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Mirtazapine A unique tool in the antidepressant toolbox
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• 08/17/25
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Mirtazapine: A unique tool in the antidepressant toolbox
Mirtazapine isn’t your typical SSRI—and that’s exactly why it can be useful in the right context.
✅ When to consider mirtazapine:
Depression with insomnia
Poor appetite or weight loss
Concern about sexual side effects
Patients struggling with GI intolerance to SSRIs
⚠️ When to avoid it:
Obesity or metabolic syndrome
Risk of daytime sedation
Orthostatic hypotension history
Mechanistically, it’s a noradrenergic and specific serotonergic antidepressant (NaSSA). It works via alpha-2 autoreceptor blockade, enhancing 5-HT1A transmission while avoiding 5-HT2/3 activity—translating to fewer GI and sexual side effects.
💡 Pro tip:
Sedation is dose-dependent and paradoxical:
Lower doses (7.5–15 mg) = more sedation
Higher doses (30–45 mg) = less sedation
In short, mirtazapine shines in cases where sleep, appetite, or tolerability limit other antidepressants—but use it strategically.
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