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Revision as of 16:37, 18 January 2011 editBeetstra (talk | contribs)Edit filter managers, Administrators172,031 edits Script assisted update of identifiers from ChemSpider, CommonChemistry and FDA for the Chem/Drugbox validation project - Updated: ChEMBL.← Previous edit		Latest revision as of 07:03, 7 December 2024 edit undo0dorkmann (talk | contribs)258 editsm →5-HT3 receptor
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			{{Short description|Antidepressant medication}}
	{{Drugbox
			{{Use dmy dates|date=February 2024}}
	| Verifiedfields = changed
			{{cs1 config |name-list-style=vanc |display-authors=6}}
	| verifiedrevid = 400313772
			{{Infobox drug
	| drug_name=Mirtazapine
			| Verifiedfields = verified
	| IUPAC_name = <small>(±)-1,2,3,4,10,14b-hexahydro-2-methylpyrazino(2,1-a)pyrido(2,3-c)(2)benzazepine</small>
			| Watchedfields = verified
	| image = Mirtazapin.svg
			| verifiedrevid = 408610027
	| imagename = 1 : 1 mixture (racemate)
			| image = Mirtazapine.svg
	| width = 200px
			| width = 175
	| image2 = Mirtazapine-from-xtal-2003-US-patent-6723845-3D-balls.png
			| alt =
	| width2 = 150
			| image2 = File:Mirtazapine-from-xtal-2003-US-patent-6723845-3D-balls.png
	| InChI = 1/C17H19N3/c1-19-9-10-20-16(12-19)15-7-3-2-5-13(15)11-14-6-4-8-18-17(14)20/h2-8,16H,9-12H2,1H3
			| width2 = 175
	| InChIKey = RONZAEMNMFQXRA-UHFFFAOYAY
			| alt2 =
			<!-- Clinical data -->
			| tradename = Remeron, Mirataz, Avanza, others
			| Drugs.com = {{drugs.com|monograph|mirtazapine}}
			| MedlinePlus = a697009
			| DailyMedID = Mirtazapine
			| pregnancy_AU = B3
			| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Mirtazapine Use During Pregnancy | website=Drugs.com | date=23 September 2019 | url=https://www.drugs.com/pregnancy/mirtazapine.html | access-date=4 March 2020 | archive-date=22 August 2020 | archive-url=https://web.archive.org/web/20200822200226/https://www.drugs.com/pregnancy/mirtazapine.html | url-status=live }}</ref>
			| routes_of_administration = ], ]
			| class = ] (NaSSA)
			| ATC_prefix = N06
			| ATC_suffix = AX11
			| ATC_supplemental =
			| legal_AU = S4
			| legal_BR = C1
			| legal_BR_comment = <ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=31 March 2023 |title=RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |url-status=live |archive-url=https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |archive-date=3 August 2023 |access-date=16 August 2023 |publisher=] |language=pt-BR |publication-date=4 April 2023}}</ref>
			| legal_CA = Rx-only
			| legal_UK = POM
			| legal_US = Rx-only
			| legal_US_comment = <ref name="Remeron FDA label">{{cite web | title=Remeron- mirtazapine tablet, film coated; Remeronsoltab- mirtazapine tablet, orally disintegrating | website=DailyMed | date=4 March 2024 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98ad1917-a094-44f5-a28f-a64a8cfcd887 | access-date=1 September 2024}}</ref><ref>{{cite web | title=Mirataz- mirtazapine ointment | website=DailyMed | date=5 April 2024 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ff9fdb7-554f-4f91-8cfc-6d05094384c6 | access-date=1 September 2024}}</ref>
			| legal_EU = Rx-only
			<!-- Pharmacokinetic data -->
			| bioavailability = 50%<ref name="pmid10885584"/><ref name = "Remeron FDA label" /><ref name = AXIT/><ref name = EMC/>
			| protein_bound = 85%<ref name="pmid10885584" /><ref name="Remeron FDA label" /><ref name = AXIT/><ref name = EMC/>
			| metabolism = ] (], ], ])<ref name="pmid10885584" /><ref name = "Remeron FDA label" /><ref name = AXIT/><ref name = EMC/><ref name=Ant2001 />
			| metabolites = Desmethylmirtazapine (contributes 3–10% of activity)<ref name=Ant2001 /><ref name="pmid10885584" >{{cite journal | vauthors = Timmer CJ, Sitsen JM, Delbressine LP | title = Clinical pharmacokinetics of mirtazapine | journal = Clinical Pharmacokinetics | volume = 38 | issue = 6 | pages = 461–474 | date = June 2000 | pmid = 10885584 | doi = 10.2165/00003088-200038060-00001 | s2cid = 27697181 }}</ref>
			| elimination_half-life = 20–40 hours<ref name="pmid10885584" /><ref name = "Remeron FDA label" /><ref name = AXIT/><ref name = EMC/>
			| excretion = ]: 75%<ref name="pmid10885584" /><br />]: 15%<ref name="pmid10885584" /><ref name = "Remeron FDA label" /><ref name = AXIT/><ref name = EMC/>
			<!-- Identifiers -->
			| IUPHAR_ligand = 7241
			| CAS_number_Ref = {{cascite|correct|CAS}}
			| CAS_number = 85650-52-8
			| PubChem = 4205
			| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
			| DrugBank = DB00370
			| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
			| ChemSpiderID = 4060
			| UNII_Ref = {{fdacite|correct|FDA}}
			| UNII = A051Q2099Q
			| KEGG_Ref = {{keggcite|correct|kegg}}
			| KEGG = D00563
			| ChEBI_Ref = {{ebicite|correct|EBI}}
			| ChEBI = 6950
			| ChEMBL_Ref = {{ebicite|correct|EBI}}
	| ChEMBL = 654		| ChEMBL = 654
			| synonyms = Mepirzapine; 6-Azamianserin; ORG-3770<ref name="IndexNominum2000" /><ref name="Drugs.com" />
			<!-- Chemical data -->
			| IUPAC_name = (±)-5-methyl-2,5,19-triazatetracyclononadeca-1(15),8,10,12,16,18-hexaene
			| C=17 | H=19 | N=3
			| SMILES = n1cccc3c1N4C(c2ccccc2C3)CN(C)CC4
	| StdInChI_Ref = {{stdinchicite|correct|chemspider}}		| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
	| StdInChI = 1S/C17H19N3/c1-19-9-10-20-16(12-19)15-7-3-2-5-13(15)11-14-6-4-8-18-17(14)20/h2-8,16H,9-12H2,1H3		| StdInChI = 1S/C17H19N3/c1-19-9-10-20-16(12-19)15-7-3-2-5-13(15)11-14-6-4-8-18-17(14)20/h2-8,16H,9-12H2,1H3
	| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}		| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
	| StdInChIKey = RONZAEMNMFQXRA-UHFFFAOYSA-N		| StdInChIKey = RONZAEMNMFQXRA-UHFFFAOYSA-N
			| chirality = ]
	| CAS_number = 61337-67-5
			| density = 1.22
	| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
			| melting_point = 114
	| ChemSpiderID = 4060
			| melting_high = 116
	| ATC_prefix = N06
			| boiling_point = 432
	| ATC_suffix = AX11
			| solubility = Soluble in ] and ]
	| PubChem = 4205
	| DrugBank = DB00370
	| KEGG_Ref = {{keggcite|changed|kegg}}
	| KEGG = D00563
	| C = 17 | H = 19 | N = 3
	| molecular_weight = 265.35 g/mol
	| melting_point = 114
	| melting_high = 116
	| boiling_point = 432
	| density = 1.22
	| solubility = Soluble in ] and ]
	| smiles = n1cccc3c1N4C(c2ccccc2C3)CN(C)CC4
	| synonyms = 6-Azamianserin, Org 3770
	| protein_bound = 85%
	| bioavailability = 50%
	| metabolism = ] (]s ] and ])<ref name="pmid10885584">{{Cite journal| author = Timmer CJ, Sitsen JM, Delbressine LP | title = Clinical pharmacokinetics of mirtazapine | journal = Clinical Pharmacokinetics | volume = 38 | issue = 6 | pages = 461–74 | year = 2000 | month = June | pmid = 10885584 | doi = 10.2165/00003088-200038060-00001| url = http://content.wkhealth.com/linkback/openurl?issn=0312-5963&volume=38&issue=6&spage=461}}</ref>
	| elimination_half-life = 20-40 hours
	| excretion = Urine (75%), Feces (15%)
	| pregnancy_category = C
	| legal_status = Rx-only
	| routes_of_administration = ]
	}}		}}
			<!-- Definition and medical uses -->
	'''Mirtazapine''' ('''Remeron''', '''Avanza''', '''Zispin''') is a ] (TeCA) used primarily in the treatment of ]. It is also sometimes used as a ], ], and ], and for the treatment of ], among other indications. Along with its close ]s ] and ], mirtazapine is one of the few ]s (NaSSAs).
			'''Mirtazapine''', sold under the brand name '''Remeron''' among others, is an ] ], and as such is used primarily to treat ].<ref name=Ant2001/><ref name=AHSF2018>{{cite web |title=Mirtazapine Monograph for Professionals |url=https://www.drugs.com/monograph/mirtazapine.html |website=Drugs.com |publisher=American Society of Health-System Pharmacists |access-date=20 November 2018 |archive-date=10 January 2021 |archive-url=https://web.archive.org/web/20210110231757/https://www.drugs.com/monograph/mirtazapine.html |url-status=live }}</ref> Its effects may take up to four weeks but can also manifest as early as one to two weeks.<ref name=AHSF2018/><ref name=Cochrane2011/> It is often used in cases of depression complicated by ] or ].<ref name=Ant2001/><ref name=Nut2002>{{cite journal | vauthors = Nutt DJ | title = Tolerability and safety aspects of mirtazapine | journal = Human Psychopharmacology | volume = 17 | issue = Suppl 1 | pages = S37–S41 | date = June 2002 | pmid = 12404669 | doi = 10.1002/hup.388 | s2cid = 23699759 }}</ref> The effectiveness of mirtazapine is comparable to other commonly prescribed antidepressants.<ref name=TI2021>{{cite web |title= Mirtazapine: Update on efficacy, safety, dose response |url=https://www.ti.ubc.ca/2021/05/06/129-mirtazapine-update-on-efficacy-safety-dose-response/ |website=www.ti.ubc.ca |access-date=8 May 2021 |archive-date=7 May 2021 |archive-url=https://web.archive.org/web/20210507191909/https://www.ti.ubc.ca/2021/05/06/129-mirtazapine-update-on-efficacy-safety-dose-response/ |url-status=live }}</ref> It is taken ].<ref name=AHSF2018/>
			<!-- Side effects and mechanism -->
	], the ''(S)''-(+)-] of mirtazapine, is currently under development for the treatment of ] and ] ]s by the same company that produced mirtazapine.<ref name="urlFuture Treatments for Depression, Anxiety, Sleep Disorders, Psychosis, and ADHD -- Neurotransmitter.net">{{Cite web| url = http://www.neurotransmitter.net/newdrugs.html | title = Future Treatments for Depression, Anxiety, Sleep Disorders, Psychosis, and ADHD -- Neurotransmitter.net | work = | accessdate = }}</ref>
			Common side effects include ], ], ] and ].<ref name=AHSF2018/> Serious side effects may include ], ], and increased ] among children.<ref name=AHSF2018/> ] symptoms may occur with stopping.<ref name=BNF74>{{cite book|title=British national formulary: BNF 74|date=2017|publisher=British Medical Association|isbn=978-0857112989|page=354|edition=74}}</ref> It is not recommended together with a ],<ref name="AHSF2018" /> although evidence supporting the danger of this combination has been challenged.<ref name="pmid16342227"/> It is unclear if use during ] is safe.<ref name="AHSF2018" /> How it works is not clear, but it may involve ] certain ] and ]s.<ref name=Ant2001/><ref name=AHSF2018/> Chemically, it is a ],<ref name=AHSF2018/> and is closely related to ]. It also has strong ]rgic effects.<ref name=Ant2001>{{cite journal | vauthors = Anttila SA, Leinonen EV | title = A review of the pharmacological and clinical profile of mirtazapine | journal = CNS Drug Reviews | volume = 7 | issue = 3 | pages = 249–264 | year = 2001 | pmid = 11607047 | pmc = 6494141 | doi = 10.1111/j.1527-3458.2001.tb00198.x }}</ref><ref name=AHSF2018/>
	==History==		<!-- History and culture -->
			Mirtazapine came into medical use in the United States in 1996.<ref name=AHSF2018/> The patent expired in 2004, and ] versions are available.<ref name=AHSF2018/><ref>{{cite book | vauthors = Schatzberg AF, Cole JO, DeBattista C | title = Manual of Clinical Psychopharmacology | edition = 7th | date= 2010| publisher = American Psychiatric Publishing | location = Arlington, VA | isbn = 978-1-58562-377-8 | chapter = 3 }}</ref> In 2022, it was the 105th most commonly prescribed medication in the United States, with more than 6{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Mirtazapine Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Mirtazapine | access-date = 30 August 2024 }}</ref>
	Mirtazapine was introduced by ] in the ] in 1990 for the treatment of depression. It quickly spread throughout the world and became a widely used antidepressant.{{Citation needed|date=February 2010}}
			{{TOC limit}}
	==Indications==		==Medical uses==
			Mirtazapine is approved by the United States ] for the treatment of major depressive disorder in adults.<ref name=":0">{{cite book |vauthors=Jilani TN, Gibbons JR, Faizy RM, Saadabadi A |chapter=Mirtazapine |date=2022 |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK519059/ |title=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30085601 |access-date=5 December 2022 |archive-date=12 December 2022 |archive-url=https://web.archive.org/web/20221212213412/https://www.ncbi.nlm.nih.gov/books/NBK519059/ |url-status=live }}</ref>
	=== Clinical ===
			===Depression===
	Mirtazapine's primary use is the ] of ].<ref name="pmid10446735">{{Cite journal| author = Gorman JM | title = Mirtazapine: clinical overview | journal = The Journal of Clinical Psychiatry | volume = 60 Suppl 17 | issue = | pages = 9–13; discussion 46–8 | year = 1999 | pmid = 10446735 | doi = | url = }}</ref> Mirtazapine has been found to be useful in the treatment of ],<ref name="pmid16166185">{{Cite journal| author = Gambi F, De Berardis D, Campanella D, ''et al.'' | title = Mirtazapine treatment of generalized anxiety disorder: a fixed dose, open label study | journal = Journal of Psychopharmacology (Oxford, England) | volume = 19 | issue = 5 | pages = 483–7 | year = 2005 | month = September | pmid = 16166185 | doi = 10.1177/0269881105056527 | url = }}</ref><ref name="pmid10453798">{{Cite journal| author = Goodnick PJ, Puig A, DeVane CL, Freund BV | title = Mirtazapine in major depression with comorbid generalized anxiety disorder | journal = The Journal of Clinical Psychiatry | volume = 60 | issue = 7 | pages = 446–8 | year = 1999 | month = July | pmid = 10453798 | doi = 10.4088/JCP.v60n0705| url = }}</ref> ],<ref name="pmid12409686">{{Cite journal| author = Van Veen JF, Van Vliet IM, Westenberg HG | title = Mirtazapine in social anxiety disorder: a pilot study | journal = International Clinical Psychopharmacology | volume = 17 | issue = 6 | pages = 315–7 | year = 2002 | month = November | pmid = 12409686 | doi = 10.1097/00004850-200211000-00008| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0268-1315&volume=17&issue=6&spage=315}}</ref><ref name="pmid16282842">{{Cite journal| author = Muehlbacher M, Nickel MK, Nickel C, ''et al.'' | title = Mirtazapine treatment of social phobia in women: a randomized, double-blind, placebo-controlled study | journal = Journal of Clinical Psychopharmacology | volume = 25 | issue = 6 | pages = 580–3 | year = 2005 | month = December | pmid = 16282842 | doi = 10.1097/01.jcp.0000186871.04984.8d| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0271-0749&volume=25&issue=6&spage=580}}</ref><ref name="pmid16868194">{{Cite journal| author = Mörtberg E | title = Mirtazapine reduces social anxiety and improves quality of life in women with social phobia | journal = Evidence-based Mental Health | volume = 9 | issue = 3 | pages = 75 | year = 2006 | month = August | pmid = 16868194 | doi = 10.1136/ebmh.9.3.75| url = http://ebmh.bmj.com/cgi/pmidlookup?view=long&pmid=16868194}}</ref><ref name="pmid17419001">{{Cite journal| author = Mrakotsky C, Masek B, Biederman J, ''et al.'' | title = Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia | journal = Journal of Anxiety Disorders | volume = 22 | issue = 1 | pages = 88–97 | year = 2008 | pmid = 17419001 | doi = 10.1016/j.janxdis.2007.01.005 | url = }}</ref><ref name="pmid12943960">{{Cite journal| author = Liappas J, Paparrigopoulos T, Tzavellas E, Christodoulou G | title = Alcohol detoxification and social anxiety symptoms: a preliminary study of the impact of mirtazapine administration | journal = Journal of Affective Disorders | volume = 76 | issue = 1-3 | pages = 279–84 | year = 2003 | month = September | pmid = 12943960 | doi = 10.1016/S0165-0327(02)00094-0| url = http://linkinghub.elsevier.com/retrieve/pii/S0165032702000940}}</ref> ],<ref name="pmid15816795">{{Cite journal| author = Koran LM, Gamel NN, Choung HW, Smith EH, Aboujaoude EN | title = Mirtazapine for obsessive-compulsive disorder: an open trial followed by double-blind discontinuation | journal = The Journal of Clinical Psychiatry | volume = 66 | issue = 4 | pages = 515–20 | year = 2005 | month = April | pmid = 15816795 | doi = 10.4088/JCP.v66n0415| url = http://article.psychiatrist.com/?ContentType=START&ID=10001277}}</ref><ref name="pmid15491244">{{Cite journal| author = Pallanti S, Quercioli L, Bruscoli M | title = Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study | journal = The Journal of Clinical Psychiatry | volume = 65 | issue = 10 | pages = 1394–9 | year = 2004 | month = October | pmid = 15491244 | doi = 10.4088/JCP.v65n1015| url = http://article.psychiatrist.com/?ContentType=START&ID=10001055}}</ref><ref name="pmid11593084">{{Cite journal| author = Koran LM, Quirk T, Lorberbaum JP, Elliott M | title = Mirtazapine treatment of obsessive-compulsive disorder | journal = Journal of Clinical Psychopharmacology | volume = 21 | issue = 5 | pages = 537–9 | year = 2001 | month = October | pmid = 11593084 | doi = 10.1097/00004714-200110000-00016| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0271-0749&volume=21&issue=5&spage=537}}</ref> ],<ref name="pmid12490773">{{Cite journal| author = Sarchiapone M, Amore M, De Risio S, ''et al.'' | title = Mirtazapine in the treatment of panic disorder: an open-label trial | journal = International Clinical Psychopharmacology | volume = 18 | issue = 1 | pages = 35–8 | year = 2003 | month = January | pmid = 12490773 | doi = 10.1097/01.yic.0000047780.24295.3e | url = | doi_brokendate = 2010-03-29 }}</ref><ref name="pmid11712626">{{Cite journal| author = Boshuisen ML, Slaap BR, Vester-Blokland ED, den Boer JA | title = The effect of mirtazapine in panic disorder: an open label pilot study with a single-blind placebo run-in period | journal = International Clinical Psychopharmacology | volume = 16 | issue = 6 | pages = 363–8 | year = 2001 | month = November | pmid = 11712626 | doi = 10.1097/00004850-200111000-00008| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0268-1315&volume=16&issue=6&spage=363}}</ref><ref name="pmid10440525">{{Cite journal| author = Carpenter LL, Leon Z, Yasmin S, Price LH | title = Clinical experience with mirtazapine in the treatment of panic disorder | journal = Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists | volume = 11 | issue = 2 | pages = 81–6 | year = 1999 | month = June | pmid = 10440525 | doi = | url = }}</ref><ref name="pmid12090820">{{Cite journal| author = Carli V, Sarchiapone M, Camardese G, Romano L, DeRisio S | title = Mirtazapine in the treatment of panic disorder | journal = Archives of General Psychiatry | volume = 59 | issue = 7 | pages = 661–2 | year = 2002 | month = July | pmid = 12090820 | doi = 10.1001/archpsyc.59.7.661| url = http://archpsyc.ama-assn.org/cgi/pmidlookup?view=long&pmid=12090820}}</ref><ref name="pmid11593305">{{Cite journal| author = Ribeiro L, Busnello JV, Kauer-Sant'Anna M, ''et al.'' | title = Mirtazapine versus fluoxetine in the treatment of panic disorder | journal = Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... | volume = 34 | issue = 10 | pages = 1303–7 | year = 2001 | month = October | pmid = 11593305 | doi = | url = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2001001000010&lng=en&nrm=iso&tlng=en}}</ref> ],<ref name="pmid12547477">{{Cite journal| author = Davidson JR, Weisler RH, Butterfield MI, ''et al.'' | title = Mirtazapine vs. placebo in posttraumatic stress disorder: a pilot trial | journal = Biological Psychiatry | volume = 53 | issue = 2 | pages = 188–91 | year = 2003 | month = January | pmid = 12547477 | doi = 10.1016/S0006-3223(02)01411-7| url = http://linkinghub.elsevier.com/retrieve/pii/S0006322302014117}}</ref><ref name="pmid16401254">{{Cite journal| author = Kim W, Pae CU, Chae JH, Jun TY, Bahk WM | title = The effectiveness of mirtazapine in the treatment of post-traumatic stress disorder: a 24-week continuation therapy | journal = Psychiatry and Clinical Neurosciences | volume = 59 | issue = 6 | pages = 743–7 | year = 2005 | month = December | pmid = 16401254 | doi = 10.1111/j.1440-1819.2005.01447.x | url = }}</ref><ref name="pmid12415552">{{Cite journal| author = Bahk WM, Pae CU, Tsoh J, ''et al.'' | title = Effects of mirtazapine in patients with post-traumatic stress disorder in Korea: a pilot study | journal = Human Psychopharmacology | volume = 17 | issue = 7 | pages = 341–4 | year = 2002 | month = October | pmid = 12415552 | doi = 10.1002/hup.426 | url = }}</ref><ref name="pmid15378676">{{Cite journal| author = Chung MY, Min KH, Jun YJ, Kim SS, Kim WC, Jun EM | title = Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder: a randomized open label trial | journal = Human Psychopharmacology | volume = 19 | issue = 7 | pages = 489–94 | year = 2004 | month = October | pmid = 15378676 | doi = 10.1002/hup.615 | url = }}</ref><ref name="pmid19584388">{{Cite journal| author = Alderman CP, Condon JT, Gilbert AL | title = An Open-Label Study of Mirtazapine as Treatment for Combat-Related PTSD(July/August) | journal = The Annals of Pharmacotherapy | volume = 43| issue = 7| pages = 1220–6| year = 2009 | month = July | pmid = 19584388 | doi = 10.1345/aph.1M009 | url = }}</ref><ref name="pmid12411239">{{Cite journal| author = Lewis JD | title = Mirtazapine for PTSD nightmares | journal = The American Journal of Psychiatry | volume = 159 | issue = 11 | pages = 1948–9 | year = 2002 | month = November | pmid = 12411239 | doi = 10.1176/appi.ajp.159.11.1948-a| url = http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=12411239}}</ref> ],<ref name="urlMirtazapine in seasonal affective disorder (SAD): a preliminary report">{{Cite web| url = http://www3.interscience.wiley.com/journal/40002009/abstract | title = Mirtazapine in seasonal affective disorder (SAD): a preliminary report | format = | work = | accessdate = }}</ref> ],<ref name="pmid14658972">{{Cite journal| author = Winokur A, DeMartinis NA, McNally DP, Gary EM, Cormier JL, Gary KA | title = Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia | journal = The Journal of Clinical Psychiatry | volume = 64 | issue = 10 | pages = 1224–9 | year = 2003 | month = October | pmid = 14658972 | doi = 10.4088/JCP.v64n1013| url = http://article.psychiatrist.com/?ContentType=START&ID=10000336}}</ref><ref name="pmid18289144">{{Cite journal| author = Kim SW, Shin IS, Kim JM, ''et al.'' | title = Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression | journal = Psychiatry and Clinical Neurosciences | volume = 62 | issue = 1 | pages = 75–83 | year = 2008 | month = February | pmid = 18289144 | doi = 10.1111/j.1440-1819.2007.01778.x | url = }}</ref><ref name="pmid18299900">{{Cite journal| author = Cankurtaran ES, Ozalp E, Soygur H, Akbiyik DI, Turhan L, Alkis N | title = Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine | journal = Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer | volume = 16 | issue = 11 | pages = 1291–8 | year = 2008 | month = November | pmid = 18299900 | doi = 10.1007/s00520-008-0425-1 | url = }}</ref> ] and ],<ref name="pmid18289144"/><ref name="pmid16632163">{{Cite journal| author = Pae CU | title = Low-dose mirtazapine may be successful treatment option for severe nausea and vomiting | journal = Progress in Neuro-psychopharmacology & Biological Psychiatry | volume = 30 | issue = 6 | pages = 1143–5 | year = 2006 | month = August | pmid = 16632163 | doi = 10.1016/j.pnpbp.2006.03.015 | url = }}</ref><ref name="pmid17587360">{{Cite journal| author = Kast RE, Foley KF | title = Cancer chemotherapy and cachexia: mirtazapine and olanzapine are 5-HT3 antagonists with good antinausea effects | journal = European Journal of Cancer Care | volume = 16 | issue = 4 | pages = 351–4 | year = 2007 | month = July | pmid = 17587360 | doi = 10.1111/j.1365-2354.2006.00760.x | url = http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0961-5423&date=2007&volume=16&issue=4&spage=351}}</ref><ref name="pmid18165563">{{Cite journal| author = Chen CC, Lin CS, Ko YP, Hung YC, Lao HC, Hsu YW | title = Premedication with mirtazapine reduces preoperative anxiety and postoperative nausea and vomiting | journal = Anesthesia and Analgesia | volume = 106 | issue = 1 | pages = 109–13, table of contents | year = 2008 | month = January | pmid = 18165563 | doi = 10.1213/01.ane.0000289636.09841.bc | url = }}</ref><ref name="pmid15946465">{{Cite journal| author = Teixeira FV, Novaretti TM, Pilon B, Pereira PG, Breda MF | title = Mirtazapine (Remeron) as treatment for non-mechanical vomiting after gastric bypass | journal = Obesity Surgery | volume = 15 | issue = 5 | pages = 707–9 | year = 2005 | month = May | pmid = 15946465 | doi = 10.1381/0960892053923923 | url = }}</ref><ref name="pmid19381036">{{Cite journal| author = Ito T, Okubo Y, Roth A | title = | language = Japanese | journal = Gan to Kagaku Ryoho. Cancer & Chemotherapy | volume = 36 | issue = 4 | pages = 623–6 | year = 2009 | month = April | pmid = 19381036 | doi = | url = http://www.pier-online.jp/abstract.php?issn=0385-0684&volume=36&issue=4&spage=623}}</ref><ref name="pmid10906359">{{Cite journal| author = Thompson DS | title = Mirtazapine for the treatment of depression and nausea in breast and gynecological oncology | journal = Psychosomatics | volume = 41 | issue = 4 | pages = 356–9 | year = 2000 | pmid = 10906359 | doi = 10.1176/appi.psy.41.4.356| url = http://psy.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10906359}}</ref> ] and associated ],<ref name="pmid19381036"/><ref name="pmid16207680">{{Cite journal| author = Mattox TW | title = Treatment of unintentional weight loss in patients with cancer | journal = Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition | volume = 20 | issue = 4 | pages = 400–10 | year = 2005 | month = August | pmid = 16207680 | doi = | url = http://ncp.sagepub.com/cgi/pmidlookup?view=long&pmid=16207680}}</ref><ref name="pmid19323618">{{Cite journal| author = Fox CB, Treadway AK, Blaszczyk AT, Sleeper RB | title = Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly | journal = Pharmacotherapy | volume = 29 | issue = 4 | pages = 383–97 | year = 2009 | month = April | pmid = 19323618 | doi = 10.1592/phco.29.4.383 | url = }}</ref> and ]<ref name="pmid12614964">{{Cite journal| author = Davis MP, Frandsen JL, Walsh D, Andresen S, Taylor S | title = Mirtazapine for pruritus | journal = Journal of Pain and Symptom Management | volume = 25 | issue = 3 | pages = 288–91 | year = 2003 | month = March | pmid = 12614964 | doi = 10.1016/S0885-3924(02)00645-0| url = http://linkinghub.elsevier.com/retrieve/pii/S0885392402006450}}</ref><ref name="pmid15153889">{{Cite journal| author = Hundley JL, Yosipovitch G | title = Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study | journal = Journal of the American Academy of Dermatology | volume = 50 | issue = 6 | pages = 889–91 | year = 2004 | month = June | pmid = 15153889 | doi = 10.1016/j.jaad.2004.01.045 | url = }}</ref><ref name="pmid16908377">{{Cite journal| author = Demierre MF, Taverna J | title = Mirtazapine and gabapentin for reducing pruritus in cutaneous T-cell lymphoma | journal = Journal of the American Academy of Dermatology | volume = 55 | issue = 3 | pages = 543–4 | year = 2006 | month = September | pmid = 16908377 | doi = 10.1016/j.jaad.2006.04.025 | url = }}</ref><ref name="pmid18713761">{{Cite journal| author = Sheen MJ, Ho ST, Lee CH, Tsung YC, Chang FL, Huang ST | title = Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus | journal = British Journal of Anaesthesia | volume = 101 | issue = 5 | pages = 711–5 | year = 2008 | month = November | pmid = 18713761 | doi = 10.1093/bja/aen241 | url = }}</ref> as well, and it may be prescribed ] for these conditions.
			Mirtazapine is primarily used for ] and other ]s.<ref name="pmid10446735">{{cite journal | vauthors = Gorman JM | title = Mirtazapine: clinical overview | journal = The Journal of Clinical Psychiatry | volume = 60 | issue = Suppl 17 | pages = 9–13; discussion 46–8 | year = 1999 | pmid = 10446735 }}</ref><ref name="pmid21644844">{{cite journal | vauthors = Benjamin S, Doraiswamy PM | title = Review of the use of mirtazapine in the treatment of depression | journal = Expert Opinion on Pharmacotherapy | volume = 12 | issue = 10 | pages = 1623–1632 | date = July 2011 | pmid = 21644844 | doi = 10.1517/14656566.2011.585459 | s2cid = 10212539 }}</ref> ] appears faster than some ]s and similar to ].<ref name=Cochrane2011/><ref name="pmid12404667" />
			In 2010, the ] recommended generic selective serotonin reuptake inhibitors as first-line choices, as they are "equally effective as other antidepressants and have a favourable ]."<ref>{{cite book|title=Pharmacological Interventions: 10.14. Clinical Practice Recommendations|chapter=Pharmacological Interventions|date=2010|publisher=National Collaborating Centre for Mental Health/British Psychological Society|url=https://www.ncbi.nlm.nih.gov/books/NBK63751/#ch10.s159|access-date=22 July 2017|archive-date=6 September 2020|archive-url=https://web.archive.org/web/20200906074156/https://www.ncbi.nlm.nih.gov/books/NBK63751/#ch10.s159|url-status=live}}</ref> For mirtazapine, it found "no difference between mirtazapine and other antidepressants on any efficacy measure, although in terms of achieving remission mirtazapine appears to have a statistical though not clinical advantage. In addition, mirtazapine has a statistical advantage over selective serotonin reuptake inhibitors in terms of reducing symptoms of ], but the difference is not clinically significant. However, there is strong evidence that patients taking mirtazapine are less likely to leave treatment early because of side effects, although this is not the case for patients reporting side effects or leaving treatment early for any reason."<ref>{{cite book|title=Pharmacological Interventions: Third-Generation Antidepressants: 10.8.3. Mirtazapine|chapter=Pharmacological Interventions|date=2010|publisher=National Collaborating Centre for Mental Health/British Psychological Society|url=https://www.ncbi.nlm.nih.gov/books/NBK63751/#ch10.s68|access-date=22 July 2017|archive-date=6 September 2020|archive-url=https://web.archive.org/web/20200906074156/https://www.ncbi.nlm.nih.gov/books/NBK63751/#ch10.s68|url-status=live}}</ref>
	===Experimental===
	Mirtazapine has had literature published on its efficacy (or lack thereof) in the following areas: for the ] of ]/],<ref name="pmid15341898">{{Cite journal| author = Castillo JL, Menendez P, Segovia L, Guilleminault C | title = Effectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome (SAHS) | journal = Sleep Medicine | volume = 5 | issue = 5 | pages = 507–8 | year = 2004 | month = September | pmid = 15341898 | doi = 10.1016/j.sleep.2004.06.004 | url = }}</ref><ref name="pmid17310863">{{Cite journal| author = Carley DW, Olopade C, Ruigt GS, Radulovacki M | title = Efficacy of mirtazapine in obstructive sleep apnea syndrome | journal = Sleep | volume = 30 | issue = 1 | pages = 35–41 | year = 2007 | month = January | pmid = 17310863 | doi = | url = }}</ref><ref name="pmid18548827">{{Cite journal| author = Marshall NS, Yee BJ, Desai AV, ''et al.'' | title = Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea | journal = Sleep | volume = 31 | issue = 6 | pages = 824–31 | year = 2008 | month = June | pmid = 18548827 | pmc = 2442407 | doi = | url = }}</ref><ref name="pmid18369672">{{Cite journal| author = Brunner H | title = Success and failure of mirtazapine as alternative treatment in elderly stroke patients with sleep apnea-a preliminary open trial | journal = Sleep & Breathing = Schlaf & Atmung | volume = 12 | issue = 3 | pages = 281–5 | year = 2008 | month = August | pmid = 18369672 | doi = 10.1007/s11325-008-0177-7 | url = }}</ref><ref name="pmid10588592">{{Cite journal| author = Carley DW, Radulovacki M | title = Mirtazapine, a mixed-profile serotonin agonist/antagonist, suppresses sleep apnea in the rat | journal = American Journal of Respiratory and Critical Care Medicine | volume = 160 | issue = 6 | pages = 1824–9 | year = 1999 | month = December | pmid = 10588592 | doi = | url = http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=10588592}}</ref> ]s such as ]s,<ref name="pmid12920393">{{Cite journal| author = Lévy E, Margolese HC | title = Migraine headache prophylaxis and treatment with low-dose mirtazapine | journal = International Clinical Psychopharmacology | volume = 18 | issue = 5 | pages = 301–3 | year = 2003 | month = September | pmid = 12920393 | doi = 10.1097/01.yic.0000080803.87368.01 | url = | doi_brokendate = 2010-03-29 }}</ref><ref name="pmid10749956">{{Cite journal| author = Brannon GE, Rolland PD, Gary JM | title = Use of mirtazapine as prophylactic treatment for migraine headache | journal = Psychosomatics | volume = 41 | issue = 2 | pages = 153–4 | year = 2000 | pmid = 10749956 | doi = 10.1176/appi.psy.41.2.153| url = http://psy.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10749956}}</ref> ]s,<ref name="pmid15159466">{{Cite journal| author = Bendtsen L, Jensen R | title = Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache | journal = Neurology | volume = 62 | issue = 10 | pages = 1706–11 | year = 2004 | month = May | pmid = 15159466 | doi = | url = http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15159466}}</ref><ref name="pmid17250728">{{Cite journal| author = Bendtsen L, Buchgreitz L, Ashina S, Jensen R | title = Combination of low-dose mirtazapine and ibuprofen for prophylaxis of chronic tension-type headache | journal = European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies | volume = 14 | issue = 2 | pages = 187–93 | year = 2007 | month = February | pmid = 17250728 | doi = 10.1111/j.1468-1331.2006.01607.x | url = }}</ref><ref name="pmid12938066">{{Cite journal| author = Martín-Araguz A, Bustamante-Martínez C, de Pedro-Pijoán JM | title = | language = Spanish; Castilian | journal = Revista De Neurologia | volume = 37 | issue = 2 | pages = 101–5 | year = 2003 | pmid = 12938066 | doi = | url = http://www.revneurol.com/LinkOut/formMedLine.asp?Refer=2002498&Revista=Revneurol}}</ref> ]s<ref name="pmid18635514">{{Cite journal| author = Sheen MJ, Ho ST | title = Mirtazapine relieves postdural puncture headache | journal = Anesthesia and Analgesia | volume = 107 | issue = 1 | pages = 346 | year = 2008 | month = July | pmid = 18635514 | doi = 10.1213/ane.0b013e3181771074 | url = }}</ref> and ]s,<ref name="pmid11279976">{{Cite journal| author = Nutt D, Law J | title = Treatment of cluster headache with mirtazapine | journal = Headache | volume = 39 | issue = 8 | pages = 586–7 | year = 1999 | month = September | pmid = 11279976 | doi = 10.1046/j.1526-4610.1999.t01-1-3908586.x| url = http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0017-8748&date=1999&volume=39&issue=8&spage=586}}</ref> ],<ref name="pmid16007504">{{Cite journal| author = Guclu S, Gol M, Dogan E, Saygili U | title = Mirtazapine use in resistant hyperemesis gravidarum: report of three cases and review of the literature | journal = Archives of Gynecology and Obstetrics | volume = 272 | issue = 4 | pages = 298–300 | year = 2005 | month = October | pmid = 16007504 | doi = 10.1007/s00404-005-0007-0 | url = }}</ref><ref name="pmid12819986">{{Cite journal| author = Rohde A, Dembinski J, Dorn C | title = Mirtazapine (Remergil) for treatment resistant hyperemesis gravidarum: rescue of a twin pregnancy | journal = Archives of Gynecology and Obstetrics | volume = 268 | issue = 3 | pages = 219–21 | year = 2003 | month = August | pmid = 12819986 | doi = 10.1007/s00404-003-0502-0 | url = }}</ref><ref name="pmid17628816">{{Cite journal| author = Schwarzer V, Heep A, Gembruch U, Rohde A | title = Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine | journal = Archives of Gynecology and Obstetrics | volume = 277 | issue = 1 | pages = 67–9 | year = 2008 | month = January | pmid = 17628816 | doi = 10.1007/s00404-007-0406-5 | url = }}</ref> ],<ref name="urlIrritable Bowel Syndrome and Mirtazapine -- THOMAS 157 (8): 1341 -- Am J Psychiatry">{{Cite web| url = http://ajp.psychiatryonline.org/cgi/content/full/157/8/1341-a | title = Irritable Bowel Syndrome and Mirtazapine -- THOMAS 157 (8): 1341 -- Am J Psychiatry | format = | work = | accessdate = }}</ref><ref name="pmid10910804">{{Cite journal| author = Thomas SG | title = Irritable bowel syndrome and mirtazapine | journal = The American Journal of Psychiatry | volume = 157 | issue = 8 | pages = 1341–2 | year = 2000 | month = August | pmid = 10910804 | doi = 10.1176/appi.ajp.157.8.1341-a| url = http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10910804}}</ref> ],<ref name="pmid16959934">{{Cite journal| author = Kim SW, Shin IS, Kim JM, ''et al.'' | title = Mirtazapine for severe gastroparesis unresponsive to conventional prokinetic treatment | journal = Psychosomatics | volume = 47 | issue = 5 | pages = 440–2 | year = 2006 | pmid = 16959934 | doi = 10.1176/appi.psy.47.5.440 | url = }}</ref> ],{{Citation needed|date=August 2010}} ],<ref name="pmid18345715">{{Cite journal| author = Han C, Pae CU, Lee BH, ''et al.'' | title = Venlafaxine versus mirtazapine in the treatment of undifferentiated somatoform disorder: a 12-week prospective, open-label, randomized, parallel-group trial | journal = Clinical Drug Investigation | volume = 28 | issue = 4 | pages = 251–61 | year = 2008 | pmid = 18345715 | doi = | url = }}</ref> ] and other ]s,<ref name="pmid11642476">{{Cite journal| author = Posey DJ, Guenin KD, Kohn AE, Swiezy NB, McDougle CJ | title = A naturalistic open-label study of mirtazapine in autistic and other pervasive developmental disorders | journal = Journal of Child and Adolescent Psychopharmacology | volume = 11 | issue = 3 | pages = 267–77 | year = 2001 | pmid = 11642476 | doi = 10.1089/10445460152595586 | url = }}</ref><ref name="pmid19364298">{{Cite journal| author = Coskun M, Karakoc S, Kircelli F, Mukaddes NM | title = Effectiveness of mirtazapine in the treatment of inappropriate sexual behaviors in individuals with autistic disorder | journal = Journal of Child and Adolescent Psychopharmacology | volume = 19 | issue = 2 | pages = 203–6 | year = 2009 | month = April | pmid = 19364298 | doi = 10.1089/cap.2008.020 | url = }}</ref><ref name="pmid18439117">{{Cite journal| author = Coskun M, Mukaddes NM | title = Mirtazapine treatment in a subject with autistic disorder and fetishism | journal = Journal of Child and Adolescent Psychopharmacology | volume = 18 | issue = 2 | pages = 206–9 | year = 2008 | month = April | pmid = 18439117 | doi = 10.1089/cap.2007.0014 | url = }}</ref><ref name="pmid16648008">{{Cite journal| author = Albertini G, Polito E, Sarà M, Di Gennaro G, Onorati P | title = Compulsive masturbation in infantile autism treated by mirtazapine | journal = Pediatric Neurology | volume = 34 | issue = 5 | pages = 417–8 | year = 2006 | month = May | pmid = 16648008 | doi = 10.1016/j.pediatrneurol.2005.10.023 | url = }}</ref><ref name="pmid11501682">{{Cite journal| author = Nguyen M, Murphy T | title = Mirtazapine for excessive masturbation in an adolescent with autism | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 40 | issue = 8 | pages = 868–9 | year = 2001 | month = August | pmid = 11501682 | doi = 10.1097/00004583-200108000-00004| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0890-8567&volume=40&issue=8&spage=868}}</ref> and ]-induced ].