The Two Faces of Mirtazapine: Linking Its Dose-Dependent Mechanisms to Clinical Practice

Рет қаралды 10,903

Psychiatry Simplified - Dr Sanil Rege

Күн бұрын

Welcome to our deep dive into Mirtazapine, a distinctive medication classified as a Noradrenergic and Specific Serotonergic Antagonist (NaSSA). In this video, Dr Sanil Rege, Consultant Psychiatrist, takes you on a journey exploring the fascinating dual effects of Mirtazapine at varying doses, shedding light on its unique action on receptor profiles and how this translates to its efficacy and tolerability in clinical practice.
Mirtazapine stands out for its ability to provide relief from anxiety, depression, and even nausea in certain medical conditions, thanks to its action on a variety of receptors, including the 5HT2A, 5HT2C, and 5HT3, as well as its histaminergic and noradrenergic activities.
At lower doses (15-30 mg), Mirtazapine acts primarily through serotonin-specific antagonism, offering benefits like anti-anxiety effects, improved sleep quality, and no sexual dysfunction, distinguishing it from other antidepressants.
However, its antihistamine properties act as a limiting factor due to weight gain.
As we increase the dose (45-60 mg), we unlock Mirtazapine’s noradrenergic effects, crucial for treating severe forms of depression through the potentiation of noradrenaline and dopamine.
Moreover, we will compare Mirtazapine with Mianserin, highlighting the reasons behind Mirtazapine's preference in clinical settings despite their similarities, including Mianserin's association with agranulocytosis.
This video is your comprehensive guide to understanding Mirtazapine's pharmacodynamics, its clinical applications, and how its receptor-specific actions contribute to its side effects and benefits at different dosages. Whether you're a healthcare professional, a student, or someone interested in the science behind psychiatric medication, join us to unravel the complexities of Mirtazapine and how it's used to combat various psychiatric and physical symptoms.
If you find value in our content, please like this video, share your experiences in the comments, and subscribe for more insightful updates.
For more resources, visit the link in the description.
#MirtazapineMechanisms
#NaSSAExplained
#DualDoseEffects
#MirtazapineVsMianserin
#DepressionTreatment
#AnxietyRelief
#Pharmacodynamics
#MentalHealthMedication
#SerotoninAntagonism
#NoradrenergicBoost
Key Moments:
0:00 Mirtazapine's mechanism of action and dosage effects.
1:45 Serotonin receptors and their effects on depression and other symptoms.
3:18 Mirtazapine's benefits and side effects.
4:51 Mirtazapine's effects on sedation, weight gain, and noradrenaline.
6:41 Mirtazapine's effects on serotonin and dopamine.
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Пікірлер: 192

@katrinat.3032 4 ай бұрын

I’m so impressed how he wrote in reverse on that clear board

@CannyAnnie 4 ай бұрын

he can just mirror the video

@BenSlover1 4 ай бұрын

Been taking the Mirtazapine ODT at bedtime for at least 25 years now. It's been miraculous for me for insomnia, and without any hangover side effect.

@j-uk2189 4 ай бұрын

Have you lost your hair or checked blood work? Increase triglicérides, makes you insulin resistant, increase chloesterol. (Dislipidemia)

@Magnetar83 4 ай бұрын

I have been taking it for 20 years and it's been working great fir me. My blood work is also normal.

@harshshah2812 4 ай бұрын

Do you lose all bones and muscle mass?

@harshshah2812 4 ай бұрын

@@Magnetar83do you lose all bones and muscles

@owenkelchner5387 4 ай бұрын

I don't know how you keep all the different neurotransmitters and their respective function so well organized. I'm a newer psych provider (PMHNP) and have a pretty good grasp on psychopharmacology but your knowledge is quite impressive. I enjoy your videos.

@PsychiatrySimplified 4 ай бұрын

Thank you 🙏🏻 . I appreciate the feedback. Welcome to psychiatry - it’s amazing!

@Brickinasock 4 ай бұрын

Thank you Dr Rege for this detailed and easy to understand explanation ❤

@PsychiatrySimplified 4 ай бұрын

Glad it was helpful!

@adrianteo2421 4 ай бұрын

Supreme Teacher

@PsychiatrySimplified 4 ай бұрын

🙏🏻

@V8-friendly 4 ай бұрын

Thanks for this interesting video! I take one 15mg Mirtazipine pill once a day at bedtime. Within 60-90min I am getting very tired and feel calm in a good way and sleep 8hrs through the whole night. I wake up very refreshed and well rested the next morning without any hangover. Anything else tried, never worked for my anxiety, so 8mg of a long acting Benzo added is the only thing that works in my case, 3 times a day 2mg. SSRI/SNRI/TCA or atypical antipsychotics never worked for chronic anxiety or panic attacks in any way for me. Mirtazipine replaced the addictive hypnotics, and no weight gain either over years now.

@PsychiatrySimplified 4 ай бұрын

That’s really good to hear! You got a good balance of efficacy and tolerability

@j-uk2189 4 ай бұрын

So pleased for you. Did you experience and side effects at all like hair loss, increase chloesterol, blood sugar etc?

@V8-friendly 4 ай бұрын

@@j-uk2189 Not a single side effect since years. God send. But of course every individual is different. Sleep quality is AMAZING!

@V8-friendly 4 ай бұрын

Not a single side effect since years. God send. But of course every individual is different. Sleep quality is AMAZING!

@konradbak4804 3 ай бұрын

I've taken it in the past. The HORRIBLE(!!!!!) morning drowsiness never subsided. Good drug with terryfying zombie-effect every morning, that lasts half a day. What a pity.......

