[Mirtazapine in the treatment of cocaine-dependence in patients with methadone] OBJECTIVE: To evaluate efficacy, interactions and adherence to treatment in cocaine-dependent patients (according to DSM- IV criteria). Its impact on reducing/quitting both cocaine and especially benzodiazepines (BZP) is of a great concern. PATIENTS AND METHODS: Thirty-one patients with an average age of 35 years, mean methadone dose of 155 mg/day and an average staying time on MMP of 21 months started treatment with MTZ, 60 mg/day as a single dose. One patient had to take 90 mg/day. One patient was excluded because of poor performance in the methadone maintenance program (MMP). In the pre-treatment evaluation, 22% of the patients did not use BZP and 40% used only cocaine. Sixty three percent used cocaine in higher dose than 0.5 g/day. (Range: 0.5-2 g). Abusive alcohol drinkers or patients with severe organic or psychiatric impairment were discarded. RESULTS: MTZ is well tolerated and its adverse effects are welcome in this kind of patients. Adherence to treatment was quite good for these reasons and because MTZ has a short latency time. No dose adjustments or interactions with other prescriptions (e.g., HAART), were shown. Hamilton-17, GCI, stress and craving scales were employed. Drug use was monitored with enzyme immune assay. At the end of the study, seven patients (23%) managed to quit cocaine. No BZP use was reported in 20 patients (80%). CONCLUSION: MTZ has shown good results in ceasing street BZP abuse, as well as reducing cocaine abuse though in the minor abusers. Treatment adherence was quite good and no evidence of interactions with drug-related treatments was reported. Journal ISSN: 1139-9287 Issue: 30-6 (2002 Nov-Dec) Pages: 337-42
Dysphoric mania induced by high-dose mirtazapine: a case for 'norepinephrine syndrome'?
Dysphoric mania induced by high-dose mirtazapine: a case for 'norepinephrine syndrome'? The antidepressant mirtazapine antagonizes central presynaptic alpha2-adrenergic auto- and heteroreceptors resulting in increased central norepinephrine and serotonin activity. Histamine H2 receptors are also antagonized, as are postsynaptic serotonin 5-HT2 and 5-HT3 receptors, leading to serotonergic activity primarily via 5-HT1A receptors. Based on the case report of a patient who developed mania with higher than recommended dosage of mirtazapine, we review the literature on the atypical nature of manic symptoms with mirtazapine. Eight subjects, including those in our study, were identified as having developed mirtazapine-induced mania with atypical features, consisting of dysphoria, irritability, insomnia, psychomotor agitation and abnormal gait. Predisposing features may have included the presence of underlying brain dysfunction and certain selective serotonin reuptake inhibitor-mirtazapine combinations. Dysphoric mania with atypical features may be induced by mirtazapine, providing support for a common hypothesis such as 'central norepinephrine hyperactivity' as the basis for development of mania with mirtazapine. Journal ISSN: 0268-1315 Issue: 17-6 (2002) Pages: 319-22
[Pharmacological justification for the use of new antidepressant drugs]
[Pharmacological justification for the use of new antidepressant drugs] This review compares a new generation of antidepressants with standard tricyclic antidepressants. It is now believed that an ideal antidepressant should be characterised by high therapeutic efficacy, good tolerance, safety of use related to low incidence of adverse effects, little potential for interactions and low cost of use. Mirtazapine, nefazodone and venlafaxine have therapeutic efficacy which is comparable with that of tricyclic antidepressants and their lack of (or insignificant) receptor effect as well as double mechanism of action makes them a safer therapeutic option. Journal ISSN: 1426-9686 Issue: 13-75 (2002) Pages: 250-2
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