Mirtazepine

BACKGROUND: Panadol Osteo (GlaxoSmithKline) is a modified-release paracetamol formulation marketed in Australia and New Zealand, comprising 33% immediate and 66% sustained-release fractions. In overdose, absorption may be delayed and the paracetamol treatment nomogram can miss potentially toxic paracetamol concentrations if only one serum estimate is taken. We report a massive ingestion of Panadol Osteo with biphasic, prolonged absorption requiring extended treatment with N-acetylcysteine...

The aim of the present study was to review the sexual side-effects of contemporary antidepressants in Australia, comparing the selective serotonin re-uptake inhibitors (SSRIs) with venlafaxine, reboxetine, mirtazepine, duloxetine, bupropion, desvenlafaxine and agomelatine. Double-blind, randomized comparative studies of these antidepressants that included assessment of sexual dysfunction with validated rating scales in patients with major depressive disorder were identified from the literature using MEDLINE, EMBASE and PsychINFO databases...

INTRODUCTION: Post-traumatic stress disorder (PTSD) may affect 10% of women and 5% of men at some stage, and symptoms may persist for several years. Risk factors include major trauma, lack of social support, peritraumatic dissociation, and psychiatric or personality factors. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent; and to treat PTSD? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review)...

INTRODUCTION: Essential tremor is one of the most common movement disorders throughout the world, with prevalence in the general population of 0.4-3.9%. Although most people with essential tremor are only mildly affected, those who seek medical care are disabled to some extent, and most are socially handicapped by the tremor. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of drug treatments in people with essential tremor of the hand? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review)...

OBJECTIVE: To ascertain if antidepressants, as a group, increase the risk for major malformations, as well as assessing each individual antidepressant. METHODS: At The Motherisk Program, we analyzed pregnancy outcomes of women (n = 1243) from prospectively collected cases in our database, who were exposed to antidepressants during their pregnancy. We then compared them with a matched comparison group of women (n = 1243) who were not exposed (nonteratogen group)...

BACKGROUND: Ekbom syndrome is a rare psychiatric disorder that can manifest as a delusion, overvalued idea or hallucination of parasitic infestations. It is more prevalent in postmenopausal women and patients are usually seeking dermatology rather than psychiatry consultation for their symptoms. CASE PRESENTATION: We present a case of Ekbom syndrome associated with recurrent depressive disorder in an elderly patient. The patient presented with tactile hallucinations of insects crawling just under her skin...

OBJECTIVE: The aim of this study was to survey doctors working in psychiatry in Australia about the practice of using two antidepressants simultaneously. METHOD: A postal survey was sent to all doctors in psychiatry in Australia enquiring about their prescribing history and their attitudes to combination antidepressants and related issues. RESULTS: Seventy-nine percent of respondents had used combination antidepressants. The most frequently reported combination was a selective serotonin reuptake inhibitor combined with a tricyclic antidepressant...

BACKGROUND: Optimal treatment of primary negative symptoms is important because their presence is associated with poor outcome. AIMS: To systematically review all studies dealing with the efficacy of pharmacological agents on primary negative symptoms. METHOD: A comprehensive search of the relevant literature was undertaken using electronic database, reference lists and personal contact. RESULTS: There is a lack of standardized research designs...

Recent studies indicate a role of the brain-derived neurotrophic factor (BDNF) in the pathophysiology of depression, as well as in the mechanism of action of antidepressant drugs (ADs). It has been shown that serum BDNF levels are decreased in depressed patients. Moreover, antidepressant treatment increases serum BDNF levels and it is positively correlated with medication response. In addition, repeated administration of ADs induces an increase in rat hippocampal or cortical BDNF gene expression. Since the most potent effect of ADs on BDNF gene expression was found after prolonged treatment, in the present study we investigated the influence of repeated treatment (twice daily for 14 days) of the new AD mirtazapine (5 or 10 mg/kg) on BDNF mRNA level (the Northern blot) in rat hippocampus and cerebral cortex...

Seizures are a known, relatively rare, consequence of antidepressant treatment. Risk estimates vary depending on the study, source of data and patient population, predisposed vs. nonpredisposed. For newer antidepressants (e.g. selective serotonin reuptake inhibitors, bupropion, mirtazepine, etc.), the risk is generally considered to be low (0.0%-0.4%) and not very different from the incidence of first seizure in the general population (0.07%-0.09%). Risk with tricyclic antidepressants at effective therapeutic doses is relatively high (0...