@BoredT-Rex 4 ай бұрын

I've had severe depression for ten years now. I'm 30. I had a severe breakdown in college. Each day my brain gets better but still years to go. No sexual desire, no relationships, sleep 16 hours a day, suicidal thoughts every second, can't be around ppl for ten years now. I've had every tx possible and nothing has helped even 1%. I've managed to get an advanced medical degree bc all I can do is read. I want to believe in these meds and you make it sound so easy but idk. My psych said there's no point in trying another med bc I've tried so many things. However this is one of the few I haven't had. Maybe I'll ask him to add it.

@Ravenclawjournalist 4 ай бұрын

I had a severe breakdown in college too. I’m also 30. Word of advice if I can give one: eat clean, exercise, stay sober. Consider those the three pillars of mental health treatment. My abusive parents to mellow me out put me on at least five different classes of mental health pills by 15. It had lifelong consequences. I didn’t start getting better from severe depression and eventually off those drugs unless I combined my treatment of severe depression with radical changes in my unhealthy lifestyle and habits of living like eating junk food, isolating myself, binging Netflix, drinking, living a sedentary lifestyle. When I altered all of that, it was far more effective than any medication I had ever been on. Support groups are vital too. Any form of community or friendship is like an instant antidote to severe depression. Good luck friend. I hope you find the help you need.

@BraniG-psyc03 4 ай бұрын

How are you doing?

@kodeh7931 2 ай бұрын

Hang in there buddy. Something ought to Work. I’m surprised your doctor has given up on you like that. You may want to switch providers

@gillsmith3723 4 ай бұрын

Brilliant - thank you. I’m just about to start cross-tapering from Venlafaxine (slow release) to Mirtazipine- with the aim of improving dsyregulated sleep. This video is v reassuring that it won’t cause risk of seratonin syndrome. Grateful to you. All good wishes

@PsychiatrySimplified 4 ай бұрын

No serotonin syndrome is not a risk. But very important to not stop venlafaxine abruptly and of withdrawals occur to go slower. Ofcourse this is not advice but discuss this with your doctor. Mirtazapine can make the switch easier as it helps with sleep

@gillsmith3723 4 ай бұрын

@@PsychiatrySimplified I’ve already watched your very helpful & informative video on stopping antidepressants and learnt about hyperbolic effect. Thanks very much for that. Also since I’ve been on Venlafaxine 225mg for 11 years my intention is to go slower than the five week reduction plan that trainee GP initially recommended (think perhaps he may lack experience in the area so not his fault). Because I have severe ME/CFS want to keep any withdrawal symptoms to a minimum. I’m hoping that gradual, symmetrical cross tapering will work out ok though can’t find a lot of advice re cross tapering of Venlafaxine with Mirtazipine online. Perhaps you would consider creating a future video on the subject if you think it warrants it..? With many thanks and wishing you a good upcoming week.

@craigallday1236 22 күн бұрын

Superb , thank you

@PsychiatrySimplified 22 күн бұрын

Pleasure

@chuckhasballs 4 ай бұрын

I love this video and your explanations. Could you please do a video about Vilazodone? I was taking it for about 3 months after having tried dozens of other medications and it was the only one that worked for me but could no longer afford it because i lost my insurance. I see it listed as both an SSRI and also a Serotonin modulator.

@sebek12345 4 ай бұрын

🎯 Key Takeaways for quick navigation: 00:00 *🧠 Mechanism of Action of Mirtazapine* - Mirtazapine is classified as an NaSSA, affecting noradrenergic and serotonergic systems. - Dual effects at different doses: lower doses primarily act as serotonin antagonists, while higher doses increase noradrenergic activity. - Serotonin-specific antagonism: targets 5-HT2A, 5-HT2C, and 5-HT3 receptors, leading to various clinical effects like anti-anxiety, anti-emesis, and promoting sleep. 03:19 *🛌 Clinical Effects of Serotonin Antagonism by Mirtazapine* - By blocking 5-HT2A, 5-HT2C, and 5-HT3 receptors, Mirtazapine offers benefits such as anti-anxiety, anti-emetic effects, and increased appetite. - It can be used in conjunction with chemotherapy to alleviate anxiety and depression-related nausea and vomiting. - Mirtazapine's histamine receptor blockade contributes to sedation but may lead to daytime grogginess and weight gain. 05:34 *⚙️ Noradrenergic Effects and Serotonin Augmentation* - Mirtazapine's alpha-2 pre-synaptic antagonism leads to increased noradrenaline, beneficial for treating severe depression. - It also acts on alpha-2 hetero receptors on serotonergic neurons, mildly increasing serotonin without significant potentiation, making it safe for augmentation therapy. - Serotonin activation of the 5-HT1A receptor increases dopamine in the prefrontal cortex, contributing to Mirtazapine's overall benefits in depression treatment. Made with HARPA AI

@sebek12345 4 ай бұрын

Summary The video discusses the dual effects of Mirtazapine (Remeron) at different doses, highlighting its mechanisms of action and clinical implications in treating depression and anxiety disorders. Highlights 🧠 Mirtazapine acts as a noradrenergic serotonin-specific antagonist (NaSSA), primarily targeting serotonin receptors at lower doses (15-30 mg) for anti-anxiety effects. 🌙 At higher doses (>30 mg), Mirtazapine increases noradrenergic activity, promoting the treatment of severe depression by potentiating noradrenaline and dopamine release. 🔵 It antagonizes serotonin receptors (5-HT2A, 5-HT2C, and 5-HT3), providing benefits such as anti-anxiety effects, anti-emetic properties, and promoting slow-wave sleep. 🍽 Mirtazapine's histamine receptor blockade leads to sedation and can contribute to weight gain, while its noradrenergic effects can alleviate severe depression symptoms. 🧭 The drug's augmentation strategy involves combining it with SSRIs or SNRIs without significant risk of serotonin syndrome. 📈 By increasing serotonin through action on Alpha 2 hetero receptors, Mirtazapine indirectly boosts dopamine in the prefrontal cortex, aiding in depression management.

