Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Mirtazapine is a tetracyclic antidepressant similar
to maprotiline (Ludiomil) and tricyclic antidepressants, for example,
desipramine (Norpramin). Depression is an all-pervasive sense of sadness and
gloom. It is believed that in some patients with depression, abnormal levels of
neurotransmitters (chemicals that nerves use to communicate with each other) may
be the cause of their depression. Mirtazapine elevates mood by raising the level
of neurotransmitters (norepinephrine and serotonin) in nerves of the brain.
Mirtazapine also blocks the effect of histamine. Mirtazapine was approved by the
FDA in 1996.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Tablet (Orally disintergrating): 15, 30, and 45 mg
STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F).
DOSING: The usual starting dose for mirtazapine is 15 mg once daily, usually
at bedtime. Doses may be increased every 1-2 weeks up to a maximum dose of 45 mg
daily. It may be taken with or without food.
DRUG INTERACTIONS: Mirtazapine adds to the sedating effects of alcohol and
other drugs that can cause sedation such as:
the benzodiazepine class of
anti-anxiety drugs (for example, diazepam [Valium], lorazepam [Ativan],
clonazepam [Klonopin], alprazolam [Xanax, Xanax XR, Niravam]),
Fluvoxamine (Luvox), ketoconazole (Nizoral) and cimetidine (Tagamet) may
increase the levels of mirtazapine in the blood which may lead to increased side
effects from mirtazapine. Carbamazepine (Tegretol) and phenytoin
(Dilantin) decrease the blood concentration of mirtazapine by increasing the
breakdown of mirtazapine in the liver, possibly reducing the effect of
mirtazapine.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
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