<ref name="urlMirtazapine for Neuroleptic-Induced Akathisia -- POYUROVSKY and WEIZMAN 158 (5): 819 -- Am J Psychiatry">{{Cite web| url = http://ajp.psychiatryonline.org/cgi/content/full/158/5/819 | title = Mirtazapine for Neuroleptic-Induced Akathisia -- POYUROVSKY and WEIZMAN 158 (5): 819 -- Am J Psychiatry | format = | work = | accessdate = }}</ref><ref name="pmid12826992">{{Cite journal| author = Poyurovsky M, Epshtein S, Fuchs C, Schneidman M, Weizman R, Weizman A | title = Efficacy of low-dose mirtazapine in neuroleptic-induced akathisia: a double-blind randomized placebo-controlled pilot study | journal = Journal of Clinical Psychopharmacology | volume = 23 | issue = 3 | pages = 305–8 | year = 2003 | month = June | pmid = 12826992 | doi = 10.1097/01.jcp.0000084027.22282.16 | url = | doi_brokendate = 2010-03-29 }}</ref><ref name="pmid12826992"/><ref name="pmid16497273">{{Cite journal| author = Poyurovsky M, Pashinian A, Weizman R, Fuchs C, Weizman A | title = Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo- and propranolol-controlled trial | journal = Biological Psychiatry | volume = 59 | issue = 11 | pages = 1071–7 | year = 2006 | month = June | pmid = 16497273 | doi = 10.1016/j.biopsych.2005.12.007 | url = }}</ref><ref name="pmid18460588">{{Cite journal| author = Hieber R, Dellenbaugh T, Nelson LA | title = Role of mirtazapine in the treatment of antipsychotic-induced akathisia | journal = The Annals of Pharmacotherapy | volume = 42 | issue = 6 | pages = 841–6 | year = 2008 | month = June | pmid = 18460588 | doi = 10.1345/aph.1K672 | url = }}</ref><ref name="pmid16569791">{{Cite journal| author = Ranjan S, Chandra PS, Chaturvedi SK, Prabhu SC, Gupta A | title = Atypical antipsychotic-induced akathisia with depression: therapeutic role of mirtazapine | journal = The Annals of Pharmacotherapy | volume = 40 | issue = 4 | pages = 771–4 | year = 2006 | month = April | pmid = 16569791 | doi = 10.1345/aph.1G561 | url = }}</ref><ref name="pmid11329417">{{Cite journal| author = Poyurovsky M, Weizman A | title = Mirtazapine for neuroleptic-induced akathisia | journal = The American Journal of Psychiatry | volume = 158 | issue = 5 | pages = 819 | year = 2001 | month = May | pmid = 11329417 | doi = 10.1176/appi.ajp.158.5.819| url = http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=11329417}}</ref>
			A 2011 ] review comparing mirtazapine to other antidepressants found that while it appeared to have a faster onset in people for whom it worked (measured at two weeks), its efficacy was about the same as other antidepressants after six weeks' use.<ref name=Cochrane2011>{{cite journal | vauthors = Watanabe N, Omori IM, Nakagawa A, Cipriani A, Barbui C, Churchill R, Furukawa TA | title = Mirtazapine versus other antidepressive agents for depression | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD006528 | date = December 2011 | pmid = 22161405 | pmc = 4158430 | doi = 10.1002/14651858.CD006528.pub2 }}</ref>
	==Pharmacology==
	=== Pharmacodynamics ===
			A 2012 review focused on antidepressants and sleep found that mirtazapine reduced the time it took to fall asleep and improved the quality of sleep in many people with sleep disorders caused by depression, but that it could also disturb ] in many people, especially at higher doses, causing ] in 8 to 28% of people and in rare cases causes ].<ref>{{cite journal | vauthors = Wichniak A, Wierzbicka A, Jernajczyk W | title = Sleep and antidepressant treatment | journal = Current Pharmaceutical Design | volume = 18 | issue = 36 | pages = 5802–5817 | date = 2012 | pmid = 22681161 | doi = 10.2174/138161212803523608 }}</ref> This seemingly paradoxical ] curve of mirtazapine with respect to somnolence is owed to the exceptionally high affinity of the drug for the ] ], ], and ] receptors; exhibiting near exclusive occupation of these receptors at doses ≤15&nbsp;mg. However, at higher doses, ] and constitutive activation of the ], ], and ]s begins to offset activity at H<sub>1</sub> receptors leading to decreased somnolence and even a subjective sensation of "activation" in treated patients.<ref>{{Cite journal|vauthors=Leonard S|date=2015|title=Dose-Dependent Sedating and Stimulating Effects of Mirtazapine|url=https://proceedings.med.ucla.edu/wp-content/uploads/2016/11/Dose-Dependent-Sedating-and-Stimulating-Effects-of-Mirtazapine.pdf|journal=Proceedings of UCLA Healthcare|volume=19|access-date=27 August 2021|archive-date=23 September 2021|archive-url=https://web.archive.org/web/20210923115736/https://www.proceedings.med.ucla.edu/wp-content/uploads/2016/11/Dose-Dependent-Sedating-and-Stimulating-Effects-of-Mirtazapine.pdf|url-status=live}}</ref>
	Mirtazapine is an ]/] at the following ]s:<ref name="pmid15771415">{{Cite journal| author = Fernández J, Alonso JM, Andrés JI, ''et al.'' | title = Discovery of new tetracyclic tetrahydrofuran derivatives as potential broad-spectrum psychotropic agents | journal = Journal of Medicinal Chemistry | volume = 48 | issue = 6 | pages = 1709–12 | year = 2005 | month = March | pmid = 15771415 | doi = 10.1021/jm049632c}}</ref><ref name="pmid3419539">{{Cite journal| author = de Boer TH, Maura G, Raiteri M, de Vos CJ, Wieringa J, Pinder RM | title = Neurochemical and autonomic pharmacological profiles of the 6-aza-analogue of mianserin, Org 3770 and its enantiomers | journal = Neuropharmacology | volume = 27 | issue = 4 | pages = 399–408 | year = 1988 | month = April | pmid = 3419539 | doi = 10.1016/0028-3908(88)90149-9| url = }}</ref>
			A 2018 analysis of 21 antidepressants found them to be fairly similar overall.<ref name=Cip2018/> It found tentative evidence for mirtazapine being in the more effective group and middle in tolerability.<ref name=Cip2018>{{cite journal | vauthors = Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JP, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JP, Geddes JR | title = Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis | journal = Lancet | volume = 391 | issue = 10128 | pages = 1357–1366 | date = April 2018 | pmid = 29477251 | pmc = 5889788 | doi = 10.1016/S0140-6736(17)32802-7 }}</ref>
	{{multicol}}
	* ] (K<sub>i</sub> = 69 nM)
	* ] (K<sub>i</sub> = ? (~20-fold lower than for 5-HT<sub>2A</sub>/<sub>2C</sub>))<ref name="pmid8636062">{{Cite journal| author = de Boer T | title = The pharmacologic profile of mirtazapine | journal = The Journal of Clinical Psychiatry | volume = 57 Suppl 4 | issue = | pages = 19–25 | year = 1996 | pmid = 8636062 | doi = | url = }}</ref>
	* ] (K<sub>i</sub> = 39 nM)
	* ] (K<sub>i</sub> = ? (similar to 5-HT<sub>2A</sub>/<sub>2C</sub>))<ref name="pmid7984289">{{Cite journal| author = Kooyman AR, Zwart R, Vanderheijden PM, Van Hooft JA, Vijverberg HP | title = Interaction between enantiomers of mianserin and ORG3770 at 5-HT3 receptors in cultured mouse neuroblastoma cells | journal = Neuropharmacology | volume = 33 | issue = 3-4 | pages = 501–7 | year = 1994 | pmid = 7984289 | doi = 10.1016/0028-3908(94)90081-7| url = }}</ref>
	* ] (K<sub>i</sub> = 265 nM)
	{{multicol-break}}
	* ] (K<sub>i</sub> = 608 nM)
	* ] (K<sub>i</sub> = 20 nM)
	* ] (K<sub>i</sub> = 18 nM)
	* ] (K<sub>i</sub> = 1.6 nM)
	* ] (K<sub>i</sub> = 794 nM)
	{{multicol-end}}
			After one week of usage, mirtazapine was found to have an earlier onset of action compared to selective serotonin reuptake inhibitors.<ref name="pmid12404667">{{cite journal | vauthors = Thompson C | title = Onset of action of antidepressants: results of different analyses | journal = Human Psychopharmacology | volume = 17 | issue = Suppl 1 | pages = S27–S32 | date = June 2002 | pmid = 12404667 | doi = 10.1002/hup.386 | s2cid = 45925573 | doi-access = free }}</ref><ref name="Maudsley">{{cite book | isbn = 978-0-47-097948-8 | title = Maudsley Prescribing Guidelines in Psychiatry | edition = 11th | vauthors = Taylor D, Paton C, Shitij K | date = 2012 | publisher = Wiley-Blackwell | location = West Sussex }}
	As well as an ] of the following ]s:
			</ref>
			===Other===
	* ] (K<sub>i</sub> = 4,600 nM)
			There is also some evidence supporting its use in treating the following conditions, for which it is sometimes prescribed off-label:
			{{div col|colwidth=30em}}
	All ] listed were assayed using ] materials except those for α<sub>1</sub>-adrenergic and mACh which are for ] tissues, due to human values being unavailable.<ref name="pmid15771415"/><ref name="pmid3419539"/> Though not known to have ever been screened, mirtazapine may act on the ] and ]s as well. Notably, mianserin (which is 6-desazamirtazapine) has been shown to have high affinity for 5-HT<sub>6</sub> and does not produce ] accumulation (indicating it is an antagonist).<ref name="pmid9225298">{{Cite journal| author = Boess FG, Monsma FJ, Carolo C, ''et al.'' | title = Functional and radioligand binding characterization of rat 5-HT6 receptors stably expressed in HEK293 cells | journal = Neuropharmacology | volume = 36 | issue = 4-5 | pages = 713–20 | year = 1997 | pmid = 9225298 | doi = 10.1016/S0028-3908(97)00019-1| url = }}</ref>
			* ]<ref name=Ant2001 /><ref name="pmid10453798">{{cite journal | vauthors = Goodnick PJ, Puig A, DeVane CL, Freund BV | title = Mirtazapine in major depression with comorbid generalized anxiety disorder | journal = The Journal of Clinical Psychiatry | volume = 60 | issue = 7 | pages = 446–448 | date = July 1999 | pmid = 10453798 | doi = 10.4088/JCP.v60n0705 }}</ref><ref>{{cite journal | vauthors = Rifkin-Zybutz R, MacNeill S, Davies SJ, Dickens C, Campbell J, Anderson IM, Chew-Graham CA, Peters TJ, Lewis G, Wiles N, Kessler D | title = Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? A secondary analysis of the MIR trial | journal = Journal of Psychopharmacology | volume = 34 | issue = 12 | pages = 1342–1349 | date = December 2020 | pmid = 33143538 | pmc = 7708671 | doi = 10.1177/0269881120965939 | doi-access = free }}</ref>
			* ]<ref name="pmid19453203">{{cite journal | vauthors = Croom KF, Perry CM, Plosker GL | title = Mirtazapine: a review of its use in major depression and other psychiatric disorders | journal = CNS Drugs | volume = 23 | issue = 5 | pages = 427–452 | year = 2009 | pmid = 19453203 | doi = 10.2165/00023210-200923050-00006 | s2cid = 41694941 }}</ref>
			* ]<ref name="pmid19453203" />
			* ]<ref name="pmid19453203" />
			* ]<ref name="pmid19453203" />
			* ]/]<ref name="pmid12647431">{{cite journal | vauthors = Landowski J | title = | language = pl | journal = Psychiatria Polska | volume = 36 | issue = 6 Suppl | pages = 125–130 | year = 2002 | pmid = 12647431 }}</ref><ref name="pmid18001374">{{cite journal | vauthors = Chinuck RS, Fortnum H, Baldwin DR | title = Appetite stimulants in cystic fibrosis: a systematic review | journal = Journal of Human Nutrition and Dietetics | volume = 20 | issue = 6 | pages = 526–537 | date = December 2007 | pmid = 18001374 | doi = 10.1111/j.1365-277X.2007.00824.x | s2cid = 22500622 }}</ref><ref name="pmid12647979">{{cite journal | vauthors = Davis MP, Khawam E, Pozuelo L, Lagman R | title = Management of symptoms associated with advanced cancer: olanzapine and mirtazapine. A World Health Organization project | journal = Expert Review of Anticancer Therapy | volume = 2 | issue = 4 | pages = 365–376 | date = August 2002 | pmid = 12647979 | doi = 10.1586/14737140.2.4.365 | s2cid = 72195061 }}</ref>
			* ]<ref name="Clark_2011">{{cite journal | vauthors = Clark MS, Smith PO, Jamieson B | title = FPIN's clinical inquiries: Antidepressants for the treatment of insomnia in patients with depression | journal = American Family Physician | volume = 84 | issue = 9 | pages = 1–2 | date = November 2011 | pmid = 22164891 | url = http://www.aafp.org/afp/2011/1101/od1.pdf | access-date = 11 July 2017 | archive-date = 9 July 2020 | archive-url = https://web.archive.org/web/20200709135601/https://www.aafp.org/afp/2011/1101/od1.pdf | url-status = live }}</ref><ref>{{Cite journal|url=http://www.psychiatrictimes.com/sleep-disorders/effects-antidepressants-sleep|title=The Effects of Antidepressants on Sleep|journal=Psychiatric Times|date=13 June 2012|access-date=11 July 2017|vauthors=Winokur A, Demartinis N|volume=29|issue=6|archive-date=10 June 2020|archive-url=https://web.archive.org/web/20200610174804/https://www.psychiatrictimes.com/sleep-disorders/effects-antidepressants-sleep|url-status=dead}}</ref>
			* ] and ]<ref name=Nut2002 /><ref name="pmid21602639">{{cite journal | vauthors = Li TC, Shiah IS, Sun CJ, Tzang RF, Huang KC, Lee WK | title = Mirtazapine relieves post-electroconvulsive therapy headaches and nausea: a case series and review of the literature | journal = The Journal of ECT | volume = 27 | issue = 2 | pages = 165–167 | date = June 2011 | pmid = 21602639 | doi = 10.1097/YCT.0b013e3181e63346 }}</ref><ref name="pmid17587360">{{cite journal | vauthors = Kast RE, Foley KF | title = Cancer chemotherapy and cachexia: mirtazapine and olanzapine are 5-HT3 antagonists with good antinausea effects | journal = European Journal of Cancer Care | volume = 16 | issue = 4 | pages = 351–354 | date = July 2007 | pmid = 17587360 | doi = 10.1111/j.1365-2354.2006.00760.x }}</ref>
			* ]<ref name="pmid12509645">{{cite journal | vauthors = Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, Zylicz Z | title = Itch: scratching more than the surface | journal = QJM | volume = 96 | issue = 1 | pages = 7–26 | date = January 2003 | pmid = 12509645 | doi = 10.1093/qjmed/hcg002 | doi-access = free }}</ref><ref name="pmid16297004">{{cite journal | vauthors = Greaves MW | title = Itch in systemic disease: therapeutic options | journal = Dermatologic Therapy | volume = 18 | issue = 4 | pages = 323–327 | year = 2005 | pmid = 16297004 | doi = 10.1111/j.1529-8019.2005.00036.x | s2cid = 3210356 | doi-access = free }}</ref>
			* ]s and ]<ref name="pmid21602639" /><ref name="pmid15549531">{{cite journal | vauthors = Colombo B, Annovazzi PO, Comi G | title = Therapy of primary headaches: the role of antidepressants | journal = Neurological Sciences | volume = 25 | issue = Suppl 3 | pages = S171–S175 | date = October 2004 | pmid = 15549531 | doi = 10.1007/s10072-004-0280-x | s2cid = 21285843 }}</ref><ref name="pmid17073214">{{cite journal | vauthors = Tajti J, Almási J | title = | language = hu | journal = Neuropsychopharmacologia Hungarica | volume = 8 | issue = 2 | pages = 67–72 | date = June 2006 | pmid = 17073214 }}</ref>
			{{div col end}}
			==Side or adverse effects==
	Antagonization of the α<sub>2</sub>-adrenergic receptors which function largely as ]s and ]s enhances ] and ] ], notably ] ]-mediated transmission in the ] and ].<ref name="pmid10446735"/><ref name="pmid11607047">{{Cite journal| author = Anttila SA, Leinonen EV | title = A review of the pharmacological and clinical profile of mirtazapine | journal = CNS Drug Reviews | volume = 7 | issue = 3 | pages = 249–64 | year = 2001 | pmid = 11607047 | doi = 10.1111/j.1527-3458.2001.tb00198.x| url = }}</ref><ref name="urlThe α2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo">{{Cite web| url = http://cat.inist.fr/?aModele=afficheN&cpsidt=3960842 | title = The α2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo | format = | work = | accessdate = }}</ref><ref name="pmid9361334">{{Cite journal| author = Berendsen HH, Broekkamp CL | title = Indirect in vivo 5-HT1A-agonistic effects of the new antidepressant mirtazapine | journal = Psychopharmacology | volume = 133 | issue = 3 | pages = 275–82 | year = 1997 | month = October | pmid = 9361334 | doi = 10.1007/s002130050402| url = http://link.springer.de/link/service/journals/00213/bibs/7133003/71330275.htm}}</ref><ref name="pmid15145142">{{Cite journal| author = Nakayama K, Sakurai T, Katsu H | title = Mirtazapine increases dopamine release in prefrontal cortex by 5-HT1A receptor activation | journal = Brain Research Bulletin | volume = 63 | issue = 3 | pages = 237–41 | year = 2004 | month = April | pmid = 15145142 | doi = 10.1016/j.brainresbull.2004.02.007 | url = http://linkinghub.elsevier.com/retrieve/pii/S0361923004000589}}</ref> Because of this, mirtazapine has been said to be a functional "]" of the 5-HT<sub>1A</sub> receptor.<ref name="pmid9361334"/> Increased activation of the central 5-HT<sub>1A</sub> receptor is thought to be a major mediator of efficacy of most antidepressant drugs.<ref name="pmid11212592">{{Cite journal| author = Blier P, Abbott FV | title = Putative mechanisms of action of antidepressant drugs in affective and anxiety disorders and pain | journal = Journal of Psychiatry & Neuroscience : JPN | volume = 26 | issue = 1 | pages = 37–43 | year = 2001 | month = January | pmid = 11212592 | pmc = 1408043 | doi = | url = http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-26/issue-1/pdf/pg37.pdf}}</ref> Unlike most conventional antidepressants, however, mirtazapine is not a ] and has no appreciable affinity for the ], ], or ]s, nor is it an ] or have any efficacy at ]/] any other ] for that matter.