@Yasen1791 4 ай бұрын

Thanks so much

@PsychiatrySimplified 4 ай бұрын

Pleasure

@bishalgupta7083 4 ай бұрын

For me sir It's mind blowing video I am paramedics from Nepal HA

@PsychiatrySimplified 4 ай бұрын

Glad you liked it 🙏🏻

@jocs8824 Ай бұрын

Thanks!

@PsychiatrySimplified Ай бұрын

Appreciate it

@paulstockton7121 2 ай бұрын

Ive just moved from 15mg from January to 30mg in May. I have dry mouth all the time and have gained weight. Ive always been 10 stone and 5'11", so weight gain is a benefit. Im hoping the increased dose improves my mood.

@yuh-zeeds414 28 күн бұрын

Thank you very much for your clarifications. Does this mean that at 15 mg mirtaza the noradrenaline and dopamine will NOT be affected? I am also interested in knowing your opinion Your opinion on valdoxan as opposed to mirtaza as far as the efficacy and side effects go especially withdrawal symptoms. I see lots of ppl complain about the withdrawal side effects!

@gingo21 4 ай бұрын

im on day 3 of 15mg of Mirtazapine , after 6 years on citalopram. I was told to do a straight switch so havent tapered and i have to say im feeling great. I no longer have insomnia and wake up feeling refreshed and energised for the first time in years. Time will tell.iv had a few nightmare and night sweats and abit of brain zaps but other than that pretty mild.

@PsychiatrySimplified 4 ай бұрын

Good to know and thanks for sharing.

@jrman413 2 ай бұрын

How are you now buddy?

@gingo21 2 ай бұрын

@@jrman413 wish i could say better. the first few weeks were great. iv now been upped to the 30mg dose. Im sleeping ok. but i feel very low. waiting to speak to my gp about it.

@sharondelue2420 2 ай бұрын

Very interesting and helpful. My doctors dont take all my brain problems into there thoughts when trying to treat me in anyway. This med seems like it would help me so much better then the Xanax then have been given me for years with nothing but putting me to sleep.

@PsychiatrySimplified 2 ай бұрын

If insomnia is an issue also look at the video on insomnia and the video on clonidine and guanfacine

@WarMonk0 4 ай бұрын

Great video. One question I had regarding anti-histamine activity, which you mentioned. I've taken Amitriptyline before and it caused me to have a massive short-term memory problems, which I believe is due to anti-histamine. Do you think mirtazapine will function in a similar way?

@PsychiatrySimplified 4 ай бұрын

At what dose? Amitriptyline and short term memory is more likely due to anticholinergic effects as we know anticholinergics are notorious with memory issues. Mirtazapine does not have anticholinergic effects. The antihistaminergic effects is why Mirtazapine is best prescribed at night. Not saying STM memory dysfunction can’t occur - but will be more due to antihistaminergic effects if excessively sedating ( high dose or not tolerated )

@liborlepka4240 10 сағат бұрын

Hi Doc, great review of Mirtzapine. I started it 3 or 4 times and every time it worked fantastic for my insomnia, anxiety, low energy, low apetite and nausea. The problem was every time I started taking it,, my liver enzymes elevated (ALT twice the limit, GGT three times the limit). Never found any substitute for Mirtazapine to help with all 4 symptoms. Would you recommend something to look for? Thanks.

@BraniG-psyc03 4 ай бұрын

How are you dr?;)..I am in Australia too.

@halcr0 14 күн бұрын

Question: Is there much 5ht1a activation at 15mg ? Thanks, incredible video !

@PsychiatrySimplified 14 күн бұрын

No not really. At higher doses this occurs

@ibitconsulting4988 4 ай бұрын

Can you do something on Transcranial electrical stimulation (tDCS) and Transcranial magnetic stimulation (TMS) please. I would like to understand your opinion.

@PsychiatrySimplified 4 ай бұрын

We’ve done a short video on TMS . kzfaq.info/get/bejne/rpuka8ullt3Xnnk.htmlsi=xEmQCvutx5UHkYRA Not yet one on TDCS but this video will help understand the principle

@AndrogenReceptor01 4 ай бұрын

Hello Dr. Rege, I asked a question similar the one I'm about to ask now: While someone is using mirtazapine, not coming off the medication, can the H-1 receptor upregulate while it's being antagonized? I'm worried about this because blocking H-1 doesn't seem too favourable for learning and cognitive outcomes. Would love to know your professional take.

@PsychiatrySimplified 4 ай бұрын

It depends on the level of arousal. Anti H1 is needed to reduce arousal. So at night this helps with sleep and reduction of anxiety . An analogy is to bring an excessive level to normalise . To downregulate excessive activation .

@jamilfox9101 4 ай бұрын

Can quiet xr 50 withdrawal cause high blood pressure?

@abdulbasit3863 4 ай бұрын

Hey, great video! For a case with a Mixed Anxiety Depressive Disorder, wherein the patient presents with difficulty focusing and anxiety-induced blurred vision, which doses would be more beneficial, and why? Thanks

@PsychiatrySimplified 4 ай бұрын

While I can't provide specific advice usual doses for anxiety disorders are 15-30 mg nocte

@abdulbasit3863 4 ай бұрын

@@PsychiatrySimplifiedthank you for the response. I was wondering if higher doses would be helpful with the derealization symptoms owing to its noradrenergic effects? And are there any noradrenergic effects at all at doses below 30mg? Thanks again

@johnpalumbo6960 4 ай бұрын

Great video. Thanks. I am very interested to learn your thoughts on apparent tolerance of this drug when administered for sleep. Is it actually a thing? I hear on the one hand people taking it with the same sedative efficacy for many years and others who notice a diminished response after just a few months. I take it for around 15 months with mixed results. One trick is if I lower from 15 to 7.5 for a week or so and then titrate up to 15 it seems to work better again. I just wondered if there is In your view a psychological basis for tolerance

@PsychiatrySimplified 4 ай бұрын

There are a few possibilities for this 1. True tolerance - tolerance of the antihistaminergic effect needing a dose increase ( doses 30 and less are more sedating than > 30 mg) 2. Insomnia is due to another mechanism - hyperarousal, agitation in which case Mirtazapine cannot address the true underlying condition 3. Comorbid medical conditions - OSA 4. Comorbid psychiatric conditions for Mirtazapine may not be effective in addressing the condition on its own.

