Mirtazapine is commonly used in elderly patients with depression who are also suffering from insomnia. Mirtazapine is often chosen because it is much safer than benzodiazepines, “z-drugs”, and antipsychotics. The mechanisms of mirtazapine (podcast episode on the pharmacology) include the release of norepinephrine via presynaptic adrenergic auto-receptor blockade, increased serotonin production through stimulation of adrenoreceptors on serotonergic cell bodies, and the direct blockade of 5-HT2 and 5-HT3 receptors. Mirtazapine has a high H1 receptor affinity, leading to antihistamine effects. So what does this mean as far as dosing of mirtazapine for insomnia?
It is, therefore, not surprising that weight loss has become a very topical subject over the years, not only for the obvious cosmetic reasons but also due to increasing awareness of the health risks to people who are overweight. There have been proven links between people being overweight and the development of conditions such as type 2 diabetes, coronary heart disease and stroke as well as some cancers, such as breast and bowel cancer.