemide. We often do this with mianserin.

Date: Thu, 21 Nov 1996 17:36:40 -0500 (EST)
From: "William B. Strek" <wstrek@athens.net>
Subject: Mirtazapine effects

I have been cautiously using mirtazapine in several of my treatment-refractory depressed patients. Generally these are elderly depressed patients with a significant co-morbid anxiety component. Several of these depressed patients had a co-morbid panic disorder and they have been able to be tapered off their benzodiazepines. One even could be completely tapered off her clonazepam, which was at 12 mg/day. She is not elderly, but is a generally anxious character, but no longer has any panic attacks on 15 mg/day of mirtazapine.

Date: Thu, 17 Apr 1997 14:17:02 -0700 (PDT)
From: Talia Puzantian <talia@itsa.ucsf.edu>
Subject: Mirtazapine effects

I have been involved in 5 or so cases in whom we have used this agent. My impression thus far from this small N is that it is very effective as an antidepressant and has some anxiolytic or "calming" properties and a usual onset of effect after 1-2 weeks (longer for full effects). The patients who we have started on mirtazapine tend to be those who have failed or not tolerated SSRI...

Subject: Mirtazapine effects
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Thu, 17 Apr 1997 23:13:00 -0640

I've been singularly unimpressed. I have given decent trials of it to five patients. Of course, they had treatment-resistant depression, but four of the five did not stick with it due to lack of efficacy. Side effects were largely tolerable.

Date: Tue, 06 May 1997 12:05:16 -0400
From: Godfrey Pearlson <godfr@welchlink.welch.jhu.edu>
Subject: Mirtazapine effects and dosage

So far I've had good luck with mirtazapine (Remeron) in 3 cases of previously treatment-resistant (failures on multiple medication classes, plus ECT) depression.

The Organon recommendation is 45 mg max -- I have one patient who is a partial responder on 60 mg/day.

Date: Wed, 16 Jul 1997 14:50:39 -0400
From: Godfrey Pearlson <godfr@welchlink.welch.jhu.edu>
Subject: Mirtazapine effects and dosage

I've had 6 or so patients who were non-responders to several prior antidepressant classes (and in 2 cases to ECT) who've remitted on Remeron (mirtazapine). After talking to the drug manufacturer and getting reprints from them on European research, I'm more comfortable pushing the dose up (in 1 case to 90 mg) where tolerated.

Date: Mon, 26 Jan 1998 19:30:36 -0500
From: Whit Garberson <jwgg@world.std.com>
Subject: Mirtazapine weight gain

Mirtazapine is well known for stimulating appetite and thereby causing weight gain... Appetite loss is such a serious issue in the fragile elderly that this could literally be lifesaving for some.

Date: Wed, 29 Apr 1998 17:48:18 -1000
From: Leslie Gise <leslieg@maui.net>
Subject: Mirtazapine dosage

The drug company sent me several abstracts of studies using up to 75-80 mg. I have one patient on 75 mg who had a low blood level (you can get blood levels) on regular doses. She has not responded.

Date: Wed, 6 May 1998 13:52:52 +0300 (EEST)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Mirtazapine dosage

In Finland 90 mg per day has been used, although the manufacturer's upper limit is only 60 mg. Mianserin (Tolvon) has been available here for a long time and also with it dose recommendations have been absolutely too low (company: up to 60 mg, in practice: up to 120 mg). Mianserin of course is a cousin of this drug.

Date: Thu, 16 Jul 1998 18:12:15 -0400
From: Benjamin Crocker <crockb@pol.net>
Subject: Mirtazapine effects

I have rarely tried to use mirtazapine for depression because there are so many other options and the aplastic anemia issue hasn't been answered to my satisfaction; but desperate insomnia in chronically parasuicidal substance abusers who have tried everything else has led me to use this agent for sleep. When they sleep, they feel a bit better. The effect doesn't always last; these are very unstable patients in whom medications rarely work well long term, so after using this agent a lot when it first came out, I am now using it very little in my more or less closed case load of longterm patients.

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