Best non sedating antidepressants

22-Jul-2017 17:49

The goal in such development is to produce agents that are more efficacious, safer and better tolerated than older medications. Although all SSRI drugs have the same mechanism of action, each SSRI has slightly different pharmacological and pharmacokinetic characteristics.

This leads to differences among the SSRIs in their half-lives, clinical activity, side effects, and drug interactions.

Mirtazapine is a newer antidepressant that exhibits both noradrenergic and serotonergic activity.

It is at least as effective as the older antidepressants for treating mild to severe depression. Although agranulocytosis is the most serious side effect, it is rare (approximately one in 1,000) and usually reversible when the medication is stopped. Many clinicians consider mirtazapine a second-line or even third-line antidepressant, to be used when older antidepressants are not tolerated or are ineffective.

It demonstrates linear kinetics over its usual dosage range and reaches peak plasma level approximately two hours after an oral dose.11 The elimination half-life is 20 to 40 hours, so a steady state is reached in approximately five days.Mirtazapine is also a good choice in depressed patients with significant anxiety or insomnia. Cost to the patient will be higher, depending on prescription filling fee*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Selective serotonin reuptake inhibitors (SSRIs) have become the drugs of choice in the treatment of depression.3 Generally, either the older tricyclic antidepressants or the newer antidepressants are used for second-line therapy.4 During the first few years of introduction to the U. market, it is reasonable for an antidepressant such as mirtazapine to be reserved for use in patients who do not tolerate or do not respond to initial therapy with SSRIs.Although mirtazapine has been used successfully in Europe for a number of years, its place in the care of patients with depression in the United States has not yet been established.*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Mirtazapine is a tetracyclic piperazinoazepine, which has a different structure from any other currently used antidepressant.Mirtazapine is metabolized in the liver via the P450 cytochrome oxidase pathway, inhibiting cytochromes 2D6, 1A2 and 3A4. Clearance of the drug is diminished in the presence of liver or renal impairment.Therefore, a lower dosage is recommended in elderly patients and those with liver or renal dysfunction.

It demonstrates linear kinetics over its usual dosage range and reaches peak plasma level approximately two hours after an oral dose.11 The elimination half-life is 20 to 40 hours, so a steady state is reached in approximately five days.Mirtazapine is also a good choice in depressed patients with significant anxiety or insomnia. Cost to the patient will be higher, depending on prescription filling fee*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Selective serotonin reuptake inhibitors (SSRIs) have become the drugs of choice in the treatment of depression.3 Generally, either the older tricyclic antidepressants or the newer antidepressants are used for second-line therapy.4 During the first few years of introduction to the U. market, it is reasonable for an antidepressant such as mirtazapine to be reserved for use in patients who do not tolerate or do not respond to initial therapy with SSRIs.Although mirtazapine has been used successfully in Europe for a number of years, its place in the care of patients with depression in the United States has not yet been established.*—Estimated cost to the pharmacist based on average wholesale prices, for one month's therapy at the lowest usual dosage level, in Red book. Mirtazapine is a tetracyclic piperazinoazepine, which has a different structure from any other currently used antidepressant.Mirtazapine is metabolized in the liver via the P450 cytochrome oxidase pathway, inhibiting cytochromes 2D6, 1A2 and 3A4. Clearance of the drug is diminished in the presence of liver or renal impairment.Therefore, a lower dosage is recommended in elderly patients and those with liver or renal dysfunction.Physicians who are concerned about the risks of elevated lipid levels and agranulocytosis may choose to reserve mirtazapine as a third-line choice.