Linezolid was initially discovered as an antidepressant because of its effect on blocking intracellular metabolism of serotonin, norepinephrine, and other biogenic amines. As time passed, it was realized that linezolid possessed antibacterial activity, and linezolid has been developed and marketed as such. In medicine we are quick to categorize drugs into specific classes as a mechanism to recall indication and use. By classifying linezolid as an antibacterial, it is common to forget about its antidepressant roots...

The affinities of the enantiomers of 1,3,4,14b-tetrahydro-2,10-dimethyl-2H,10H-pyrazino[2,1-d]pyrrolo[1,2-b] [1,2,5]benzotriazepine (10-methyl-10-azaaptazepine, 5) and 2-methyl-1,3,4,14b-tetrahydro-2H-pyrazino[2,1-d]pyrrolo[1,2-b] [1,2,5]benzothiadiazepine 10,10-dioxide (tiaaptazepine, 6) were evaluated in receptor binding assays. Compound (+)-(S)-5, the most significant tested enantiomer, showed good affinities for 5-HT1A, 5-HT2A 5-HT2C and alpha2NA receptors, moderate affinities for DA1, DA3r and 5-HT3 receptors and it was devoid of affinity for DA2, alpha(1NA) and muscarinic receptors...

BACKGROUND: High levels of public spending, rising costs of treatments and scarcity of mental health resources have intensified the need for information on the cost-effectiveness of interventions for depression. There have been few reviews that consider the cost-effectiveness of all treatments for depression together. METHODS: Systematic review of published economic evaluations of interventions for depression to identify where evidence of cost-effectiveness exists and where ambiguity remains...

A significant weight gain in the course of treatment of epilepsy with valproic acid (VPA) was described in several clinical studies. We recently demonstrated that postprandial insulin levels are increased in patients with VPA therapy. This possible modulation of pancreatic insulin secretion by VPA could be due to the structure of VPA as a fatty acid derivative and thus to direct stimulation of pancreatic insulin secretion or competition with free fatty acids (FFA) for albumin binding. In order to investigate the effect of VPA on insulin secretion in pancreatic islet cells we performed in vitro experiments with islets from pancreases of multiorgan donors...

Overdose experience with the anti-epileptic agent zonisamide (Zonegran, ZNS) is limited. We present a case of suspected zonisamide overdose previously reported in abstract form, manifesting as seizures, dysrhythmias and death of an 18-y-o woman after single ingestion of 4.8 g ZNS in a suicide attempt. The patient experienced multiple generalized tonic-clonic seizures and copious airway secretions. En route to the emergency department, she sustained cardiopulmonary arrest from which she was resuscitated. CT scan of the head approximately 24 h after initial presentation revealed massive cerebral edema with tonsillar herniation; brain death was confirmed...

Third-generation antidepressants are a group of antidepressant agents of variable action, not confined to serotonin reuptake inhibition. These agents include venlafaxine, reboxetine, nefazodone and mirtazapine. Claims have been made for these agents in terms of improved efficacy, faster speed of onset of effect and greater safety in the treatment of depression compared with previous medications, such as the selective serotonin reuptake inhibitors (SSRIs). This article reviews the evidence for these improvements...

"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...

We investigated if response to the fenfluramine challenge test could predict outcome in 47 nonpsychiatric patients with chronic functional gastrointestinal disorder (FGD) treated with mianserin, a drug closely related to mirtazepine, or placebo. Sixty milligrams of fenfluramine was given orally in the morning on nonfasting basis. Serum cortisol (COR) and prolactin (PRL) were analyzed at baseline, and after 120, 180, and 240 minutes. Patients were then randomized into a 7-week double-blind treatment trial with mianserin or placebo...

Depression is a common and disabling condition and is especially disabling for patients who also have epilepsy. Antidepressants, particularly the tricyclic antidepressants are well known to be associated with seizure activity, but this is a very neglected area of research. Most of the data on the proconvulsive effects of antidepressants come from either work in animal models or from research into the effects of antidepressants in overdose. Both of these situations may tell us little about the behaviour of antidepressants in patients with epilepsy...

The release of neurotransmitters is modulated through presynaptic autoreceptors that are acted upon by the neurone's own transmitter. The presynaptic inhibitory terminal autoreceptors were first described for noradrenergic neurones (alpha 2-adrenoceptors) and subsequently for other neurotransmitters: dopamine (D2/D3), acetylcholine (M2), GABA (GABAB), histamine (H3) and serotonin (5-HT10). This negative feedback loop introduces terminal regulation into the neural secretory event. Saloman Langer describes how presynaptic terminal facilitatory receptors exist for the modulation of acetylcholine release and these autoreceptors are of the nicotinic subtype...