			A 2011 Cochrane review found that, compared with other antidepressants, it is more likely to cause weight gain and sleepiness, but it is less likely to cause tremors than tricyclic antidepressants, and less likely to cause nausea and sexual dysfunction than selective serotonin reuptake inhibitors.<ref name=Cochrane2011/>
			Very common (≥10% incidence) adverse effects include constipation, ], sleepiness, increased ] (17%) and weight gain (>7% increase in <50% of children).<ref name = "Remeron FDA label" /><ref name = AXIT>{{cite web|title=Axit Mirtazapine PRODUCT INFORMATION|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05345-3|work=TGA eBusiness Services|publisher=alphapharm|access-date=15 October 2013|date=25 October 2011|archive-date=20 September 2020|archive-url=https://web.archive.org/web/20200920021431/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05345-3|url-status=live}}</ref><ref name = EMC>{{cite web|title=Mirtazapine 30 mg Tablets – Summary of Product Characteristics|date=20 March 2013|access-date=24 October 2013|format=PDF|url=http://www.medicines.org.uk/emc/medicine/25201/SPC/Mirtazapine+30+mg+Tablets/|work=electronic Medicines Compendium|publisher=Sandoz Limited|archive-url=https://web.archive.org/web/20170731104144/http://www.medicines.org.uk/emc/medicine/25201/SPC/Mirtazapine+30+mg+Tablets/|archive-date=31 July 2017}}</ref><ref name = MS>{{cite web|title=mirtazapine (Rx) – Remeron, Remeron SolTab|work=Medscape|publisher=WebMD|access-date=24 October 2013|url=http://reference.medscape.com/drug/remeron-soltab-mirtazapine-342966|archive-date=29 October 2013|archive-url=https://web.archive.org/web/20131029200106/http://reference.medscape.com/drug/remeron-soltab-mirtazapine-342966|url-status=live}}</ref><ref name = "AMH">{{cite web | title = Australian Medicines Handbook | url = http://www.amh.net.au/ | year = 2013 | publisher = Australian Medicines Handbook Pty Ltd | access-date = 5 October 2013 | archive-date = 27 September 2011 | archive-url = https://web.archive.org/web/20110927131220/http://www.amh.net.au/ | url-status = live }}</ref><ref name = "BNF">{{cite book | title = British National Formulary (BNF) | year = 2013 | edition = 65th | publisher = Pharmaceutical Press | pages = 1120 | isbn = 978-0857110848 | url = https://archive.org/details/bnf65britishnati0000unse | url-access = registration }}</ref><ref>{{cite web|title=Remeron (Mirtazapine) Drug Information|url=http://www.rxlist.com/remeron-drug/side-effects-interactions.htm|website=RxList|access-date=28 March 2016|archive-date=4 May 2017|archive-url=https://web.archive.org/web/20170504234252/http://www.rxlist.com/remeron-drug/side-effects-interactions.htm|url-status=live}}</ref><ref>{{cite journal | vauthors = Hummel J, Westphal S, Weber-Hamann B, Gilles M, Lederbogen F, Angermeier T, Luley C, Deuschle M, Kopf D | title = Serum lipoproteins improve after successful pharmacologic antidepressant treatment: a randomized open-label prospective trial | journal = The Journal of Clinical Psychiatry | volume = 72 | issue = 7 | pages = 885–891 | date = July 2011 | pmid = 21294998 | doi = 10.4088/JCP.09m05853blu }}</ref><ref>{{cite journal | vauthors = McIntyre RS, Soczynska JK, Konarski JZ, Kennedy SH | title = The effect of antidepressants on lipid homeostasis: a cardiac safety concern? | journal = Expert Opinion on Drug Safety | volume = 5 | issue = 4 | pages = 523–537 | date = July 2006 | pmid = 16774491 | doi = 10.1517/14740338.5.4.523 | s2cid = 23740352 }}</ref>
	More recent findings suggest that mirtazapine also possesses a second antidepressant property, which is likely to be just as important as its actions at the α<sub>2</sub>-adrenergic receptor in mitigating depression, mirtazapine's secondary antidepressant properties are likely to be mediated by its blockade of serotonin receptors, notably 5-HT<sub>2C</sub>.<ref name="pmid18709360">{{Cite journal| author = Dekeyne A, Millan MJ | title = Discriminative stimulus properties of the atypical antidepressant, mirtazapine, in rats: a pharmacological characterization | journal = Psychopharmacology | volume = 203 | issue = 2 | pages = 329–41 | year = 2009 | month = April | pmid = 18709360 | doi = 10.1007/s00213-008-1259-8}}</ref><ref name="pmid16433010">{{Cite journal| author = Millan MJ | title = Serotonin 5-HT2C receptors as a target for the treatment of depressive and anxious states: focus on novel therapeutic strategies | journal = Thérapie | volume = 60 | issue = 5 | pages = 441–60 | year = 2005 | pmid = 16433010 | doi = 10.2515/therapie:2005065| url = }}</ref><ref name="urlwww.psychotropical.com">{{Cite web| url = http://www.psychotropical.com/Antidepressants_mirtazapine.shtml | title = www.psychotropical.com | work = | accessdate = }}</ref><ref name="urlwww.psychotropical.com">{{Cite web| url = http://www.psychotropical.com/Mirt_medioc_science.shtml | title = www.psychotropical.com | work = | accessdate = }}</ref> The 5-HT<sub>2C</sub> receptor normally works to inhibit the release of the ]s ] and ] in various parts of the brain, notably in the ]s such as the ] (VTA).<ref name="pmid15056702">{{Cite journal| author = De Deurwaerdère P, Navailles S, Berg KA, Clarke WP, Spampinato U | title = Constitutive activity of the serotonin2C receptor inhibits in vivo dopamine release in the rat striatum and nucleus accumbens | journal = The Journal of Neuroscience : the Official Journal of the Society for Neuroscience | volume = 24 | issue = 13 | pages = 3235–41 | year = 2004 | month = March | pmid = 15056702 | doi = 10.1523/JNEUROSCI.0112-04.2004 | url = }}</ref><ref name="pmid17367945">{{Cite journal| author = Bubar MJ, Cunningham KA | title = Distribution of serotonin 5-HT2C receptors in the ventral tegmental area | journal = Neuroscience | volume = 146 | issue = 1 | pages = 286–97 | year = 2007 | month = April | pmid = 17367945 | pmc = 1939890 | doi = 10.1016/j.neuroscience.2006.12.071 | url = }}</ref> By blocking it, mirtazapine disinhibits dopamine and norepinephrine activity in these areas, causing a pronounced antidepressant and anxiolytic response.<ref name="pmid10762339">{{Cite journal| author = Millan MJ, Gobert A, Rivet JM, ''et al.'' | title = Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of alpha2-adrenergic and serotonin2C receptors: a comparison with citalopram | journal = The European Journal of Neuroscience | volume = 12 | issue = 3 | pages = 1079–95 | year = 2000 | month = March | pmid = 10762339 | doi = 10.1046/j.1460-9568.2000.00982.x| url = http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0953-816X&date=2000&volume=12&issue=3&spage=1079}}</ref> Indeed, the novel antidepressant ] acts primarily as a 5-HT<sub>2C</sub> receptor antagonist and has antidepressant efficacy at least comparable to that of the SSRIs and SNRIs.<ref name="pmid12750432">{{Cite journal| author = Millan MJ, Gobert A, Lejeune F, ''et al.'' | title = The novel melatonin agonist agomelatine (S20098) is an antagonist at 5-hydroxytryptamine2C receptors, blockade of which enhances the activity of frontocortical dopaminergic and adrenergic pathways | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 306 | issue = 3 | pages = 954–64 | year = 2003 | month = September | pmid = 12750432 | doi = 10.1124/jpet.103.051797 | url = }}</ref><ref name="urlFebruary 2009: agomelatine (Valdoxan) licensed in the EU to treat major depression">{{Cite web| url = http://www.agomelatine.org/2009-valdoxan.html | title = February 2009: agomelatine (Valdoxan) licensed in the EU to treat major depression | work = | accessdate = }}</ref>
			Common (1–10% incidence) adverse effects include weakness, ], dizziness, ]s (muscle twitches), ] (swelling, usually of the lower limbs), and negative lab results like ], elevated serum ]s, and elevated total ].<ref name = EMC/>
	Antagonism of the 5-HT<sub>2A</sub> and 5-HT<sub>2C</sub> receptors has beneficial effects on ], ] and ], as well as sexual function regarding the latter receptor.<ref name="pmid11607047"/><ref name="pmid10333982">{{Cite journal| author = Fawcett J, Barkin RL | title = Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression | journal = Journal of Affective Disorders | volume = 51 | issue = 3 | pages = 267–85 | year = 1998 | month = December | pmid = 10333982 | doi = 10.1016/S0165-0327(98)00224-9| url = http://linkinghub.elsevier.com/retrieve/pii/S0165-0327(98)00224-9}}</ref> Additionally, antagonism of the 5-HT<sub>3</sub> receptor, the mechanism of action of ] ], significantly improves pre-existing symptoms of ], ], ], and general ] in afflicted individuals.<ref name="pmid11585276">{{Cite journal| author = Kast RE | title = Mirtazapine may be useful in treating nausea and insomnia of cancer chemotherapy | journal = Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer | volume = 9 | issue = 6 | pages = 469–70 | year = 2001 | month = September | pmid = 11585276 | doi = | url = http://link.springer.de/link/service/journals/00520/bibs/1009006/10090469.htm}}</ref> Mirtazapine may be used as an inexpensive antiemetic alternative to ondansetron.<ref name="pmid17587360"/> Blockade of the 5-HT<sub>3</sub> receptors has also shown to improve anxiety and to be effective in the treatment of ] in several studies.<ref name="urlThe psychopharmacology of 5-HT3 receptors">{{Cite web| url = http://cat.inist.fr/?aModele=afficheN&cpsidt=4556300 | title = The psychopharmacology of 5-HT3 receptors | format = | work = | accessdate = }}</ref> Mirtazapine appears to enhance ] function as well and reverses ]-induced memory deficits in rodents,<ref name="pmid10817523">{{Cite journal| author = Nowakowska E, Chodera A, Kus K | title = Behavioral and memory improving effects of mirtazapine in rats | journal = Polish Journal of Pharmacology | volume = 51 | issue = 6 | pages = 463–9 | year = 1999 | pmid = 10817523 | doi = | url = }}</ref> effects which may be attributed to 5-HT<sub>3</sub> antagonism.<ref name="pmid9098839">{{Cite journal| author = Roychoudhury M, Kulkarni SK | title = Effects of ondansetron on short-term memory retrieval in mice | journal = Methods and Findings in Experimental and Clinical Pharmacology | volume = 19 | issue = 1 | pages = 43–6 | year = 1997 | pmid = 9098839 | doi = | url = }}</ref> In contrast to mirtazapine, the SSRIs, SNRIs, TCAs, and MAOIs all increase the general activity of the 5-HT<sub>2A</sub>, 5-HT<sub>2C</sub>, and 5-HT<sub>3</sub> receptors, leading to a host of negative changes and side effects, the most prominent of which include ], ], ] (impaired ] and ]), ], and ], 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.<ref name="pmid10333982"/><ref name="pmid16946177">{{Cite journal| author = McGrath PJ, Stewart JW, Fava M, ''et al.'' | title = Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report | journal = The American Journal of Psychiatry | volume = 163 | issue = 9 | pages = 1531–41; quiz 1666 | year = 2006 | month = September | pmid = 16946177 | doi = 10.1176/appi.ajp.163.9.1531 | url = http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=16946177}}</ref><ref name="pmid12590402">{{Cite journal| author = Sennef C, Timmer CJ, Sitsen JM | title = Mirtazapine in combination with amitriptyline: a drug-drug interaction study in healthy subjects | journal = Human Psychopharmacology | volume = 18 | issue = 2 | pages = 91–101 | year = 2003 | month = March | pmid = 12590402 | doi = 10.1002/hup.441}}</ref><ref name="pmid12028939">{{Cite journal| author = Gándara Martín Jde L, Agüera Ortiz L, Ferre Navarrete F, Rojo Rodés E, Ros Montalbán S | title = | language = Spanish; Castilian | journal = Actas Españolas De Psiquiatría | volume = 30 | issue = 2 | pages = 75–84 | year = 2002 | pmid = 12028939 | doi = | url = http://www.arsxxi.com/Revistas/mostrararticulo.php?idarticulo=13031118}}</ref><ref name="pmid15560319">{{Cite journal| author = Caldis EV, Gair RD | title = Mirtazapine for treatment of nausea induced by selective serotonin reuptake inhibitors | journal = Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie | volume = 49 | issue = 10 | pages = 707 | year = 2004 | month = October | pmid = 15560319 | doi = | url = }}</ref><ref name="pmid18204355">{{Cite journal| author = Ravindran LN, Eisfeld BS, Kennedy SH | title = Combining mirtazapine and duloxetine in treatment-resistant depression improves outcomes and sexual function | journal = Journal of Clinical Psychopharmacology | volume = 28 | issue = 1 | pages = 107–8 | year = 2008 | month = February | pmid = 18204355 | doi = 10.1097/JCP.0b013e318160d609 | url = }}</ref>
			Mirtazapine is not considered to have a risk of many of the side effects often associated with other antidepressants like the selective serotonin reuptake inhibitors and may improve certain ones when taken in conjunction with them.<ref name=Ant2001/><ref name="pmid10333982"/> (Those adverse effects include ], ], ], ] and ], ], ], increased ], ], ] and ].<ref name=Ant2001/><ref name="pmid10333982"/>)
	Mirtazapine is a very strong H<sub>1</sub> receptor antagonist and as a result, it can cause powerful ] and ] effects.<ref name="urlwww.psychotropical.com"/> After a short period of chronic treatment, however, the H<sub>1</sub> receptor tends to ] 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 H<sub>1</sub> receptor may improve pre-existing ], ], ], and ] in afflicted individuals; hence, this may actually be a positive thing for some. It may also contribute to ], however.{{Citation needed|date=August 2010}} Mirtazapine has very low affinity for the ]s and therefore lacks significant ] properties at clinically used doses.
			In general, some antidepressants, especially selective serotonin reuptake inhibitors, can ] exacerbate some peoples' depression or anxiety or cause ].<ref name="pmid17143567">{{cite journal | vauthors = Möller HJ | title = Is there evidence for negative effects of antidepressants on suicidality in depressive patients? A systematic review | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 256 | issue = 8 | pages = 476–496 | date = December 2006 | pmid = 17143567 | doi = 10.1007/s00406-006-0689-8 | s2cid = 22708700 }}</ref> Despite its sedating action, mirtazapine is also believed to be capable of this, so in the United States and certain other countries, it carries a ] label warning of these potential effects, especially for people under the age of 25.<ref name="AHSF2018" />
	In contrast to ]’s and ], mirtazapine also has ] properties involving particularly kappa κ3- and to a lesser extend mu μ-], which may significantly contribute to its mood elevating effects.<ref> Schreiber S, Bleich A, Pick Ch G (2001). “Venlafaxine and Mirtazapine. Different mechanisms of antidepressant action, common opioid-mediated antinociceptive effects—A possible opioid involvement in severe depression?”. ''Journal of Molecular Neuroscience '''18''' (1-2)'' : p. 143-149. </ref>
			Mirtazapine may induce ] (non-inflammatory joint pain).<ref name=mirtaartha>{{cite journal | vauthors = Passier A, van Puijenbroek E | title = Mirtazapine-induced arthralgia | journal = British Journal of Clinical Pharmacology | volume = 60 | issue = 5 | pages = 570–572 | date = November 2005 | pmid = 16236049 | pmc = 1884949 | doi = 10.1111/j.1365-2125.2005.02481.x }}</ref>
	]
			A case report published in 2000 noted an instance in which mirtazapine counteracted the action of ], causing a dangerous rise in blood pressure.<ref>{{cite journal | vauthors = Abo-Zena RA, Bobek MB, Dweik RA | title = Hypertensive urgency induced by an interaction of mirtazapine and clonidine | journal = Pharmacotherapy | volume = 20 | issue = 4 | pages = 476–478 | date = April 2000 | pmid = 10772378 | doi = 10.1592/phco.20.5.476.35061 | s2cid = 9959199 }}</ref>
	===Pharmacokinetics===
	Mirtazapine is typically prescribed in doses ranging from 15&nbsp;mg to 45&nbsp;mg. However, in severely depressed individuals, doses as high as 120&nbsp;mg have been used with success.{{Citation needed|date=July 2009}} Mirtazapine has a ] 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.
