June09 psychotherapeutic agents- mirtazapine
Peak Development for .
Vol. 10 Issue 6
Peak Development Resources P.O. Box 13267
After completion the learner should be able to:
1. Identify appropriate indications for use of
unknown. It is believed to increase levels of
neurotransmitters, such as norepinephrine and
2. Relate general characteristics of mirtazapine to specific patient situations.
serotonin. The drug antagonizes selected 5-HT receptors. It also produces significant
3. Apply nursing process considerations for
Peak Development for… Medication
antihistamine and alpha-adrenergic blocking
mirtazapine to specific patient situations.
effects, resulting in effects such as drowsiness
are components of
—Rapidly and completely absorbed
health disorder, affecting nearly 30% of adults at
some time during their lives. Three forms of
—Highly protein bound; studies
depression include major depression, dysthymia
have shown that the drug enters breast milk
and bipolar disorder. The Diagnostic and
—Metabolized in the liver; effects
Statistical Manual of Mental Disorders 4th
edition characterizes symptoms of depression
as depressed mood or loss of interest or
pleasure in all usual activities. Other common
—Predominantly via the kidneys,
symptoms include weight loss and anorexia,
Peak Development for… Medication
with a smaller amount eliminated via the
is intended only as
insomnia or hypersomnia, fatigue, inability to
concentrate, feelings of worthlessness and guilt,
administer medications. Every effort has been made to verify the
depression is believed to involve an insufficiency
Alcohol and other CNS depressants
of the neurotransmitters serotonin and/or Concurrent use may increase CNS depression.
norepinephrine. Environmental, social, and Antihypertensive drugs:
Concurrent use may
in the field of drug therapy, the reader is advised to consult the
genetic factors also play an important role.
Medication is the primary therapy for MAO
: Concurrent use may result in
depression. Other treatment options include
serious adverse effects, including seizures,
information. This is particularly important for new or seldom used
electro-convulsive therapy and psychotherapy.
severe hypertension and/or hyperthermia.
These drugs should not be administered within
judgment is required in all patient care situations. It is the reader’s
Mirtazapine is indicated for the treatment
Sedation with resulting drowsiness is a
of major depressive disorder. It is not for use in
treatment of bipolar disorder. Mirtazapine is
approximately half of patients who take the
classified as a tetracyclic antidepressant, and is
drug. This may or may not resolve over time.
structurally unrelated to selective serotonin
orthostatic hypotension, constipation, nausea,
increased appetite, weight gain, or muscle pain.
antidepressants, and monoamine oxidase Changes in mood or mental status may occur,
including anxiety, agitation, confusion, hallucinations, or mania.
with meals. The dosage is most commonly administered in a
The drug may also cause decreased saliva production, causing
single daily dose, usually at bedtime, due to the sedative effects.
dry mouth and increasing the risk for dental caries, gingivitis, and
Observe for therapeutic effects:
It is important to note that
oral yeast. Blood dyscrasias, such as neutropenia or therapeutic effects of mirtazapine may not begin until 1-4 weeks
agranulocytosis, may rarely occur, increasing risk for infection.
following initial administration. Behavior indicating a positive
Mirtazapine has less adverse effect on sexual function than other
therapeutic response includes increased feelings of worth and
antidepressants, which may be helpful for patients who have had
well being, interest in surrounding environment, increased
participation in social activities and improved appearance.
Mirtazapine is contraindicated for use in patients who have
drowsiness, nausea, weight gain, constipation, or changes in
known hypersensitivity to this drug. Caution should be used in
mood or mental status. Because there may be increased risk of
patients with hepatic or renal impairment, hypotension, heart
suicide with antidepressant therapy, each patient must be
failure or other cardiovascular problems made worse by
carefully screened for suicide risk. This is especially important at
hypotension, and history of seizures, mania, or drug the onset of treatment and with dosage changes, when risk
appears to increase. Blood pressure and white blood cell count
should also be monitored periodically to assess for hypotension
Determine baseline status
: A complete mental/psychological
status assessment is necessary to measure therapeutic effect, as
mirtazapine focuses on measures to promote compliance and
well as to determine suicide potential. Any patient who is a risk to
safety with drug regimen. Patients and family members should
himself or others requires hospitalization for initial intervention.
Take note of the patient’s affect, thought patterns, appetite, sleep
• The medication may need to be taken for several weeks
patterns and appearance. In addition, perform a complete
before significant improvement in symptoms is noted.
physical assessment and review renal and liver function studies,
• Continue taking the medication even when mood is improved.
as well as baseline white blood cell count.
• Do not discontinue the medication or change the dosage
Identify risk factors:
Screen for factors that may increase risk
without contacting the prescriber.
of adverse drug reactions, such as hypotension, liver or renal
• Change positions slowly until drug effects are known.
impairment, blood dyscrasias, history of seizures, mania or drug
• Avoid hazardous activities involving machinery and driving
dependence. A complete medication history is important to
until drug effects are known, due to potential effects of
prevent serious complications related to drug interactions. If
MAO inhibitor drugs have been taken, document discontinue
• Do not use any prescription or over-the-counter drugs without
checking with the doctor who prescribed the mirtazapine.
• Engage in exercise and reduce caloric intake to prevent
There are no documented adverse effects to a nursing infant.
This drug is used in pregnant and breastfeeding women only
• Watch for suicidal ideation, particularly at onset of treatment
when drug benefits outweigh possible risks. Safety and efficacy
for use in the pediatric population have not been established.
• Avoid the use of alcohol or CNS depressant medications.
There are no known problems that limit use in the geriatric
• Brush and floss teeth daily, and have regular dental exams.
population, although this group is more likely to have renal or
• Seek immediate treatment if adverse changes in mental
status occur, such as confusion, agitation, mania, or suicidal
• Contact physician promptly if signs of infection occur, such as
The desired outcomes of therapy are decreased symptoms
of depression and absence of suicidal ideation.
• Keep all appointments for medical follow-up or psychological
: Mirtazapine is available in oral
tablet form (Remeron) and in oral disintegrating tablet form (Remeron SolTab). The oral disintegrating tablet is placed on top
Appropriate use of antidepressant medication, along with
of the tongue, where it immediately dissolves. Mirtazapine may
education, monitoring, and counseling, can help patients to
be administered without regard to meals. If nausea occurs,
manage symptoms of depression and enjoy improved quality of
however, the patient may find it helpful to take the medication
Peak Development for… Medication Administration
Psychotherapeutic Agents: Mirtazapine (Remeron)
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