@johnpalumbo6960 4 ай бұрын

@PsychiatrySimplified thank you for answering. It seems to me ( through anecdotal reading) that there is tremendous personal variance to point 1.

@jocs8824 Ай бұрын

Are the higher doses 45 and up also associated with even more 5-HT2a/c/3 blockade along with the increase in noradrenaline and serotonin? or does that effect top out at the 30mg dose?

@PsychiatrySimplified Ай бұрын

The 5HT2 / 5HT1A particularly increases as that potentiates DA. But alpha2 is main receptor which is blocked at higher doses for NA potentiation

@ShadowMan66 4 ай бұрын

Dr this is off topic but I was wanting to ask if it is possible to come straight off Quetiapine 25mgs as I have been on it for 9mths. It is the lowest dose and as it is not working in helping for anxiety for which was prescribes off label. Is it possible to come off it without any tapering? My Dr seems to think it will be ok but is there known to be any discontinuation syndrome?

@PsychiatrySimplified 4 ай бұрын

Some can - some can’t . Rebound insomnia is a risk. A safer way of doing it is to drop to 12.5 mg and then wait for 2-3 weeks to ensure no rebound insomnia or anxiety . Then to cease. If rebound occurs it simply means one may have to wean slower or may need to counteract the insomnia with other meds short term. A lot depends on stressors, underlying control of Illness - hence why medical supervision is essential. Ps not medical advice

@ShadowMan66 4 ай бұрын

@@PsychiatrySimplified Thank you so much!

@hubertuszczewski5808 2 ай бұрын

Hello. Very interesting. I have important question. What is the influence of mirtazapine on narrowing or widening of blood vessels? Especially celebral? Should it widen them via blocking alpha2 noradrenaline repeptors? Or should rather narrow them by increasing serotonin (like SSRI and triptans do)?

@PsychiatrySimplified 2 ай бұрын

Mirtazapine is unlikely to have a significant effect in that aspect - while it increases NA via alpha 2 antagonism - hypertension is not often a clinical issue hence the vasoconstriction potential is not significant. Similarly it does not have a hypotension effect - it may have indirect effects on vessels via reducing anxiety, treating depression and inproving vascular tone etc

@hubertuszczewski5808 2 ай бұрын

@@PsychiatrySimplified Thanks for your reply

@labratbrent 4 күн бұрын

I have to shave of a little from 30mg to reduce the noradrenaline but get the best of the histamine and serotonin. Depression. anxiety and PTSD results in sleep as a lotto win. I’m also on 75 mg of Amitriptyline also at night. I get 6 hours if lucky and wake up on fire. Then I use CBT therapy. Plus 2 Valium. For the day until the sleep anxiety is silenced by mirtazapine.

@Crcmvnt 12 күн бұрын

Took this for four days. 3 of the nights I didn’t sleep at all.

@PsychiatrySimplified 11 күн бұрын

Dose? Rule out mixed state. Also RLS 28% with Mirtazapine.

@ianmelling6686 6 күн бұрын

Are mirtazepine 30 mg ok for tinnitus please

@Practitionher 2 ай бұрын

Learned it was dose dependent before I knew what that meant . At 7.5 I have the best sleep I can recall in so many years I have slow MAOA (T;T) , which affects serotonin I have fast COMT (-/-) and VDR TAQ1 gene (+/+) which leads to really low dopamine. I take adderall in am for low dopamine effects. Wondering if I just took a higher dose of mirtazipine I would get both great sleep and less need for a stimulant .. 🤔 hmm

@PsychiatrySimplified Ай бұрын

Worth discussing this with the doctor. The dopaminergic potentiation with mirtazapine is not as sognificant as with a stimulant but combinations are used to extract synergy.

@Practitionher Ай бұрын

Thanks for replying

@kathleenharris3403 3 ай бұрын

I would like to continue 15 mg Remeron for mood and sleep yet my pa wants to start Pristiq? Can i take Remeron bedtime and Pristiq morning without problems? I am not feeling the side effect issues report w the Pristiq i have yet to try it because of what i read. Btw my dna says Remeron isn't really my best choice but i love it for me, go figure.

@PsychiatrySimplified 3 ай бұрын

We can’t provide individualised advice. In general pristiq can be coprescribed and is a common combination. At higher doses of both this combination is called California rocket fuel used in the severe cases of depression. However Mirtazapine is commonly used at low doses with other ADs including pristiq to assist with insomnia and anxiety .ps not advice

@Korag4 4 ай бұрын

next video mechanism of bupropion pls

@PsychiatrySimplified 4 ай бұрын

Ah yes that’s missing from the list

@katrinat.3032 4 ай бұрын

Yes please and it’s use in chronic pain

@salamalmudarris5032 3 ай бұрын

I took 7.5 mg mirtazapine and it made me sleep for two days (day and night). I reduced it to 3.25 and slept well with fatigue the next day. I reduced it to 1 mg which helped me sleep but also with a feeling of fatigue during the day. The problem with this medicine is that its half-life is so long (20 to 30 hours long).

@joshmatthews7224 25 күн бұрын

Hi. Quick question if someone is still having anxiety and depression at a dose of 30mg would a 45mg dose make anxiety worse but depressive symptoms better ?