			In a study comparing 32 antidepressants of all pharmacological classes, mirtazapine was one of the antidepressants most likely to cause ], ], ], ]s and ].<ref>{{cite journal | vauthors = Natter J, Yokoyama T, Michel B | title = Relative frequency of drug-induced sleep disorders for 32 antidepressants in a large set of Internet user reviews | journal = Sleep | volume = 44 | issue = 12 | pages = zsab174 | date = December 2021 | pmid = 34252190 | doi = 10.1093/sleep/zsab174 | doi-access = free }}</ref>
	==Chemistry==
	]
			Mirtazapine has been associated with an increased ] compared to other antidepressants in several studies. However, it is more likely that the residual differences between people prescribed mirtazapine rather than a selective serotonin reuptake inhibitor account for the difference in risk of mortality.<ref name="pmid35105363">{{cite journal | vauthors = Joseph RM, Jack RH, Morriss R, Knaggs RD, Butler D, Hollis C, Hippisley-Cox J, Coupland C | title = The risk of all-cause and cause-specific mortality in people prescribed mirtazapine: an active comparator cohort study using electronic health records | journal = BMC Med | volume = 20 | issue = 1 | pages = 43 | date = February 2022 | pmid = 35105363 | pmc = 8809032 | doi = 10.1186/s12916-022-02247-x | url = | doi-access = free }}</ref>
	Mirtazapine is a ] of ]s and the (''S'')-(+)-enantiomer is known as ].
			==Withdrawal==
	A four step ] of mirtazapine has been published.<ref name="Rao_2006">{{Cite journal| author = Rao DVSN, Dandala R, Bharathi C, Handa VK, Sivakumaran M, Naidu A | title = Synthesis of potential related substances of mirtazapine | journal = Arkivoc | volume = 2006 | issue = | pages = 127–132 | year = 2006 | month = Dec | pmid = | doi = | url = http://www.arkat-usa.org/get-file/22868/ }}</ref><ref name="pmid123455">{{Ref patent | country = US | number = 4062848 | status = patent | title = Tetracyclic compounds | gdate = 1977-12-13 | pubdate = 1977-12-13 | pridate = 1976-03-23 | inventor = Van der Burg WJ }}</ref>
			Stopping Mirtazapine and other antidepressants may cause ] symptoms.<ref name=Ant2001/><ref name="pmid11444761">{{cite journal | vauthors = Blier P | title = Pharmacology of rapid-onset antidepressant treatment strategies | journal = The Journal of Clinical Psychiatry | volume = 62 | issue = Suppl 15 | pages = 12–17 | year = 2001 | pmid = 11444761 }}</ref> A gradual and slow reduction in dose is recommended to minimize such symptoms.<ref name="pmid15819135">{{cite journal | vauthors = Vlaminck JJ, van Vliet IM, Zitman FG | title = | language = nl | journal = Nederlands Tijdschrift voor Geneeskunde | volume = 149 | issue = 13 | pages = 698–701 | date = March 2005 | pmid = 15819135 }}</ref> Effects of sudden cessation of treatment with mirtazapine may include ], ], ], ]s, ], ], ], ], ], ], ], ], ]-like symptoms, ]-like symptoms such as ], ]s, and sometimes ] or ].<ref name="pmid10986577">{{cite journal | vauthors = Klesmer J, Sarcevic A, Fomari V | title = Panic attacks during discontinuation of mirtazepine | journal = Canadian Journal of Psychiatry | volume = 45 | issue = 6 | pages = 570–571 | date = August 2000 | pmid = 10986577 }}</ref><ref name="pmid10789310">{{cite journal | vauthors = MacCall C, Callender J | title = Mirtazapine withdrawal causing hypomania | journal = The British Journal of Psychiatry | volume = 175 | issue = 4 | pages = 390 | date = October 1999 | pmid = 10789310 | doi = 10.1192/bjp.175.4.390a | doi-access = free }}</ref><ref name="pmid12776393">{{cite journal | vauthors = Ali S, Milev R | title = Switch to mania upon discontinuation of antidepressants in patients with mood disorders: a review of the literature | journal = Canadian Journal of Psychiatry | volume = 48 | issue = 4 | pages = 258–264 | date = May 2003 | pmid = 12776393 | doi = 10.1177/070674370304800410 | doi-access = free }}</ref>
			==Overdose==
	==Efficacy and tolerability==
			Mirtazapine is considered to be relatively safe in the event of an ],<ref name="Maudsley"/> although it is considered slightly more ] in overdose than most of the selective serotonin reuptake inhibitors (except ]).<ref>{{cite journal | vauthors = White N, Litovitz T, Clancy C | title = Suicidal antidepressant overdoses: a comparative analysis by antidepressant type | journal = Journal of Medical Toxicology | volume = 4 | issue = 4 | pages = 238–250 | date = December 2008 | pmid = 19031375 | pmc = 3550116 | doi = 10.1007/bf03161207 }}</ref> Unlike the tricyclic antidepressants, mirtazapine showed no significant ] ]s at 7 to 22 times the maximum recommended dose.<ref name="pmid10333982"/>
	Mirtazapine has been found to be one of the most effective antidepressants available and has a generally tolerable ] profile. In a major ] 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, ], ], and ] in terms of antidepressant efficacy, while it was average in regards to tolerability.<ref name="pmid11607047"/><ref name="pmid19185342">{{Cite journal| author = Cipriani A, Furukawa TA, Salanti G, ''et al.'' | title = Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis | journal = Lancet | volume = 373 | issue = 9665 | pages = 746–58 | year = 2009 | month = February | pmid = 19185342 | doi = 10.1016/S0140-6736(09)60046-5 | url = http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)60046-5}}</ref><ref name="mir">Croom KF, Perry CM, Plosker GL..CNSDrugs;2009 23(5):427-452. doi: 10.2165/00023210-200923050-00006.</ref> Mirtazapine has been demonstrated to be superior to ] as well.<ref name="pmid7622801">{{Cite journal| author = van Moffaert M, de Wilde J, Vereecken A, ''et al.'' | title = Mirtazapine is more effective than trazodone: a double-blind controlled study in hospitalized patients with major depression | journal = International Clinical Psychopharmacology | volume = 10 | issue = 1 | pages = 3–9 | year = 1995 | month = March | pmid = 7622801 | doi = 10.1097/00004850-199503000-00001| url = }}</ref> Mirtazapine has also been shown to be equal in efficacy to many of the TCAs, including ], ], and ], but with a much improved tolerability profile.<ref name="pmid11607047"/><ref name="pmid10333982"/> However, two other studies found mirtazapine inferior to the TCA ].<ref name="pmid8912401">{{Cite journal| author = Bruijn JA, Moleman P, Mulder PG, ''et al.'' | title = A double-blind, fixed blood-level study comparing mirtazapine with imipramine in depressed in-patients | journal = Psychopharmacology | volume = 127 | issue = 3 | pages = 231–7 | year = 1996 | month = October | pmid = 8912401 | doi = | url = http://link.springer.de/link/service/journals/00213/bibs/6127003/61270231.htm}}</ref><ref name="pmid10463374">{{Cite journal| author = Bruijn JA, Moleman P, Mulder PG, van den Broek WW | title = Depressed in-patients respond differently to imipramine and mirtazapine | journal = Pharmacopsychiatry | volume = 32 | issue = 3 | pages = 87–92 | year = 1999 | month = May | pmid = 10463374 | doi = 10.1055/s-2007-979200| url = }}</ref> One study compared the combination of ] and mirtazapine versus the ] ] and found them to be equally effective, though the ] was much less tolerable in terms of ]s and ]s.<ref name="pmid16946177"/>
			Twelve reported fatalities have been attributed to mirtazapine overdose.<ref>{{cite journal | vauthors = Nikolaou P, Dona A, Papoutsis I, Spiliopoulou C, Maravelias C | title = Death Due to Mirtazapine Overdose | doi=10.1080/15563650902952273 | quote = Abstracts of the XXIX International Congress of the European Association of Poison Centres and Clinical Toxicologists, May 12–15, 2009, Stockholm, Sweden | year = 2009 | journal = Clinical Toxicology | volume = 47 | issue = 5 | pages = 436–510 |s2cid=218861198 | doi-access = free }}</ref><ref>{{cite book | vauthors = Baselt RC | title = Disposition of Toxic Drugs and Chemicals in Man | edition = 8th | publisher = Biomedical Publications | location = Foster City, CA | year = 2008 | pages = 1045–7 | isbn = 978-0-9626523-7-0 }}</ref> The fatal toxicity index (deaths per million prescriptions) for mirtazapine is 3.1 (95% CI: 0.1 to 17.2).<ref name=":0" /> This is similar to that observed with selective serotonin reuptake inhibitors.<ref name="bmj325">{{cite journal | vauthors = Buckley NA, McManus PR | title = Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data | journal = BMJ | volume = 325 | issue = 7376 | pages = 1332–1333 | date = December 2002 | pmid = 12468481 | pmc = 137809 | doi = 10.1136/bmj.325.7376.1332 }}</ref>{{Unreliable medical source|date=October 2011}}
	==Adverse effects==
	Common ]s of mirtazapine: ], ], ], ], ]/], increased ] and subsequent ],<ref>Medications or Substances causing Excessive hunger http://www.wrongdiagnosis.com/symptoms/excessive_hunger/side-effects.htm</ref> ], ], enhanced ] and ], and vivid, bizarre, ] ]s or ]s.{{Citation needed|date=September 2010}}
			==Interactions==
	Rarer side effects: ]/], ], ], ] and/or ] (]), excessive mellowness or ], difficulty ], ], decreased ], ], ]s, spontaneous ], ], and ].<ref name="pmid11607047"/><ref name="pmid18756499">{{Cite journal| author = Kim SW, Shin IS, Kim JM, Park KH, Youn T, Yoon JS | title = Factors potentiating the risk of mirtazapine-associated restless legs syndrome | journal = Human Psychopharmacology | volume = 23 | issue = 7 | pages = 615–20 | year = 2008 | month = October | pmid = 18756499 | doi = 10.1002/hup.965}}</ref><ref name="pmid8930008">{{Cite journal| author = Montgomery SA | title = Safety of mirtazapine: a review | journal = International Clinical Psychopharmacology | volume = 10 Suppl 4 | issue = | pages = 37–45 | year = 1995 | month = December | pmid = 8930008 | doi = | url = }}</ref><ref name="pmid12680749">{{Cite journal| author = Biswas PN, Wilton LV, Shakir SA | title = The pharmacovigilance of mirtazapine: results of a prescription event monitoring study on 13554 patients in England | journal = Journal of Psychopharmacology (Oxford, England) | volume = 17 | issue = 1 | pages = 121–6 | year = 2003 | month = March | pmid = 12680749 | doi = 10.1177/0269881103017001716| url = http://jop.sagepub.com/cgi/pmidlookup?view=long&pmid=12680749}}</ref> Mirtazapine has also occasionally been reported to cause mild ] effects in some patients, including ], ] and ] ]s. Most of these side effects are generally mild and become less prominent over time.<ref name="pmid11607047"/>
			Concurrent use with inhibitors or inducers of the ] ]s ], ], and/or ] can result in altered concentrations of mirtazapine, as these are the main ]s responsible for its metabolism.<ref name="pmid10885584"/><ref name=Ant2001 /> As examples, ] and ], inhibitors of these enzymes, are known to modestly increase mirtazapine levels, while ], an inducer, considerably decreases them.<ref name="pmid10885584" /> ] impairment and moderate ] have been reported to decrease the oral clearance of mirtazapine by about 30%; ] decreases it by 50%.<ref name="pmid10885584" />
			Mirtazapine in combination with a ], ], or ] as an ] strategy is considered to be relatively safe and is often employed therapeutically but caution should be given when combined with ]. There is a combination of ] and mirtazapine, sometimes referred to as "California rocket fuel".<ref name="isbn0-521-74609-4">{{cite book | vauthors = Stahl SM | title = Stahl's Essential Psychopharmacology Online: Print and Online | publisher = Cambridge University Press | location = Cambridge, UK | year = 2008 | isbn = 978-0-521-74609-0 | url = http://stahlonline.cambridge.org/prescribers_drug.jsf?page=0521683505c57_p325-330.html.therapeutics&name=Mirtazapine&title=Therapeutics | access-date = 21 January 2012 | archive-date = 19 June 2020 | archive-url = https://web.archive.org/web/20200619204935/https://stahlonline.cambridge.org/prescribers_drug.jsf?page=0521683505c57_p325-330.html.therapeutics&name=Mirtazapine&title=Therapeutics | url-status = live }}</ref><ref>{{cite journal | vauthors = Silva J, Mota J, Azevedo P | title = California rocket fuel: And what about being a first line treatment? | journal = European Psychiatry | date=March 2016 | volume = 33 | pages = S551 | doi = 10.1016/j.eurpsy.2016.01.2033 | s2cid = 75595266 }}</ref> Several case reports document ] induced by the combination of mirtazapine with other agents (],<ref>{{cite journal | vauthors = Wu CS, Tong SH, Ong CT, Sung SF | title = Serotonin Syndrome Induced by Combined Use of Mirtazapine and Olanzapine Complicated with Rhabdomyolysis, Acute Renal Failure, and Acute Pulmonary Edema-A Case Report | journal = Acta Neurologica Taiwanica | volume = 24 | issue = 4 | pages = 117–121 | date = December 2015 | pmid = 27333965 }}</ref> ],<ref>{{cite journal | vauthors = Saguin E, Keou S, Ratnam C, Mennessier C, Delacour H, Lahutte B | title = Severe rhabdomyolysis induced by quetiapine and mirtazapine in a French military soldier | journal = Journal of the Royal Army Medical Corps | volume = 164 | issue = 2 | pages = 127–129 | date = May 2018 | pmid = 29632134 | doi = 10.1136/jramc-2018-000939 | s2cid = 4737517 }}</ref> ] and ]<ref>{{cite journal | vauthors = Houlihan DJ | title = Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine | journal = The Annals of Pharmacotherapy | volume = 38 | issue = 3 | pages = 411–413 | date = March 2004 | pmid = 14970364 | doi = 10.1345/aph.1D344 | s2cid = 33912489 }}</ref>). Adding ] to treatment with mirtazapine may cause a significant increase in mirtazapine concentration. This interaction may necessitate an adjustment of the mirtazapine dosage.<ref>{{cite journal | vauthors = Anttila AK, Rasanen L, Leinonen EV | title = Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold | journal = The Annals of Pharmacotherapy | volume = 35 | issue = 10 | pages = 1221–1223 | date = October 2001 | pmid = 11675851 | doi = 10.1345/aph.1A014 | s2cid = 44807359 }}</ref><ref>{{Cite web |title=Fluvoxamine and mirtazapine Interactions |url=https://www.drugs.com/drug-interactions/fluvoxamine-with-mirtazapine-1128-0-1640-0.html |access-date=4 December 2022 |website=Drugs.com |archive-date=4 December 2022 |archive-url=https://web.archive.org/web/20221204190716/https://www.drugs.com/drug-interactions/fluvoxamine-with-mirtazapine-1128-0-1640-0.html |url-status=live }}</ref>
	Very rare, potentially serious ]s may include ], ], ], ]s, ], ],<ref name="pmid12680749"/> and ] (occurs in 1/1,000 patients){{Citation needed|date=May 2010}}.
