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Mirtazapine for Moderate, Severe, or Refractory Depression

Author: Kellie Wilson, PharmD
(Click author's name for bio)

CE: 2 hours Pharmacology: 2 hours
Rated 4.7 out of 5.0 based on 1161 reviews

Course Summary

Mirtazapine is an antidepressant with a labeled use for the treatment of major depressive disorder. Ongoing studies are comparing the benefits and risks of mirtazapine in specific population groups, including the elderly and individuals with severe mood dysregulation. Mirtazapine is known to be well-tolerated and effective. Combination therapy for individuals with treatment-resistant depression has been investigated in terms of the clinical benefits of mirtazapine when administered with other psychotropic agents. Mirtazapine has a low potential to interact with antipsychotics, tricyclic antidepressants, and some selective serotonin reuptake inhibitors (CYP2D6 metabolizers), making it an option for non-responders to monotherapy for depression, anxiety symptoms, and sleep disturbance. The basic pharmacological profile of mirtazapine, clinical indications, and the potential for mirtazapine toxicity are discussed in the following sections, which include prescribing and current published information.

Course Format


Course Syllabus

I.  Introduction

II.  Pharmacological Profile and Uses
     1.  Available Forms and Dosing
     2.  Common Uses

III.  Drug Warnings, Contraindications, and Potential Adverse Effects
     1.  Drug-drug Interactions
     2.  Suicidality
     3.  Serotonin Syndrome
     4.  Anticholinergic Effects
     5.  Cardiovascular
     6.  Orthostatic Hypotension
     7.  Central Nervous System
     8.  Hypomania and Mania 
     9.  Hyponatremia
     10.  Ophthalmic
     11.  Hematologic
     12.  Weight Gain and Increased Appetite
     13.  Discontinuation Syndrome
     14.  Pregnancy and Breastfeeding 

IV.  Case Study: Suicide Attempt by Mirtazapine Overdose

V.  Summary


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