@PsychiatrySimplified 25 күн бұрын

No necessarily. The domains of depression consists of activity: slowing of activity or agitation. The second domain is cognition which is executive function planning sequencing decision-making etc and the cognitive appraisal of situations. For example depression the appraisal becomes more negative. There is a bias towards negative stimuli. More than positive stimuli and the third dimension is emotions. This includes emotional control but also the ability to respond to reward i.e. the Hedonic drive the ability to experience pleasure in activities that One generally would experience pleasure. with mirtazapine higher than 30 mg - 45 and 60 mg of cognition and activity are addressed to a greater extent due to Dopamine and Noradrenaline increase. however whilst Anxiety can improve ; hyper arousal and agitation may worsen. to understand this deeper. Please see the video between Please see the video for the differences between Anxiety vs hyperarousal vs agitation as can also include psychomotor activity changes. Often patients describe anxiety but this tends to be more hyper arousal and agitation. This can be part of a melancholic depression or even mixed features. The treatment simply does not include high doses of antidepressants as this can worsen the hyperarousal, agitation Becomes important for the clinician to be able to look at all of these domains and then utilise medication to target. This of course becomes clearer when medication is taken- if the anxiety worsens, Then it would be important to identify if this was because of hyper arousal or agitation and then treating that helps the antidepressant work better. This of course requires the diagnostic evaluation to identify whether this is more than just a Depressive syndrome i.e. whether there is a mixed state possibly present. This is not medical advice

@chrishobson6844 4 ай бұрын

Hello, I'm curious about the cognitive effects of mirtazapine and guanfacine. Given that guanfacine, an alpha-2 agonist, is known to enhance cognitive function, could mirtazapine, an alpha-2 antagonist, potentially impair cognitive function?

@PsychiatrySimplified 4 ай бұрын

No because it’s a alpha 2 presynaptic agonist. I cover it in the video - increase of NA and DA ( via 5HT1A)

@chrishobson6844 4 ай бұрын

@@PsychiatrySimplified Thank you for your response, though I am still a bit confused. In your discussion about guanfacine, you mentioned its role as an alpha 2 agonist, which reduces overall noradrenaline activity but improves neural network connections, particularly in ADHD treatment. While I understand that mirtazapine can enhance cognitive function by increasing noradrenaline and dopamine levels, as an alpha 2 antagonist, does it weaken the same neural network connections that guanfacine strengthens?

@PsychiatrySimplified 3 ай бұрын

Clonidine is alpha 2 presynaptic agonist - Reduces NA and hyperarousal as presyanaptic > postsynaptic 2. Guanfacine post synaptic alpha2 - create impact on cognition and some possible reduction of hyperarousal but more activation of alpha2 receptors in PFC - cognition 3. Mirtazapine alpha 2 presynaptic antagonist ⬆️NA . 5HT1A partial agonist activity - ⬆️DA

@karenpeart5997 3 ай бұрын

Can mirtazapine effect calcium levels

@waynebrocklehurst1768 18 күн бұрын

I've suffered with long covid" brain fog, confusion, emotions, forgetting simple things, simlar to dementia. Vitimin levels low, serum folate. Mirtizapine has helped upto 90% of my condition? Somehow, it had helped!

@PsychiatrySimplified 18 күн бұрын

What dose ? Yes many ‘psychiatric medications can help’ Infact in the most extreme cases there are many others that do. They are better thought of as neurotransmitter reuptake inhibitors - so for example Mirtazapine with its low dose antihistamine effect can help with mast cell stabilisation, arousal reduction and improved sleep. Higher doses improve dopamine and noradrenaline potentiation so improve cogntion , activity.

@waynebrocklehurst1768 18 күн бұрын

@PsychiatrySimplified yes improved cognitive function, I've gained some weight, and helped with my sleep pattern. My dose is 30 mg per day at night, still left with extreme tinnitus and stomach issues. Mirtazapine has helped 85/90 % still have little issues, cognitively and holding instant memory as to repeat 1st words spoken. I'm currently in work part-time, with a understanding employer. Thank you for answering my questions.

@hello37175 4 ай бұрын

Hi doctor. I have a long history of depression and anxiety and have tried many antidepressants over the years. However, since 2011, I’m taking Fluoxetine 20 mg morning and Mirtazapine 15 mg night. The fluoxetine capsules however give me a heartburn problem occasionally, so I take Zactin, the dispersible tab. Recently however, the Zactin has been recalled and there is no other dispersable alternatives. So now I’m considering stopping the fluoxetine altogether and just take the mirtazapine. Do you think I’ll be okay ?

@PsychiatrySimplified 4 ай бұрын

It’s really a question for your doctor. It depends on the specific symptoms , the severity etc. your doctor knows your history and hence can make an individualised recommendation.

@hello37175 4 ай бұрын

@@PsychiatrySimplifiedthank you sir for your reply. The fluoxetine/ mirtazapine combo was prescribed by a psychiatrist in India, and the GPs here in Australia refill the script every six months, so I don’t really have a doctor, never seen a psychiatrist here in Australia.

@PsychiatrySimplified 4 ай бұрын

Most GPs are able to manage this part in Australia. Have a discussion in detail and they can consider a referral to a psychiatrist if needed. If there are challenges consider a Gp with an interest in mental health. With side effects in general there are 4 options 1 wait and watch and rule out other causes of heart burn. 2. Reduce dose or cease 3. Switch agent 4. Augment . These options need to be considered for each person individually . For example if fluoxetine is stopped then withdrawal symptoms ( usually low risk as fluoxetine is long acting) need to be managed and Mirtazapine dose may need to be adjusted upwards. This is one example. Importantly it depends on the main symptoms that the medications are prescribed for. Ps not medical advice

@hello37175 3 ай бұрын

@@PsychiatrySimplifiedThank you 🙏🏽

@sheridanwhiteside6503 4 ай бұрын

Would Mirtazapine have any benefit for tension headaches?