			According to information from the manufacturers, mirtazapine should not be started within two weeks of any ] usage; likewise, monoamine oxidase inhibitors should not be administered within two weeks of discontinuing mirtazapine.<ref name="AHSF2018" />
	Mirtazapine has a lower risk to cause many of the side effects encountered with other antidepressants, such as decreased ], ], ] and ], ], ], increased ], increased ]/], ], and ] (consisting of loss of ] and ]).<ref name="pmid11607047"/><ref name="pmid10333982"/>
			The addition of mirtazapine to a monoamine oxidase inhibitor, while potentially having typical or idiosyncratic (unique to the individual) reactions not herein described, does not appear to cause serotonin syndrome.<ref name="pmid16460699" /> This is per the fact that the ] receptor is the predominant serotonin receptor thought to be involved in the ] of serotonin syndrome (with the ] receptor seeming to be protective).<ref name="pmid16460699" /><ref name="pmid16342227" /> Mirtazapine is a potent ] receptor antagonist, and ], a medication that shares this property, mediates recovery from serotonin syndrome and is an ] against it.<ref name="pmid16342227" /><ref name="pmid23145389">{{cite journal | vauthors = Iqbal MM, Basil MJ, Kaplan J, Iqbal MT | title = Overview of serotonin syndrome | journal = Annals of Clinical Psychiatry | volume = 24 | issue = 4 | pages = 310–318 | date = November 2012 | pmid = 23145389 }}</ref>
	In general, some antidepressants may have the capacity to exacerbate some patients' depression or ] or cause ], particularly early in the treatment. It has been proven that mirtazapine has a faster onset of antidepressant action compared to SSRIs.<ref name="pmid20531012">{{Cite journal| author = Thase ME | last2 = Nierenberg | first2 = AA | last3 = Vrijland | first3 = P | last4 = Van Oers | first4 = HJ | last5 = Schutte | first5 = AJ | last6 = Simmons | first6 = JH | title = 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. | journal = Int Clin Psychopharmacol | volume = 25 | issue = 4 | pages = 189–98 | year = 2010 | month = July | pmid = 20531012 | doi = 10.1097/YIC.0b013e328330adb2| url = http://www.ncbi.nlm.nih.gov/pubmed/20531012 }}</ref>
			There is a possible interaction that results in a hypertensive crisis when mirtazapine is given to a patient who has already been on steady doses of clonidine. This involves a subtle consideration, when patients have been on chronic therapy with clonidine and suddenly stop the dosing, a rapid hypertensive rebound sometimes (20%) occurs from increased sympathetic outflow. Clonidine's blood pressure lowering effects are due to stimulation of presynaptic α<sub>2</sub> autoreceptors in the CNS which suppress sympathetic outflow. Mirtazapine itself blocks these same α<sub>2</sub> autoreceptors, so the effect of adding mirtazapine to a patient stabilized on clonidine may precipitate withdrawal symptoms.<ref>{{cite web|url=https://www.reliasmedia.com/articles/46173-interaction-between-mirtazapine-and-clonidine|title=Interactions Between Mirtazapine and Clonidine|access-date=15 January 2021|archive-date=21 January 2021|archive-url=https://web.archive.org/web/20210121041118/https://www.reliasmedia.com/articles/46173-interaction-between-mirtazapine-and-clonidine|url-status=live}}</ref>
	==Discontinuation==
	Mirtazapine and other ]s may cause a ] upon ].<ref name="pmid11607047"/><ref name="pmid9653542">{{Cite journal| author = Benazzi F | title = Mirtazapine withdrawal symptoms | journal = Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie | volume = 43 | issue = 5 | pages = 525 | year = 1998 | month = June | pmid = 9653542 | doi = | url = }}</ref><ref name="pmid15014614">{{Cite journal| author = Berigan TR | title = Mirtazapine-Associated Withdrawal Symptoms: A Case Report | journal = Primary Care Companion to the Journal of Clinical Psychiatry | volume = 3 | issue = 3 | pages = 143 | year = 2001 | month = June | pmid = 15014614 | pmc = 181176 | doi = | url = }}</ref><ref name="pmid11444761">{{Cite journal| author = Blier P | title = Pharmacology of rapid-onset antidepressant treatment strategies | journal = The Journal of Clinical Psychiatry | volume = 62 Suppl 15 | issue = | pages = 12–7 | year = 2001 | pmid = 11444761 | doi = | url = }}</ref> 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 ].<ref name="pmid12369270">{{Cite journal| author = van Broekhoven F, Kan CC, Zitman FG | title = Dependence potential of antidepressants compared to benzodiazepines | journal = Progress in Neuro-psychopharmacology & Biological Psychiatry | volume = 26 | issue = 5 | pages = 939–43 | year = 2002 | month = June | pmid = 12369270 | doi = 10.1016/S0278-5846(02)00209-9| url = http://linkinghub.elsevier.com/retrieve/pii/S0278-5846(02)00209-9}}</ref> A gradual and slow reduction in dose is recommended in order to minimize withdrawal symptoms.<ref name="pmid15819135">{{Cite journal| author = Vlaminck JJ, van Vliet IM, Zitman FG | title = | language = Dutch; Flemish | journal = Nederlands Tijdschrift Voor Geneeskunde | volume = 149 | issue = 13 | pages = 698–701 | year = 2005 | month = March | pmid = 15819135 | doi = | url = }}</ref> Effects of sudden cessation of treatment with mirtazapine may include depression, ], ]s, ], restlessness, ], decreased ], ], ], ] and ], ]-like symptoms such as ] and ], ], and sometimes ]/].<ref name="pmid9653542"/><ref name="pmid15014614"/><ref name="pmid10986577">{{Cite journal| author = Klesmer J, Sarcevic A, Fomari V | title = Panic attacks during discontinuation of mirtazepine | journal = Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie | volume = 45 | issue = 6 | pages = 570–1 | year = 2000 | month = August | pmid = 10986577 | doi = | url = }}</ref><ref name="pmid10789310">{{Cite journal| author = MacCall C, Callender J | title = Mirtazapine withdrawal causing hypomania | journal = The British Journal of Psychiatry : the Journal of Mental Science | volume = 175 | issue = | pages = 390 | year = 1999 | month = October | pmid = 10789310 | doi = 10.1192/bjp.175.4.390a| url = }}</ref><ref name="pmid12776393">{{Cite journal| author = Ali S, Milev R | title = Switch to mania upon discontinuation of antidepressants in patients with mood disorders: a review of the literature | journal = Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie | volume = 48 | issue = 4 | pages = 258–64 | year = 2003 | month = May | pmid = 12776393 | doi = | url = }}</ref>
			Mirtazapine has been used as a ] to block the effects of ]s like ] and ] (LSD).<ref name="YatesMelon2024">{{cite journal | vauthors = Yates G, Melon E | title = Trip-killers: a concerning practice associated with psychedelic drug use | journal = Emerg Med J | volume = 41 | issue = 2 | pages = 112–113 | date = January 2024 | pmid = 38123961 | doi = 10.1136/emermed-2023-213377 | url = }}</ref><ref name="Suran2024">{{cite journal | vauthors = Suran M | title = Study Finds Hundreds of Reddit Posts on "Trip-Killers" for Psychedelic Drugs | journal = JAMA | volume = 331 | issue = 8 | pages = 632–634 | date = February 2024 | pmid = 38294772 | doi = 10.1001/jama.2023.28257 | url = }}</ref>
	==Interactions==
	The potential for dangerous ]s with mirtazapine is considered to be very low, if not completely negligible. As a ], mirtazapine will not cause ] at any dose, nor is it capable of causing ]-induced ], unlike the SSRIs and MAOIs, respectively. In fact, mirtazapine can actually be used to treat serotonin syndrome.<ref name="pmid8741027">{{Cite journal| author = Hoes MJ, Zeijpveld JH | title = Mirtazapine as treatment for serotonin syndrome | journal = Pharmacopsychiatry | volume = 29 | issue = 2 | pages = 81 | year = 1996 | month = March | pmid = 8741027 | doi = 10.1055/s-2007-979550| url = }}</ref>
			==Pharmacology==
	Mirtazapine may, however, increase the effects of ] and ] drugs, such as ], ], and ],{{Citation needed|date=August 2010}} and it has also been reported to reduce or block the effects of some ]s including ]s such as ], ] and ].{{Citation needed|date=September 2009}} ] and ] decrease effects of mirtazapine.{{Citation needed|date=August 2010}} ], ], ], ] and ] may increase effects of mirtazapine.{{Citation needed|date=August 2010}}
			===Pharmacodynamics===
	Mirtazapine in combination with an SSRI, SNRI, or TCA as an ] strategy is safe and is often used therapeutically.<ref name="pmid10333982"/><ref name="pmid16946177"/><ref name="pmid12590402"/><ref name="pmid12028939"/><ref name="pmid18204355"/> Mirtazapine and MAOIs are said to be contraindicated by some sources; however, there is no true indication that this is actually the case, and there is no proper literature on the subject warning against the combination whatsoever. Only a single study has mentioned anything significantly important regarding the combination, and they reported that it does not result in any incidence of serotonin-related toxicity.<ref name="pmid16460699">{{Cite journal| author = Gillman PK | title = A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action | journal = Biological Psychiatry | volume = 59 | issue = 11 | pages = 1046–51 | year = 2006 | month = June | pmid = 16460699 | doi = 10.1016/j.biopsych.2005.11.016 | url = http://linkinghub.elsevier.com/retrieve/pii/S0006-3223(05)01441-1}}</ref> However, mirtazapine has been associated with inducing hypertension in ]-treated patients.<ref name="pmid10772378">{{Cite journal| author = Abo-Zena RA, Bobek MB, Dweik RA | title = Hypertensive urgency induced by an interaction of mirtazapine and clonidine. | journal = Pharmacotherapy | volume = 20 | issue = 4 | pages = 476–8 | year = 2000 | month = April | pmid = 10772378 | doi = 10.1592/phco.20.5.476.35061}}</ref>
			{{See also|Pharmacology of antidepressants|Tetracyclic antidepressant#Pharmacology}}
			{| class="wikitable floatright sortable" style="font-size:small;"
			|+Mirtazapine<ref name="PDSP">{{cite web|url=https://pdsp.unc.edu/databases/pdsp.php?receptorDD=&receptor=&speciesDD=&species=&sourcesDD=&source=&hotLigandDD=&hotLigand=&testLigandDD=&testFreeRadio=testFreeRadio&testLigand=mirtazepine&referenceDD=&reference=&KiGreater=&KiLess=&kiAllRadio=all&doQuery=Submit+Query|title=PDSP K<sub>i</sub> Database|author1-link=Bryan Roth|vauthors=Roth BL, Driscol J|work=Psychoactive Drug Screening Program (PDSP)|publisher=University of North Carolina at Chapel Hill and the United States National Institute of Mental Health|access-date=14 August 2017|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828173607/https://pdsp.unc.edu/databases/pdsp.php?receptorDD=&receptor=&speciesDD=&species=&sourcesDD=&source=&hotLigandDD=&hotLigand=&testLigandDD=&testFreeRadio=testFreeRadio&testLigand=mirtazepine&referenceDD=&reference=&KiGreater=&KiLess=&kiAllRadio=all&doQuery=Submit+Query|url-status=live}}</ref>
			|-
			! data-sort-type=number | !!''K''<sub>i</sub> (nM) !! Species !! Ref
			|-
			| {{abbrlink|SERT|Serotonin transporter}} || 10000+ || Human || <ref name="pmid9537821">{{cite journal | vauthors = Tatsumi M, Groshan K, Blakely RD, Richelson E | title = Pharmacological profile of antidepressants and related compounds at human monoamine transporters | journal = European Journal of Pharmacology | volume = 340 | issue = 2–3 | pages = 249–258 | date = December 1997 | pmid = 9537821 | doi = 10.1016/s0014-2999(97)01393-9 }}</ref><ref name="pmid16517171" />
			|-
			| {{abbrlink|NET|Norepinephrine transporter}} || 4600+ || Human || <ref name="pmid17471183" /><ref name="pmid9537821" />
			|-
			| {{abbrlink|DAT|Dopamine transporter}} || 10000+ || Human || <ref name="pmid9537821" /><ref name="pmid16517171" />
			|-
			| ] || data-sort-value=3330 | 3330–5010 || Human || <ref name=Ant2001 /><ref name="pmid16517171" />
			|-
			| ] || data-sort-value=3534 | 3534–12600 || Human || <ref name=Ant2001 /><ref name="pmid16517171" />
			|-
			| ] || 794–5,010 || Human || <ref name=Ant2001 /><ref name="pmid16517171" />
			|-
			| ] || 728 || Human || <ref name="pmid16517171" />
			|-
			| ] || 583 || Human || <ref name="pmid16517171" />
			|-
			| ] || data-sort-value=6 |'''6.3–69'''|| '''Human'''|| <ref name=Ant2001 /><ref name="pmid16517171" />
			|-
			| ] ||200|| Human || <ref name=Ant2001 />
			|-
			| ] || data-sort-value=8 |'''8.9–39'''|| '''Human'''|| <ref name=Ant2001 /><ref name="pmid16517171" />
			|-
			| ]|| '''8.1'''|| '''Human'''||<ref name="A review of the pharmacological and">{{cite journal | vauthors = Anttila SA, Leinonen EV | title = A review of the pharmacological and clinical profile of mirtazapine | journal = CNS Drug Reviews | volume = 7 | issue = 3 | pages = 249–264 | date = 2001 | pmid = 11607047 | pmc = 6494141 | doi = 10.1111/j.1527-3458.2001.tb00198.x }}</ref>
			|-
			| ] || 10000+ || Human || <ref name="pmid16517171" />
			|-
			| ] || 670 || Human || <ref name="pmid16517171" />
			|-
			| ] || {{abbr|ND|No data}} || {{abbr|ND|No data}} || {{abbr|ND|No data}}<ref name="pmid16517171" />
			|-
			| ] ||265|| Human || <ref name="pmid16517171" />
			|-
			| ] ||1815|| Human || <ref name="pmid16517171" />
			|-
			| ] ||'''20'''|| '''Human'''|| <ref name="pmid16517171" />
			|-
			| ] ||88|| Human || <ref name="pmid16517171" />
			|-
			| ] ||'''18'''|| '''Human'''|| <ref name="pmid16517171" />
			|-
			| ] || 10000+ || Human || <ref name="pmid16517171" />
			|-
			| ] || data-sort-value=4167 | 4167 || Rat ||
			|-
			| ] || 5454+ || Human || <ref name="pmid16517171" />
			|-
			| ] || data-sort-value=5723 | 5,723 || Human ||<ref name="pmid16517171" />
			|-
			| ] || data-sort-value=2518 | 2,518 || Human || <ref name="pmid16517171" />
			|-
			| ] ||'''0.14–1.6'''|| '''Human'''|| <ref name="pmid22033803">{{cite journal | vauthors = Appl H, Holzammer T, Dove S, Haen E, Strasser A, Seifert R | title = Interactions of recombinant human histamine H<sub>1</sub>R, H<sub>2</sub>R, H<sub>3</sub>R, and H<sub>4</sub>R receptors with 34 antidepressants and antipsychotics | journal = Naunyn-Schmiedeberg's Archives of Pharmacology | volume = 385 | issue = 2 | pages = 145–170 | date = February 2012 | pmid = 22033803 | doi = 10.1007/s00210-011-0704-0 | s2cid = 14274150 }}</ref><ref name=Ant2001/><ref name="pmid16517171">{{cite journal | vauthors = Van der Mey M, Windhorst AD, Klok RP, Herscheid JD, Kennis LE, Bischoff F, Bakker M, Langlois X, Heylen L, Jurzak M, Leysen JE | title = Synthesis and biodistribution of R107474, a new radiolabeled alpha2-adrenoceptor antagonist | journal = Bioorganic & Medicinal Chemistry | volume = 14 | issue = 13 | pages = 4526–4534 | date = July 2006 | pmid = 16517171 | doi = 10.1016/j.bmc.2006.02.029 }}</ref>
			|-
			| ] || 10000+ || Rat || <ref name="pmid3419539">{{cite journal | vauthors = de Boer TH, Maura G, Raiteri M, de Vos CJ, Wieringa J, Pinder RM | title = Neurochemical and autonomic pharmacological profiles of the 6-aza-analogue of mianserin, Org 3770 and its enantiomers | journal = Neuropharmacology | volume = 27 | issue = 4 | pages = 399–408 | date = April 1988 | pmid = 3419539 | doi = 10.1016/0028-3908(88)90149-9 | s2cid = 582691 }}</ref><ref name="pmid22033803" />
			|-
			| ] || data-sort-value=83200 | 83200 || Human || <ref name="pmid22033803" />
			|-
			| ] || 100000+ || Human || <ref name="pmid22033803" />
			|-
			| {{abbrlink|mACh|Muscarinic acetylcholine receptor}} || 670 || Human || <ref name=Ant2001 /><ref name="pmid17471183">{{cite journal | vauthors = Gillman PK | title = Tricyclic antidepressant pharmacology and therapeutic drug interactions updated | journal = British Journal of Pharmacology | volume = 151 | issue = 6 | pages = 737–748 | date = July 2007 | pmid = 17471183 | pmc = 2014120 | doi = 10.1038/sj.bjp.0707253 }}</ref>
			|-
			| {{abbrlink|VGSC|Voltage-gated sodium channel}} || data-sort-value=6905 | 6905 || Rat || <ref name="pmid16517171" />
			|-
			| {{abbrlink|VDCC|Voltage-dependent calcium channel}} || 10000+ || Rat || <ref name="pmid16517171" />
			|- class="sortbottom"
			| colspan="4" style="width: 1px;" | Values are K<sub>i</sub> (nM). The smaller the value, the more strongly the drug binds to the site.
			|}
			Mirtazapine is sometimes described as a ] (NaSSA),<ref name=Ant2001 /> although the actual evidence in support of this label has been regarded as poor.<ref name="pmid16342227" /> It is a tetracyclic ]-azepine.<ref>{{cite web|title=Mirtazapine|url=https://www.drugbank.ca/drugs/DB00370|website=Drugbank|access-date=16 January 2020|archive-date=19 August 2020|archive-url=https://web.archive.org/web/20200819113616/https://www.drugbank.ca/drugs/DB00370|url-status=live}}</ref>
	==Overdose==
	Mirtazapine is relatively safe if an ] is taken.<ref name="pmid11757992">{{Cite journal| author = Velazquez C, Carlson A, Stokes KA, Leikin JB | title = Relative safety of mirtazapine overdose | journal = Veterinary and Human Toxicology | volume = 43 | issue = 6 | pages = 342–4 | year = 2001 | month = December | pmid = 11757992 | doi = | url = }}</ref> Unlike the TCAs, mirtazapine shows no significant ] ]s at 7 to 22 times the maximum recommended dose.<ref name="pmid10333982"/> Overdose with as much as 30 to 50 times the standard dose has shown to be relatively non-toxic.<ref name="pmid9807651">{{Cite journal| author = Holzbach R, Jahn H, Pajonk FG, Mähne C | title = Suicide attempts with mirtazapine overdose without complications | journal = Biological Psychiatry | volume = 44 | issue = 9 | pages = 925–6 | year = 1998 | month = November | pmid = 9807651 | doi = 10.1016/S0006-3223(98)00081-X| url = http://linkinghub.elsevier.com/retrieve/pii/S0006-3223(98)00081-X}}</ref> One case in which 1,200&nbsp;mg was ingested proved non-fatal.<ref name="pmid9861579">{{Cite journal| author = Retz W, Maier S, Maris F, Rösler M | title = Non-fatal mirtazapine overdose | journal = International Clinical Psychopharmacology | volume = 13 | issue = 6 | pages = 277–9 | year = 1998 | month = November | pmid = 9861579 | doi = 10.1097/00004850-199811000-00007| url = }}</ref>
			Mirtazapine has ], ], and ] activity.<ref name=Ant2001 /><ref name="pmid9090573">{{cite journal | vauthors = Frazer A | title = Pharmacology of antidepressants | journal = Journal of Clinical Psychopharmacology | volume = 17 | issue = Suppl 1 | pages = 2S–18S | date = April 1997 | pmid = 9090573 | doi = 10.1097/00004714-199704001-00002 }}</ref> It is specifically a potent ] or ] of the ], ], and ]s, the ] ], ], and the ] ].<ref name=Ant2001 /><ref name="pmid9090573" /> Unlike many other antidepressants, it does not ] the ] of ], ], or ],<ref name=Ant2001 /><ref name="pmid9090573" /> nor does it inhibit ].<ref name="pmid21200377">{{cite journal | vauthors = Fisar Z, Hroudová J, Raboch J | title = Inhibition of monoamine oxidase activity by antidepressants and mood stabilizers | journal = Neuro Endocrinology Letters | volume = 31 | issue = 5 | pages = 645–656 | year = 2010 | pmid = 21200377 }}</ref> Similarly, mirtazapine has weak or no activity as an ] or ] of ] or ]s, in contrast to most tricyclic antidepressants.<ref name=Ant2001 /><ref name="pmid16517171" /><ref name="pmid9090573" /> In accordance, it has better ] and low ] in ].<ref name=Ant2001 /><ref name="pmid11357798">{{cite journal | vauthors = Richelson E | title = Pharmacology of antidepressants | journal = Mayo Clinic Proceedings | volume = 76 | issue = 5 | pages = 511–527 | date = May 2001 | pmid = 11357798 | doi = 10.4065/76.5.511 | doi-access = free }}</ref> As an H<sub>1</sub> receptor antagonist, mirtazapine is extremely potent, and is in fact one of the most potent H<sub>1</sub> receptor inverse agonists among tricyclic and tetracyclic antidepressants and most antihistamines in general.<ref name="pmid17471183" /><ref name="BruntonChabner2011">{{cite book| vauthors = Brunton L, Chabner BA, Knollman B |title=Goodman and Gilman's The Pharmacological Basis of Therapeutics, Twelfth Edition|url=https://books.google.com/books?id=e_yAOpyyaowC|date=14 January 2011|publisher=McGraw Hill Professional|isbn=978-0-07-176939-6|page=410}}</ref><ref name="SchatzbergNemeroff2017">{{cite book|vauthors=Schatzberg AF, Nemeroff CB|title=The American Psychiatric Association Publishing Textbook of Psychopharmacology|url=https://books.google.com/books?id=v9wnDwAAQBAJ&pg=PA322|date=10 May 2017|publisher=American Psychiatric Pub|isbn=978-1-61537-122-8|pages=322–|access-date=14 August 2017|archive-date=10 January 2023|archive-url=https://web.archive.org/web/20230110194022/https://books.google.com/books?id=v9wnDwAAQBAJ&pg=PA322|url-status=live}}</ref> Antagonism of the ] is by far the strongest activity of mirtazapine, with the drug acting as a selective H<sub>1</sub> receptor antagonist at low concentrations.<ref name=Ant2001 /><ref name="pmid16517171" />
	12 fatalities have been attributed to mirtazapine overdose in literature.<ref>P. Nikolaou, A. Dona, I. Papoutsis et al. Death due to mirtazapine overdose. Clin. Toxicol. 47: 453, 2009.</ref><ref>R. Baselt, ''Disposition of Toxic Drugs and Chemicals in Man'', 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1045-1047.</ref> 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.<ref name="bmj325">{{Cite journal| author = Buckley N, McManus P | title = Fatal toxicity of serotinergic antidepressants | journal = BMJ | volume = 325 | issue = 7376 | pages = 1332–3 | year = 2002 | month = December | pmid = 12468481 | url = http://www.ncbi.nlm.nih.gov/pubmed/12468481 | pmc = 137809 | doi=10.1136/bmj.325.7376.1332}}</ref>
			The (''S'')-(+) enantiomer of mirtazapine is responsible for antagonism of the serotonin ] and ] receptors,<ref name = MD/> while the (''R'')-(–) ] is responsible for antagonism of the 5-HT<sub>3</sub> receptor.<ref name = MD>{{cite book|veditors=Brayfield A|chapter=Mirtazapine|title=Martindale: The Complete Drug Reference|publisher=The Royal Pharmaceutical Society of Great Britain|access-date=3 November 2013|date=30 January 2013|chapter-url=http://www.medicinescomplete.com/mc/martindale/current/11022-r.htm|archive-date=14 January 2021|archive-url=https://web.archive.org/web/20210114165327/https://about.medicinescomplete.com/|url-status=live}}</ref> Both enantiomers are involved in antagonism of the H<sub>1</sub> and α<sub>2</sub>-adrenergic receptors,<ref name = AXIT/><ref name = MD/> although the (''S'')-(+) enantiomer is the stronger antihistamine.<ref name="pmid23728612" />
	==See also==
	{{Col-begin}}
	{{Col-1-of-2}}
	* ] (NaSSA)
	* ] (TeCA)
	* ] (α<sub>2</sub> Blocker)
	{{Col-2-of-2}}
	* ]
	* ]
	* ]
	{{Col-end}}
			Although not clinically relevant, mirtazapine has been found to act as a ] of the ] at high concentrations (] = 7.2&nbsp;μM).<ref name="pmid22708686">{{cite journal | vauthors = Olianas MC, Dedoni S, Onali P | title = The atypical antidepressant mianserin exhibits agonist activity at κ-opioid receptors | journal = British Journal of Pharmacology | volume = 167 | issue = 6 | pages = 1329–1341 | date = November 2012 | pmid = 22708686 | pmc = 3504997 | doi = 10.1111/j.1476-5381.2012.02078.x }}</ref>
	==References==
	{{Reflist}}
			====α<sub>2</sub>-Adrenergic receptor====
	==Further reading==
			Antagonism of the α<sub>2</sub>-adrenergic receptors, which function largely as ] ]s and ]s, enhances ] and ] ], notably ] ] mediated transmission in the ] and ]; hence, mirtazapine's classification as a NaSSA. Indirect α<sub>1</sub> adrenoceptor-mediated enhancement of serotonin cell firing and direct blockade of inhibitory α<sub>2</sub> heteroreceptors located on serotonin terminals are held responsible for the increase in extracellular serotonin.<ref name=Ant2001/><ref name="pmid10446735"/><ref name="pmid7912194">{{cite journal | vauthors = De Boer T, Nefkens F, Van Helvoirt A | title = The alpha 2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo | journal = European Journal of Pharmacology | volume = 253 | issue = 1–2 | pages = R5–R6 | date = February 1994 | pmid = 7912194 | doi = 10.1016/0014-2999(94)90778-1 }}</ref>{{Unreliable medical source|date=October 2011}}<ref name="pmid9361334">{{cite journal | vauthors = Berendsen HH, Broekkamp CL | title = Indirect in vivo 5-HT1A-agonistic effects of the new antidepressant mirtazapine | journal = Psychopharmacology | volume = 133 | issue = 3 | pages = 275–282 | date = October 1997 | pmid = 9361334 | doi = 10.1007/s002130050402 | s2cid = 230492 }}</ref><ref name="pmid15145142">{{cite journal | vauthors = Nakayama K, Sakurai T, Katsu H | title = Mirtazapine increases dopamine release in prefrontal cortex by 5-HT1A receptor activation | journal = Brain Research Bulletin | volume = 63 | issue = 3 | pages = 237–241 | date = April 2004 | pmid = 15145142 | doi = 10.1016/j.brainresbull.2004.02.007 | s2cid = 14393829 }}</ref>{{Unreliable medical source|date=October 2011}} Because of this, mirtazapine has been said to be a functional "]" of the 5-HT<sub>1A</sub> receptor.<ref name="pmid9361334"/> Increased activation of the central 5-HT<sub>1A</sub> receptor is thought to be a major mediator of efficacy of most antidepressant drugs.<ref name="pmid11212592">{{cite journal | vauthors = Blier P, Abbott FV | title = Putative mechanisms of action of antidepressant drugs in affective and anxiety disorders and pain | journal = Journal of Psychiatry & Neuroscience | volume = 26 | issue = 1 | pages = 37–43 | date = January 2001 | pmid = 11212592 | pmc = 1408043 | url = http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-26/issue-1/pdf/pg37.pdf | access-date = 20 June 2009 | url-status = dead | archive-url = https://web.archive.org/web/20160306214237/https://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-26/issue-1/pdf/pg37.pdf | archive-date = 6 March 2016 }}</ref>
	* {{Cite journal| author = Stimmel GL, Dopheide JA, Stahl SM | title = Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects | journal = Pharmacotherapy | volume = 17 | issue = 1 | pages = 10–21 | year = 1997 | pmid = 9017762 | doi = | url = }}
	* {{Cite journal| author = Croom KF, Perry CM, Plosker GL | title = Mirtazapine: a review of its use in major depression and other psychiatric disorders | journal = CNS Drugs | volume = 23 | issue = 5 | pages = 427–52 | year = 2009 | pmid = 19453203 | doi = 10.2165/00023210-200923050-00006 | url = http://content.wkhealth.com/linkback/openurl?issn=1172-7047&volume=23&issue=5&spage=427}}
	* {{Cite journal| author = Anttila SA, Leinonen EV | title = A review of the pharmacological and clinical profile of mirtazapine | journal = CNS Drug Reviews | volume = 7 | issue = 3 | pages = 249–64 | year = 2001 | pmid = 11607047 | doi = 10.1111/j.1527-3458.2001.tb00198.x| url = }}
	* {{Cite journal| author = Timmer CJ, Sitsen JM, Delbressine LP | title = Clinical pharmacokinetics of mirtazapine | journal = Clinical Pharmacokinetics | volume = 38 | issue = 6 | pages = 461–74 | year = 2000 | month = June | pmid = 10885584 | doi = 10.2165/00003088-200038060-00001| url = http://content.wkhealth.com/linkback/openurl?issn=0312-5963&volume=38&issue=6&spage=461}}
			====5-HT<sub>2</sub> receptor====
	==External links==
			Antagonism of the ] subfamily of receptors and inverse agonism of the ] receptor appears to be in part responsible for mirtazapine's efficacy in the treatment of depressive states.<ref name="pmid16433010">{{cite journal | vauthors = Millan MJ | title = Serotonin 5-HT2C receptors as a target for the treatment of depressive and anxious states: focus on novel therapeutic strategies | journal = Therapie | volume = 60 | issue = 5 | pages = 441–460 | year = 2005 | pmid = 16433010 | doi = 10.2515/therapie:2005065 }}</ref><ref name="pmid18709360">{{cite journal | vauthors = Dekeyne A, Millan MJ | title = Discriminative stimulus properties of the atypical antidepressant, mirtazapine, in rats: a pharmacological characterization | journal = Psychopharmacology | volume = 203 | issue = 2 | pages = 329–341 | date = April 2009 | pmid = 18709360 | doi = 10.1007/s00213-008-1259-8 | doi-access = free }}</ref>
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			Mirtazapine increases dopamine release in the prefrontal cortex.<ref></ref><ref name="pmid10762339"/> Accordingly, it was shown that by blocking the ] and ] receptors mirtazapine disinhibited ] and norepinephrine activity in these areas in rats.<ref name="pmid10762339">{{cite journal | vauthors = Millan MJ, Gobert A, Rivet JM, Adhumeau-Auclair A, Cussac D, Newman-Tancredi A, Dekeyne A, Nicolas JP, Lejeune F | title = Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of alpha2-adrenergic and serotonin2C receptors: a comparison with citalopram | journal = The European Journal of Neuroscience | volume = 12 | issue = 3 | pages = 1079–1095 | date = March 2000 | pmid = 10762339 | doi = 10.1046/j.1460-9568.2000.00982.x | s2cid = 23098292 | doi-access = free }}</ref> In addition, mirtazapine's antagonism of ] receptors has beneficial effects on ], ] and ], as well as sexual function regarding the latter receptor.<ref name=Ant2001/><ref name="pmid10333982">{{cite journal | vauthors = Fawcett J, Barkin RL | title = Review of the results from clinical studies on the efficacy, safety and tolerability of mirtazapine for the treatment of patients with major depression | journal = Journal of Affective Disorders | volume = 51 | issue = 3 | pages = 267–285 | date = December 1998 | pmid = 10333982 | doi = 10.1016/S0165-0327(98)00224-9 }}</ref> Mirtazapine has been shown to lower drug seeking behaviour (more specifically to methamphetamine) in various human and animal studies.<ref name="Graves_2012">{{cite journal | vauthors = Graves SM, Napier TC | title = SB 206553, a putative 5-HT2C inverse agonist, attenuates methamphetamine-seeking in rats | journal = BMC Neuroscience | volume = 13 | issue = 1 | pages = 65 | date = June 2012 | pmid = 22697313 | pmc = 3441362 | doi = 10.1186/1471-2202-13-65 | doi-access = free }}</ref><ref name="pmid22065532">{{cite journal | vauthors = Colfax GN, Santos GM, Das M, Santos DM, Matheson T, Gasper J, Shoptaw S, Vittinghoff E | title = Mirtazapine to reduce methamphetamine use: a randomized controlled trial | journal = Archives of General Psychiatry | volume = 68 | issue = 11 | pages = 1168–1175 | date = November 2011 | pmid = 22065532 | pmc = 3437988 | doi = 10.1001/archgenpsychiatry.2011.124 }}</ref><ref name="pmid18945553">{{cite journal | vauthors = Herrold AA, Shen F, Graham MP, Harper LK, Specio SE, Tedford CE, Napier TC | title = Mirtazapine treatment after conditioning with methamphetamine alters subsequent expression of place preference | journal = Drug and Alcohol Dependence | volume = 99 | issue = 1–3 | pages = 231–239 | date = January 2009 | pmid = 18945553 | doi = 10.1016/j.drugalcdep.2008.08.005 }}</ref> It is also being investigated in substance abuse disorders to reduce withdrawal effects and improve remission rates.<ref name="Graves_2012"/><ref name="pmid18633741">{{cite journal | vauthors = Rose ME, Grant JE | title = Pharmacotherapy for methamphetamine dependence: a review of the pathophysiology of methamphetamine addiction and the theoretical basis and efficacy of pharmacotherapeutic interventions | journal = Annals of Clinical Psychiatry | volume = 20 | issue = 3 | pages = 145–155 | year = 2008 | pmid = 18633741 | doi = 10.1080/10401230802177656 }}</ref><ref name="pmid22095579">{{cite journal | vauthors = Brackins T, Brahm NC, Kissack JC | title = Treatments for methamphetamine abuse: a literature review for the clinician | journal = Journal of Pharmacy Practice | volume = 24 | issue = 6 | pages = 541–550 | date = December 2011 | pmid = 22095579 | doi = 10.1177/0897190011426557 | s2cid = 37335642 }}</ref><ref name="pmid23617468">{{cite journal | vauthors = Brensilver M, Heinzerling KG, Shoptaw S | title = Pharmacotherapy of amphetamine-type stimulant dependence: an update | journal = Drug and Alcohol Review | volume = 32 | issue = 5 | pages = 449–460 | date = September 2013 | pmid = 23617468 | pmc = 4251965 | doi = 10.1111/dar.12048 }}</ref>
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			Mirtazapine significantly improves pre-existing symptoms of nausea, ], diarrhea, and ] in affected individuals.<ref name="pmid11585276">{{cite journal | vauthors = Kast RE | title = Mirtazapine may be useful in treating nausea and insomnia of cancer chemotherapy | journal = Supportive Care in Cancer | volume = 9 | issue = 6 | pages = 469–470 | date = September 2001 | pmid = 11585276 | doi = 10.1007/s005200000215 | s2cid = 24132032 }}</ref> Mirtazapine may be used as an inexpensive antiemetic alternative to ].<ref name="pmid17587360"/> In conjunction with ], mirtazapine has been investigated for the purpose of reducing ] use in dependent individuals with success.<ref name="pmid22065532" /><ref name="pmid18633741" /><ref name="pmid22095579" /><ref name="pmid23617468" /> In contrast to mirtazapine, the selective serotonin reuptake inhibitors, ]s, monoamine oxidase inhibitors, and some ]s increase the general activity of the ], ], and ] receptors leading to a number of negative changes and side effects, the most prominent of which including anorexia, ], ], and ], among others. Its reduced incidence of sexual dysfunction (such as loss of ] and ]) could be a product of negligible binding to the serotonin transporter (as is generally the cause of sexual dysfunction with most selective serotonin reuptake inhibitors) and antagonism of the 5-HT<sub>2A</sub> receptors; however, Mirtazapine's high affinity towards and inverse agonism of the 5-HT<sub>2C</sub> receptors may greatly attenuate those pro-sexual factors (as evidenced by the pro-sexual effects of drugs like ] and ] which agonize 5-HT<sub>2C</sub> receptors in a reasonably selective manner). As a result, it is often combined with these drugs to reduce their side-effect profile and to produce a stronger antidepressant effect.<ref name="pmid10333982"/><ref name="pmid15560319">{{cite journal | vauthors = Caldis EV, Gair RD | title = Mirtazapine for treatment of nausea induced by selective serotonin reuptake inhibitors | journal = Canadian Journal of Psychiatry | volume = 49 | issue = 10 | pages = 707 | date = October 2004 | pmid = 15560319 | doi = 10.1177/070674370404901014 | doi-access = free }}</ref>
			Mirtazapine does not have pro-] activity and thus does not cause ].<ref name="pmid16342227">{{cite journal | vauthors = Gillman PK | title = A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status | journal = Human Psychopharmacology | volume = 21 | issue = 2 | pages = 117–125 | date = March 2006 | pmid = 16342227 | doi = 10.1002/hup.750 | s2cid = 23442056 }}</ref><ref name="pmid16460699">{{cite journal | vauthors = Gillman PK | title = A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action | journal = Biological Psychiatry | volume = 59 | issue = 11 | pages = 1046–1051 | date = June 2006 | pmid = 16460699 | doi = 10.1016/j.biopsych.2005.11.016 | s2cid = 12179122 }}</ref> This is in accordance with the fact that it is not a ] or monoamine oxidase inhibitor, nor a ].<ref name="pmid16342227" /><ref name="pmid16460699" /> There are no reports of serotonin syndrome in association with mirtazapine alone, and mirtazapine has not been found to cause serotonin syndrome in ].<ref name="pmid16342227" /><ref name="pmid16460699" /><ref name="pmid24228948">{{cite journal | vauthors = Berling I, Isbister GK | title = Mirtazapine overdose is unlikely to cause major toxicity | journal = Clinical Toxicology | volume = 52 | issue = 1 | pages = 20–24 | date = January 2014 | pmid = 24228948 | pmc = 3894718 | doi = 10.3109/15563650.2013.859264 }}</ref> However, there are a handful of ]s of serotonin syndrome occurring with mirtazapine in combination with serotonergic drugs like selective serotonin reuptake inhibitors, although such reports are very rare, and do not necessarily implicate mirtazapine as causative.<ref name="pmid16342227" /><ref name="pmid19994622">{{cite journal | vauthors = Freijo Guerrero J, Tardón Ruiz de Gauna L, Gómez JJ, Aguilera Celorrio L | title = | language = es | journal = Revista Espanola de Anestesiologia y Reanimacion | volume = 56 | issue = 8 | pages = 515–516 | date = October 2009 | pmid = 19994622 | doi = 10.1016/s0034-9356(09)70444-x }}</ref><ref name="pmid20430060">{{cite journal | vauthors = Butler MC, Di Battista M, Warden M | title = Sertraline-induced serotonin syndrome followed by mirtazapine reaction | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 34 | issue = 6 | pages = 1128–1129 | date = August 2010 | pmid = 20430060 | doi = 10.1016/j.pnpbp.2010.04.015 | s2cid = 20985498 }}</ref><ref name="pmid22752315">{{cite journal | vauthors = Decoutere L, De Winter S, Vander Weyden L, Spriet I, Schrooten M, Tournoy J, Fagard K | title = A venlafaxine and mirtazapine-induced serotonin syndrome confirmed by de- and re-challenge | journal = International Journal of Clinical Pharmacy | volume = 34 | issue = 5 | pages = 686–688 | date = October 2012 | pmid = 22752315 | doi = 10.1007/s11096-012-9666-7 | s2cid = 38692665 }}</ref>
			====5-HT<sub>3</sub> receptor====
			(R)-(–)-mirtazapine is a potent 5-HT<sub>3</sub> blocker. It may relieve ]-related and advanced ]-related ].<ref name="pmid17587360"/>
			====H<sub>1</sub> receptor====
			Mirtazapine is a very strong ] antagonist and, as a result, it can cause powerful ] and ] effects.<ref name=Ant2001 /> A single 15&nbsp;mg dose of mirtazapine to healthy volunteers has been found to result in over 80% occupancy of the ] and to induce intense ].<ref name="pmid23728612">{{cite journal | vauthors = Sato H, Ito C, Tashiro M, Hiraoka K, Shibuya K, Funaki Y, Iwata R, Matsuoka H, Yanai K | title = Histamine H<sub>1</sub> receptor occupancy by the new-generation antidepressants fluvoxamine and mirtazapine: a positron emission tomography study in healthy volunteers | journal = Psychopharmacology | volume = 230 | issue = 2 | pages = 227–234 | date = November 2013 | pmid = 23728612 | doi = 10.1007/s00213-013-3146-1 | s2cid = 3052216 }}</ref> After a short period of chronic treatment, however, the H<sub>1</sub> receptor tends to ] 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 H<sub>1</sub> receptor may improve pre-existing ], ], ], and insomnia in affected individuals. It may also contribute to weight gain, however. In contrast to the H<sub>1</sub> receptor, mirtazapine has only low affinity for the ]s, although ] side effects like ], ], and ] are still sometimes seen in clinical practice.<ref name="pmid9090576">{{cite journal | vauthors = Burrows GD, Kremer CM | title = Mirtazapine: clinical advantages in the treatment of depression | journal = Journal of Clinical Psychopharmacology | volume = 17 | issue = Suppl 1 | pages = 34S–39S | date = April 1997 | pmid = 9090576 | doi = 10.1097/00004714-199704001-00005 }}</ref>
			===Pharmacokinetics===
			The ] ] of mirtazapine is about 50%. It is found mostly ] to ]s, about 85%. It is ] primarily in the ] by ] and ] via ] ]s, ], ], ].<ref>{{cite journal | vauthors = Zhu Y, Chen G, Zhang K, Chen C, Chen W, Zhu M, Jiang H | title = High-Throughput Metabolic Soft-Spot Identification in Liver Microsomes by LC/UV/MS: Application of a Single Variable Incubation Time Approach | journal = Molecules | volume = 27 | issue = 22 | pages = 8058 | date = November 2022 | pmid = 36432161 | pmc = 9693510 | doi = 10.3390/molecules27228058 | doi-access = free }}</ref><ref name="A review of the pharmacological and"/> The overall elimination half-life is 20–40 hours, and this is independent of dosage.<ref name="pmid10885584" /> It is conjugated in the ] for excretion in the ], where 75% of the drug is excreted,<ref>{{cite book |vauthors = Al-Majed A, Bakheit AH, Alharbi RM, Abdel Aziz HA |journal=Profiles of Drug Substances, Excipients, and Related Methodology |title=Mirtazapine |series=Profiles of Drug Substances, Excipients and Related Methodology |date=1 January 2018 |volume=43 |pages=209–254 |doi=10.1016/bs.podrm.2018.01.002 |pmid=29678261 |isbn=9780128151259 }}</ref> and about 15% is ] in ].<ref name=Schatzberg/>{{rp|430}} Desmethylmirtazapine is an active metabolite of mirtazapine which is believed to contribute about 3-10% to the drug's overall effects and has a half-life of about 25 hours.<ref name="pmid10885584" />
			==Chemistry==
			Mirtazapine is a ] piperazinoazepine; ] was developed by the same team of organic chemists and mirtazapine differs from it via the addition of a nitrogen atom in one of the rings.<ref name=Schatzberg/>{{rp|429}}<ref>{{cite web|title=Mirtazapine label – Australia|url=http://secure.healthlinks.net.au/content/msd/pi.cfm?product=mkpavant|publisher=GuildLink, a wholly owned subsidiary company of the Pharmacy Guild of Australia.|date=27 May 2016|access-date=22 July 2017|archive-date=21 November 2018|archive-url=https://web.archive.org/web/20181121120001/http://secure.healthlinks.net.au/content/msd/pi.cfm?product=mkpavant|url-status=dead}}</ref><ref>{{cite journal | vauthors = Kelder J, Funke C, De Boer T, Delbressine L, Leysen D, Nickolson V | title = A comparison of the physicochemical and biological properties of mirtazapine and mianserin | journal = The Journal of Pharmacy and Pharmacology | volume = 49 | issue = 4 | pages = 403–411 | date = April 1997 | pmid = 9232538 | doi = 10.1111/j.2042-7158.1997.tb06814.x | s2cid = 12270528 | doi-access = free }}</ref> It is a ] of ]s. The (''S'')-(+)-enantiomer is known as ].