@PsychiatrySimplified 4 ай бұрын

If they are mediated by anxiety then it’s possible

3 ай бұрын

Does Mianserin have the same properties, that is, at higher doses it blocks noradrenaline and at lower serotonin? Also, is Mianserin as effective as Mirtazapine for promoting sleep?

@PsychiatrySimplified 3 ай бұрын

Yes Mianserin has similar properties. Both Mirtazapine and Mianserin do not block noradrenaline - they increase noradrenaline by blocking alpha 2 presynaptic receptors. They are serotonin receptor antagonists - so it doesn’t reduce serotonin but blocks specific serotonin receptors. Mirtazapine has greater antihistaminergic property

3 ай бұрын

@@PsychiatrySimplified do you know at which dose mianserin starts to affect the noradrenic level?

@PsychiatrySimplified 3 ай бұрын

Higher range

@PsychiatrySimplified 3 ай бұрын

It occurs at Low and High levels. Study shows that low levels via alpha 2 ; higher levels potentially NET inhibition ( animal study)

@teamburyoutdoors6989 4 ай бұрын

Can you take mirtazapine and zyprexa together? I just chanted from that to mirtazapine but was wondering if taken together is safe ?

@PsychiatrySimplified 4 ай бұрын

Theoretically yes. Please seek medical advice as olanzapine is prescribed for other indications that Mirtazapine may not be able to address.

@teamburyoutdoors6989 3 ай бұрын

@@PsychiatrySimplified the zyprexa mostly worked for my depression.. now the mirtazapine is working for my anxiety but now my depression is creeping back .I have only been on mirtazapine a few weeks 15mg idk what to do. I see a nurse practitioner she does her best bet ehh could be better

@PsychiatrySimplified 3 ай бұрын

Ceasing olanzapine can be associate with rebound insomnia or agitation so this has to be done gradually if a decision is made to reduce and cease - but also anxiety has to be differentiated from hyperarousal and agitation. Olanzapine treats agitation , Mirtazapine doesn’t. Ps not medical advice. We will be releasing a video in 3 weeks on anxiety vs hyperarousal vs agitation

@SagarGupta-bt4xo 29 күн бұрын

Sir I am from India, is it possible to make an online appointment with you

@PsychiatrySimplified 29 күн бұрын

Sorry cannot due to medicolegal reasons

@bliglum 2 ай бұрын

I was just prescribed this med. But everyone says it causes weight gain, and I already struggle with that... Does the 'increased appetite' side effect go away, or does it persist?

@PsychiatrySimplified 2 ай бұрын

It's variable. In some it persists some it doesn't - same as with weight gain. Best to discuss it with the doctor as there are options to address this

@Yasen1791 Ай бұрын

Dear Dr Sanil. Did your patients improve significantly After increasing the dose to 60 mg Thank you

@PsychiatrySimplified Ай бұрын

Improvement is not linked to drug only - it depends on 1. Desired improvement in patient - cognition, sleep, anxiety, emotion etc .. what is one targeting 2. Nature of illness Based on the above when Mirtazapine is used appropriately for the right targets in the right condition yes 60 mg leads to improving those specific targets

@karenpeart5997 2 ай бұрын

What does 15mg do to blood pressure please ? I can't find any information on this Snyone ?

@PsychiatrySimplified 2 ай бұрын

Not much. If anything if elevated BP is linked to anxiety this may slightly reduce. Unlikely to have any significant effect on BP.

@karenpeart5997 2 ай бұрын

@@PsychiatrySimplified so elevated bp can cause anxiety

@PsychiatrySimplified Ай бұрын

It’s bidirectional . If elevated Bp results in tachycardia then an elevated HR can lead to anxiety - and anxiety itself increases BP and HR.

@karenpeart5997 Ай бұрын

@@PsychiatrySimplified so BP doesn't actually cause anxiety? As my resting heart rate is always on the lower side resting 53. Only shoots up to about 110 in panic ,then I panic about the elevated heart rate.

@PsychiatrySimplified Ай бұрын

@@karenpeart5997 it’s the autonomic nervous system arousal but this can be from both directions - so cognition / thought increasing anxiety or increased heart rate triggering off panic thoughts

@jamilfox9101 4 ай бұрын

Why/how some antidepressants cause high blood glucose/interact with diabetes medicine?

@PsychiatrySimplified 4 ай бұрын

Mirtazapine can lead to increased glucose lipid levels and weight gain via antihistaminergic action

@jamilfox9101 4 ай бұрын

@@PsychiatrySimplified Sir what about vortioxetine? I started vortioxetine 12 days ago. Now BP is always high (140+, 90+), I take olmesartan 10mg at night and bisoprolol 2.5mg and vortioxetine 10mg together after breakfast.

@PsychiatrySimplified 4 ай бұрын

Vortioxetine does not affect blood sugar and is a metabolically friendly agent

@jamilfox9101 4 ай бұрын

@@PsychiatrySimplified sir I think it's(vortioxtine) decreasing the efficiency of blood pressure medicines(olmesartan, bisoprolol). I'm also withdrawing Quetiapine XR 50(Day four off Quetiapine). I don't know which one causing high blood pressure 😞. Anyway thanks sir for your kind replies.

@PsychiatrySimplified 4 ай бұрын

It’s likely a cumulative effect - increase in Vortioxetine increases noradrenaline which can increase BP combined with reduction of quetiapine which can also increase arousal and hendry indirectly BP. But theoretically this should not be sustained - however this depends on one’s risk factors and vulnerabilities . The doctor should be able to counteract this . Wish you well. Not advice

@DennisBolanos 4 ай бұрын

Dr. Rege, is it true that benzodiazepines and alcohol are the only substances that extinguish social anxiety?

@PsychiatrySimplified 4 ай бұрын

Not really - but we know that they are used to facilitate social contact in this context. For treatment however CBT is very effective as social anxiety as a construct is associated with fear of embarrassment or scrutiny hence addressing that is important. In terms of medications besides usual ADs - phenelzine is used for resistant social anxiety - it’s one of the agents that increases GABA in the brain. Having said that psychological therapy is most likely to give longer lasting benefits in social anxiety

@DennisBolanos 4 ай бұрын

@@PsychiatrySimplified Great, thanks for the info!

@woox200sx 4 ай бұрын

@@PsychiatrySimplifiedIs Parnate ( Tranylcypromine ) also useful for social anxiety?

@PsychiatrySimplified 4 ай бұрын

Not really - not mentioned specifically while phenelzine is mentioned for resistant social anxiety. Moclobemide also indicated

@SagarGupta-bt4xo Ай бұрын

Sir, will noradrenaline increase if mirtazapine 7.5 mg is taken?

@PsychiatrySimplified Ай бұрын

Unlikely at this dose. Alpha2 presynaptic antagonism for NE potentiation occurs at 45 and 60 mg.

@SagarGupta-bt4xo 29 күн бұрын

@@PsychiatrySimplifiedthank you so much sir 🙏🙏🙏

@IDGAF56852 4 ай бұрын

This medication caused serotonin syndrome for me which can be a life threatening condition. I took a 20 mg dose daily for about 3 months before it started causing problems for me.

@PsychiatrySimplified 4 ай бұрын

That is very unusual . Was it jumpy legs or was it actual clonus and hyperreflexia. Sometimes activation phenomenon - sweating, , arousal , restlessness can be misdiagnosed as SS. Not in anyways minimising your experience but more trying to ascertain if it was SS or something else. As the mechanism of the agent significantly minimised the possibility of SS.

@IDGAF56852 4 ай бұрын

@@PsychiatrySimplified I had restless leg syndrome really bad,I couldn’t lay still,I had to keep continuously moving,it was absolutely horrible.

@PsychiatrySimplified 4 ай бұрын

Yes that’s RLS - 28 % incidence with Mirtazapine . If this happens it could point to a few things and can point to potential treatment options 1. Mixed state 2. Iron deficiency 3. DA deficit so conditions like ADHD

@IDGAF56852 4 ай бұрын

@@PsychiatrySimplified thanks for your input,I appreciate it. Yeah my GP just attributed it to too much serotonin so I was taken off it. But then I was prescribed duloxetine-now that drug really messed me up. 6 weeks I took those little tiny white evil beads and I missed one morning and the side effects were horrendous ! It was worse than the mirtazapine side effects I had,so I weened myself off the duloxetine by slowly removing half a dozen beads each day until I was down to only a dozen in each pill,then I was able to just cut them out. Took about 8 weeks to get off that medication. That duloxetine is by far the worst prescription drug I’ve ever taken. Now 6 years later I’m not taking anything except one sleeping tablet ( survorexant / belsomra ) and melatonin. Thanks again for your information 👍

@IDGAF56852 4 ай бұрын

@@PsychiatrySimplified I had blood tests done and my iron was good,and there is adhd in my family. Plus I was diagnosed with drug induced psychosis from abusing marijuana and amphetamines when I was younger-35 years ago when I was in my early 20s I was a full blown marijuana user and took amphetamines weekly for many years.

@Yasen1791 Ай бұрын

Hi Dr Sanil. I will ask my doctor to prescribe 60mg because 45mg is not doing much Should I take it at night??

@PsychiatrySimplified Ай бұрын

Yes generally prescribed at night. But i cannot advise specifically for you. Please discuss this with your doctor

@Yasen1791 Ай бұрын

Thank you so much sir

@alexguitarman100 3 ай бұрын

From my own experience mirtazapine comes with sexual side effects. This is my second stint of being on mirtazapine was on it last year for 8 months and came off due to side effects. I was experiencing really bad sexual dysfunction thinking it was the finasteride I was taking along side with it which is a hairloss pill. I came off both meds at the same time and sexual functioning came back to normal (male 28 with a very high sex drive). I've recently gone back on only mirtazapine and now experiencing really bad sexual dysfunction again.... so really it was the mirtazapine all along. 30mg is the only dose that puts me to sleep at night and I honestly cant seem to sleep or function without them. I'm really stuck as ive had so much time off work due to severe mental health issues and insomnia and it's the only thing that is allowing me to function for work. The sexual side effects are unbearable...erectile dysfunction, gentle numbness, difficulty to orgasm the whole lot. Why is this not being mentioned anywhere??

@PsychiatrySimplified 3 ай бұрын

Sorry to hear ! It is ‘rarish’ which also fits in with its mechanism so it’s unfortunate. It’s incidence is low that ofcourse doesn’t mean it can’t happen at all. There are several other options for treating depression that don’t affect sexual function

@alexguitarman100 3 ай бұрын

@@PsychiatrySimplified is there any science behind it? what are the other options?

@HANZELVANDERLAAY 3 ай бұрын

Some welcome that side effect as woman are absolutely crazy nowadays 🤠🥳

@user-in4mz9go4d 27 күн бұрын

I took this for the first time as my psychiatrist just gave it to me but bro, having taken it just once at 15mg, i feel like someone who's been drugged. I fell in the toilet, my speech slurred and my sentences need to be completed by someone else i feel awful on it. I was given a 2months worth but i cant

@creaturanoctis 2 ай бұрын

I took mirtazapine for just two nights in a row to combat insomnia. First I took 7,5 mg and then even 3,25 mg. It gave me horrible brainfog, drowsiness and derealization throughout the day, even though I took it at night. I felt like I was partly floating above my body. Still, I am now thinking about giving it another try for depression and panic/anxiety, mainly because it doesn't have the side effects that SSRI's have. Is the sedating feeling expected to go away once you get used to it? And is it different with different doses?