			]s of mirtazapine include ], ], and ].
			===Synthesis===
			A ] of mirtazapine has been published. The first step of synthesis is a ] between the molecule 2-chloro 3-cyano] and the molecule 1-methyl-3-phenyl].<ref>{{cite journal | doi = 10.1080/00304940709458595| title = Improved Synthesis of Mirtazapine| journal = Organic Preparations and Procedures International| volume = 39| issue = 4| pages = 399–402| year = 2007| vauthors = Srinivasa Rao DV, Dandala R, Handa VK, Sivakumaran M, Raghava Reddy AV, Naidu A | s2cid = 98056931}}</ref>
			==History==
			Mirtazapine was first synthesized at ] and published in 1989, was first approved for use in major depressive disorder in the Netherlands in 1994, and was introduced in the United States in 1996 under the brand name Remeron.<ref name=Schatzberg>{{cite book| vauthors = Schatzberg AF | veditors = Schatzberg AF, Nemeroff CB |title=The American Psychiatric Publishing Textbook of Psychopharmacology|date=2009|publisher=American Psychiatric Pub.|location=Washington, D.C.|isbn=9781585623099|edition=4th|chapter=Chapter 21: Mirtazapine}}</ref>{{rp|429}}<ref>{{cite journal| vauthors = Kaspersen FM, Van Rooij FA, Sperling EG, Wieringa JH |title=The synthesis of org 3770 labelled with 3H, 13C AND 14C|journal=Journal of Labelled Compounds and Radiopharmaceuticals|date=September 1989|volume=27|issue=9|pages=1055–1068|doi=10.1002/jlcr.2580270911}}</ref><ref>{{cite web|title=Remeron New FDA Drug Approvalh|url=http://www.centerwatch.com/drug-information/fda-approved-drugs/drug/135/remeron-mirtazapine|website=Centerwatch|access-date=26 August 2016|archive-date=5 August 2019|archive-url=https://web.archive.org/web/20190805013642/https://www.centerwatch.com/drug-information/fda-approved-drugs/drug/135/remeron-mirtazapine|url-status=live}}</ref>
			==Society and culture==
			]
			===Generic names===
			Mirtazapine is the English and French ] of the drug and its {{abbrlink|INN|International Nonproprietary Name}}, {{abbrlink|USAN|United States Adopted Name}}, {{abbrlink|USP|United States Pharmacopeia}}, {{abbrlink|BAN|British Approved Name}}, {{abbrlink|DCF|Dénomination Commune Française}}, and {{abbrlink|JAN|Japanese Accepted Name}}.<ref name="IndexNominum2000">{{cite book|title=Index Nominum 2000: International Drug Directory|url=https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA696|year=2000|publisher=Taylor & Francis|isbn=978-3-88763-075-1|pages=696–}}</ref><ref name="Drugs.com">{{cite web|url=https://www.drugs.com/international/mirtazapine.html|title=Mirtazapine - Drugs.com|access-date=14 August 2017|archive-date=17 November 2018|archive-url=https://web.archive.org/web/20181117063153/https://www.drugs.com/international/mirtazapine.html|url-status=live}}</ref><ref name="MortonHall2012">{{cite book| vauthors = Morton IK, Hall JM |title=Concise Dictionary of Pharmacological Agents: Properties and Synonyms|url=https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA183|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-94-011-4439-1|page=183}}</ref> Its generic name in Spanish, Italian, and Portuguese is mirtazapina and in German, Turkish and Swedish is mirtazapin.<ref name="IndexNominum2000" /><ref name="Drugs.com" />
			===Brand names===
			Mirtazapine is marketed under many brand names worldwide, including Adco-Mirteron, Afloyan, Amirel, Arintapin Smelt, Avanza, Axit, Azapin, Beron, Bilanz, Blumirtax, Calixta, Ciblex, Combar, Comenter, Depreram, Divaril, Esprital, Maz, Menelat, Mepirzapine, Merdaten, Meronin, Mi Er Ning, Milivin, Minelza, Minivane, Mirastad, Mirazep, Miro, Miron, Mirrador, Mirt, Mirta, Mirtabene, Mirtadepi, Mirtagamma, Mirtagen, Mirtalan, Mirtamor, Mirtamylan, Mirtan, Mirtaneo, Mirtanza, Mirtapax, Mirtapil, Mirtapine, Mirtaron, Mirtastad, Mirtax, Mirtaz, Mirtazap, Mirtazapin, Mirtazapina, Mirtazapine, Mirtazapinum, Mirtazelon, Mirtazon, Mirtazonal, Mirtel, Mirtimash, Mirtin, Mirtine, Mirtor, Mirzapine, Mirzaten, Mirzest, Mitaprex, Mitaxind, Mitocent, Mitrazin, Mizapin, Motofen, Mytra, Norset, Noxibel, Pharmataz, Promyrtil, Rapizapine, Ramure, Razapina, Redepra, Reflex, Remergil, Remergon, Remeron, Remirta, Rexer, Saxib, Sinmaron, Smilon, Tazepin, Tazimed, Tetrazic, Tifona, U-Mirtaron, U-zepine, Valdren, Vastat, Velorin, Yarocen, Zania, Zapex, Zestat, Zismirt, Zispin, Zuleptan, and Zulin.<ref name="Drugs.com" />
			==Research==
			The use of mirtazapine has been explored in several additional conditions:
			* ]/]<ref name="pmid19388881">{{cite journal | vauthors = Kohler M, Bloch KE, Stradling JR | title = Pharmacological approaches to the treatment of obstructive sleep apnoea | journal = Expert Opinion on Investigational Drugs | volume = 18 | issue = 5 | pages = 647–656 | date = May 2009 | pmid = 19388881 | doi = 10.1517/13543780902877674 | s2cid = 57089477 | url = https://www.zora.uzh.ch/id/eprint/28318/1/28318_manuscript.pdf | access-date = 23 December 2021 | archive-date = 12 April 2022 | archive-url = https://web.archive.org/web/20220412003252/https://www.zora.uzh.ch/id/eprint/28318/1/28318_manuscript.pdf | url-status = dead }}</ref><ref name="pmid18548827">{{cite journal | vauthors = Marshall NS, Yee BJ, Desai AV, Buchanan PR, Wong KK, Crompton R, Melehan KL, Zack N, Rao SG, Gendreau RM, Kranzler J, Grunstein RR | title = Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea | journal = Sleep | volume = 31 | issue = 6 | pages = 824–831 | date = June 2008 | pmid = 18548827 | pmc = 2442407 | doi = 10.1093/sleep/31.6.824 }}</ref>
			* Secondary symptoms of ]s and other ]s<ref name="pmid15584771">{{cite journal | vauthors = Masi G | title = Pharmacotherapy of pervasive developmental disorders in children and adolescents | journal = CNS Drugs | volume = 18 | issue = 14 | pages = 1031–1052 | year = 2004 | pmid = 15584771 | doi = 10.2165/00023210-200418140-00006 | s2cid = 25531695 }}</ref><ref name="pmid12589395">{{cite journal | vauthors = Marek GJ, Carpenter LL, McDougle CJ, Price LH | title = Synergistic action of 5-HT2A antagonists and selective serotonin reuptake inhibitors in neuropsychiatric disorders | journal = Neuropsychopharmacology | volume = 28 | issue = 2 | pages = 402–412 | date = February 2003 | pmid = 12589395 | doi = 10.1038/sj.npp.1300057 | doi-access = free }}</ref>
			* ]-induced ].<ref name="pmid19378382">{{cite journal | vauthors = Kumar R, Sachdev PS | title = Akathisia and second-generation antipsychotic drugs | journal = Current Opinion in Psychiatry | volume = 22 | issue = 3 | pages = 293–299 | date = May 2009 | pmid = 19378382 | doi = 10.1097/YCO.0b013e32832a16da | s2cid = 31506138 }}</ref><ref name="pmid18460588">{{cite journal | vauthors = Hieber R, Dellenbaugh T, Nelson LA | title = Role of mirtazapine in the treatment of antipsychotic-induced akathisia | journal = The Annals of Pharmacotherapy | volume = 42 | issue = 6 | pages = 841–846 | date = June 2008 | pmid = 18460588 | doi = 10.1345/aph.1K672 | s2cid = 19733585 }}</ref>
			* ], ] and ]<ref>{{cite journal | vauthors = Graves SM, Rafeyan R, Watts J, Napier TC | title = Mirtazapine, and mirtazapine-like compounds as possible pharmacotherapy for substance abuse disorders: evidence from the bench and the bedside | journal = Pharmacology & Therapeutics | volume = 136 | issue = 3 | pages = 343–353 | date = December 2012 | pmid = 22960395 | pmc = 3483434 | doi = 10.1016/j.pharmthera.2012.08.013 }}</ref>
			* Negative, depressive and cognitive symptoms of ] (as an adjunct)<ref>{{cite book | isbn = 9789400758056 | title = Polypharmacy in Psychiatry Practice, Volume I | vauthors = Ritsner, MS | veditors = Ritsner MS | year = 2013 | publisher = Springer Science+Business Media Dordrecht | doi = 10.1007/978-94-007-5805-6 | s2cid = 7705779 }}</ref><ref>{{cite journal | vauthors = Vidal C, Reese C, Fischer BA, Chiapelli J, Himelhoch S | title = Meta-Analysis of Efficacy of Mirtazapine as an Adjunctive Treatment of Negative Symptoms in Schizophrenia | journal = Clinical Schizophrenia & Related Psychoses | volume = 9 | issue = 2 | pages = 88–95 | date = Jul 2015 | pmid = 23491969 | doi = 10.3371/CSRP.VIRE.030813 }}</ref>
			* A case report has been published in which mirtazapine reduced visual hallucinations in a patient with ] psychosis (PDP).<ref>{{cite journal | vauthors = Tagai K, Nagata T, Shinagawa S, Tsuno N, Ozone M, Nakayama K | title = Mirtazapine improves visual hallucinations in Parkinson's disease: a case report | journal = Psychogeriatrics | volume = 13 | issue = 2 | pages = 103–107 | date = June 2013 | pmid = 23909968 | doi = 10.1111/j.1479-8301.2012.00432.x | s2cid = 1154368 | doi-access = free }}</ref> This is in alignment with recent findings that ]s at the ] are efficacious in attenuating the symptoms of Parkinson's disease psychosis. As is supported by the common practice of prescribing low-dose ] and ] for PDP at doses too low to antagonize the ], but sufficiently high doses to inversely agonize the 5-HT<sub>2A</sub> receptors.<ref name="Maudsley" />
			* Eight case reports have been reported in five papers on the use of mirtazapine in the treatment of ] as of 2017.<ref>{{cite journal | vauthors = Eskeland S, Halvorsen JA, Tanum L | title = Antidepressants have Anti-inflammatory Effects that may be Relevant to Dermatology: A Systematic Review | journal = Acta Dermato-Venereologica | volume = 97 | issue = 8 | pages = 897–905 | date = August 2017 | pmid = 28512664 | doi = 10.2340/00015555-2702 | doi-access = free | hdl = 10852/63759 | hdl-access = free }}</ref>
			* Mirtazapine to alleviate severe ] in patients with COPD or interstitial lung diseases (BETTER-B). <ref>{{cite journal |vauthors= Higginson IJ, Brown ST, Oluyase OO, May P, Maddocks M, Costantini M, Bajwah S, Normand C, Bausewein C, Simon T, Ryan K, Currow D, Johnson M, Hart S, Mather H, Krajnik M, Tanzi S, Ghirotto L, Bolton C, Janowiak P, Turola E, Jolley C, Murden G, Wilcock A, Farsides B, Brown JM | date=September 2024 |title= Mirtazapine to alleviate severe breathlessness in patients with COPD or interstitial lung diseases (BETTER-B). |journal=The Lancet Respiratory Medicine | volume=42 | doi=10.1016/S2213-2600(24)00187-5 | doi-access=free | pmid=39278621}}</ref>
			==Veterinary use==
			Mirtazapine also has some veterinary use in cats and dogs. Mirtazapine is sometimes prescribed as an appetite stimulant for cats or dogs experiencing loss of appetite due to medical conditions such as ]. It is especially useful for treating combined poor appetite and nausea in cats and dogs.<ref>{{cite journal|title=Mirtazapine (Remeron)|website=Vin.com|url=http://www.veterinarypartner.com/Content.plx?P=A&A=2552|date=8 August 2017|vauthors=Gfeller R, Thomas M, Mayo I|access-date=12 January 2013|archive-date=6 December 2010|archive-url=https://web.archive.org/web/20101206073647/http://www.veterinarypartner.com/Content.plx?P=A|url-status=live}}</ref><ref>{{cite journal | vauthors = Agnew W, Korman R | title = Pharmacological appetite stimulation: rational choices in the inappetent cat | journal = Journal of Feline Medicine and Surgery | volume = 16 | issue = 9 | pages = 749–756 | date = September 2014 | pmid = 25146662 | doi = 10.1177/1098612X14545273 | s2cid = 37126352 | pmc = 11185246 }}</ref>
			Mirtazapine is indicated for bodyweight gain in cats experiencing poor appetite and weight loss resulting from chronic medical conditions.<ref name="Mirataz EPAR">{{cite web | title=Mirataz EPAR | website=] | date=11 October 2019 | url=https://www.ema.europa.eu/en/medicines/veterinary/EPAR/mirataz | access-date=12 July 2020 | archive-date=29 October 2020 | archive-url=https://web.archive.org/web/20201029151621/https://www.ema.europa.eu/en/medicines/veterinary/EPAR/mirataz | url-status=live }} Text was copied from this source, which is copyright European Medicines Agency, 2020. Reproduction is authorised provided the source is acknowledged.</ref><ref name="Mirataz FDA label">{{cite web | title=Mirataz- mirtazapine ointment | website=DailyMed | date=8 May 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f4a55914-6b6e-4e81-a84c-3999aa7bd79e | access-date=12 July 2020 | archive-date=12 July 2020 | archive-url=https://web.archive.org/web/20200712223906/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f4a55914-6b6e-4e81-a84c-3999aa7bd79e | url-status=live }}</ref>
			There are two options for administration: tablets given orally, and an ointment applied topically to the inner surface of the ear.<ref name="Mirataz EPAR" /><ref name="Mirataz FDA label" />
			The most common side effects include signs of local irritation or inflammation at the site where the ointment is applied and behavioural changes (increased meowing, hyperactivity, disoriented state or inability to coordinate muscle movements, lack of energy/weakness, attention-seeking, and aggression).<ref name="Mirataz EPAR" /><ref name="Mirataz FDA label" />
			== References ==
			{{Reflist}}
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	{{Antidepressants}}		{{Antidepressants}}
	{{Antiemetics}}		{{Anxiolytics}}
	{{Hypnotics}}		{{Hypnotics}}
			{{Insomnia pharmacotherapies}}
	{{Adrenergics}}
			{{Appetite stimulants}}
	{{Histaminergics}}
	{{Serotonergics}}		{{Antiemetics}}
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			{{Adrenergic receptor modulators}}
			{{Histamine receptor modulators}}
			{{Serotonin receptor modulators}}
			}}
	{{Tricyclics}}		{{Tricyclics}}
			{{Portal bar | Medicine}}
			{{Authority control}}
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