@PsychiatrySimplified 2 ай бұрын

The antihistaminergic effect that leads to the grogginess is meant to ease as the receptor desensitises. But if it persists beyond 7 days to the same extent ( where intensity doesn’t reduce ) then it’s likely a side effect.

@creaturanoctis 2 ай бұрын

@@PsychiatrySimplified Alright, thank you for your answer. Couldn't hurt to give it another try I guess. I just hope I won't gain weight or get high cholesterol.

@PsychiatrySimplified 2 ай бұрын

It can be picked up Early and managed if that happens in clinical practice

@SM-by8mg 4 ай бұрын

Doctor , with huge respect I have a question for you that have you people ever used any psychiatric medicines such SSRI ,SNRI ,Metazapine etc by yourself . These medicines causes a lot of damages to receptors and level of neurotransmitter than benefits to someone. I took SSRI Escitalopram for 6 months in 2020 and still struggling to achieve my mental energy and motivation till date.

@PsychiatrySimplified 4 ай бұрын

I would recommend discussing this with your doctor

@pvn271 4 ай бұрын

yes i have and it worked great lol...your condition is not due to escitalopram but more likely to be due to your underlying issues

@SM-by8mg 4 ай бұрын

@@pvn271 Great to hear from someone that it benefits you. In my case after using ssri , I could not be able to achieve my mental energy and motivation. Feels abruptions in natural level of neurotransmitters

@PsychiatrySimplified 4 ай бұрын

That’s the reason why a clinical assessment is needed by a medical professional. Motivation , mental energy are targets that can be addressed but it requires an evaluation first

@SM-by8mg 4 ай бұрын

@@PsychiatrySimplified Sir How the mental energy and motivation can be addressed? Is there any solution for this issues specifically . I did many assessments with the psychiatrist but have not found any solution for it 😌

@sebastian993 2 ай бұрын

the histamine side effects are bad. great for my hay fever & anxiety induced insomnia, but it results in headaches, dryness & lethargy. compared to the countless SSRI & SNRI drugs I've taken in the past, Mirtazapine is far superior, though, particularly in terms of side effects. this includes less sexual dysfunction, no tachycardia, better sleep & decreased brain fog/confusion (i.e. more clear thinking & better concentration). having only been on them for 1 week, i cannot say if they'll reduce my depression significantly, but so far i do feel more positive. why any doctor would prescribe the newer antidepressants to these older tetracyclics is beyond me? pressure & lobbying from big pharma, i suppose?

@PsychiatrySimplified Ай бұрын

Certain newer antidepresants have advantages - just like mirrazapine was once upon a time an improvement on SSRIs until it becomes generic. Each agent has its unique feature than when used well can make a difference

@j-uk2189 4 ай бұрын

Shall I slap my psychiatrist who said mirtazapine doesn’t work depression, anxiety and sleep, but take seroquel instead!? lol

@PsychiatrySimplified 4 ай бұрын

We don’t advocate for violence 😃

@antea9055 4 ай бұрын

Blood concentrations is double in women according to the initial research of this drug and doctors does not care. Do not know. Coming of high dose of this drug is a Nightmare! Those who have trouble sleeping normally before mirtazapine risks extreem insomnia on any percentage reduction.

@PsychiatrySimplified 4 ай бұрын

Yes rebound insomnia is a risk when coming off.

@fredrikaternelius9127 4 ай бұрын

⁠@@PsychiatrySimplifiedthanks for an amazing video.🎉 I was given mirtazapin against migraines but due to the very sedative effect I stopped after only 3,5 weeks. It’s months since I stopped and my sleep is still a big mess. Can you explain why or what to do about it? Can it have increased my cortisol levels?

@PsychiatrySimplified 4 ай бұрын

If insomnia is an issue - watch the video we did on insomnia. The type of insomnia needs to be targeted . So there are few options but it depends on the nature, so please discuss this with a doctor .

@randyward1985 28 күн бұрын

I was actually prescribed 90mg of this stuff. It was too much.

@nenadcubric2663 Ай бұрын

Weight Gain a Lot!!!

@KennethNordin Ай бұрын

Worthless video only presenting all we already knew about mirtazapine

@PsychiatrySimplified Ай бұрын

Thanks for the comment. Worthless to YOU. So while its worthless to you ; it may not be for everyone. 👍🏼

@KennethNordin Ай бұрын

@@PsychiatrySimplified No it's not at all worthless. I regret that I wrote in that way. My question is more that you dont describe the drug for what it is. Mrtazapine are very versatile and also got effect on sleep and helps with anxiety symtoms. But, sorry for the plump words from me. I really like our channel, that's a fact

@PsychiatrySimplified Ай бұрын

Thanks for that! I guess I was abrupt myself . I’ve got two videos on Mirtazapine - perhaps I’ve covered it there. But fair point 👍. And sorry if I was abrupt

@craigallday1236 22 күн бұрын

Extremely interesting I thought

@fredflintstoner596 4 ай бұрын

Mrs Richards: "I paid for a room with a view !" Basil: (pointing to the lovely view) "That is Torquay, Madam ." Mrs Richards: "It's not good enough!" Basil: "May I ask what you were expecting to see out of a Torquay hotel bedroom window ? Sydney Opera House, perhaps? the Hanging Gardens of Babylon? Herds of wildebeest sweeping majestically past?..." Mrs Richards: "Don't be silly! I expect to be able to see the sea!" Basil: "You can see the sea, it's over there between the land and the sky." Mrs Richards: "I'm not satisfied. But I shall stay. But I expect a reduction." Basil: "Why?! Because Krakatoa's not erupting at the moment ?"