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Environmental Science and Pollution... Sep 2022Citalopram (CTP) and mirtazapine (MTP) are two typical psychoactive drugs used for the depression treatment. As emerging pollutants, CTP and MTP have raised concern...
Citalopram (CTP) and mirtazapine (MTP) are two typical psychoactive drugs used for the depression treatment. As emerging pollutants, CTP and MTP have raised concern because of their harmful effect on aquatic organisms. Therefore, the ecotoxicological risk of these two pollutants to aquatic organisms should be given more attention. In this study, the effects of CTP and MTP on the feeding rate, heartbeat, nutritional enzymes, and their related gene expression of D. magna were investigated under single and binary mixture pollutant exposure. Subsequently, the recovery of exposed D. magna was studied to assess the toxic persistence of those pollutants. After 24-h exposure, the ingestion rate decreased by 34.2% and 21.5%, in the group of 1.45 mg/L CTP (C-H) and binary mixture with high concentration (Mix-H), respectively. After 24-h recovery, the feeding rate of D. magna was stimulated by a compensatory response. Over the exposure period, the heartbeat rate of D. magna increased significantly in the groups of CTP, MTP, and their binary mixture with low concentration (Mix-L), and then, their heartbeat rate was recovered during the recovery period. The activity of α-amylase (AMS) and trypsin were significantly changed in most of the exposed daphnia, both during the exposure and recovery period. CTP/MTP exposure stimulated the expression of the AMS gene. MTP and Mix-H exposure inhibited the expression of the trypsin gene and the other groups stimulated its expression. After 24-h recovery, the stimulating or inhibitory effects were alleviated. There were different responses between gene expression and enzyme activity. In conclusion, our results highlighted the toxic effects at high concentrations of single and mixed pollution of CTP and MTP on the feeding rate, heartbeat, AMS and trypsin enzyme activity, and expression of related genes of D. magna to assess the environment risk of them.
Topics: Animals; Antidepressive Agents; Aquatic Organisms; Citalopram; Cytidine Triphosphate; Daphnia; Mirtazapine; Trypsin; Water Pollutants, Chemical; Zooplankton; alpha-Amylases
PubMed: 35501432
DOI: 10.1007/s11356-022-20203-3 -
Frontiers in Immunology 2023Due to the high prevalence of depression among cancer patients, antidepressant medications are frequently administered as adjuvant treatment. However, the safety of such...
Due to the high prevalence of depression among cancer patients, antidepressant medications are frequently administered as adjuvant treatment. However, the safety of such medications in the development of metastasis is unclear. In this study, we investigated the effects of fluoxetine, desipramine, and mirtazapine on the liver metastasis of murine C26 colon carcinoma (cc). Balb/c male mice were administered these antidepressants intraperitoneally (i.p.) for 14 days following intrasplenic injections of C26 colon carcinoma cells. Desipramine and fluoxetine, but not mirtazapine, significantly increased the number of tumor foci and total volume of the tumor in liver tissue. This effect was associated with a decrease in the ability of splenocytes to produce interleukin (IL)-1β and interferon (IFN)-γ and an increase in their ability to produce interleukin (IL)-10. Similar changes were observed in plasma IL-1β, IFN-γ, and IL-10 levels. The current study demonstrates that the stimulatory effect of desipramine and fluoxetine, but not mirtazapine, on experimental colon cancer liver metastasis is associated with a suppression of immune defenses against the tumor.
Topics: Male; Mice; Animals; Fluoxetine; Mirtazapine; Desipramine; Cytokines; Antidepressive Agents; Liver Neoplasms; Carcinoma; Colonic Neoplasms
PubMed: 37409130
DOI: 10.3389/fimmu.2023.1160977 -
International Psychogeriatrics Oct 2022To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
DESIGN
Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
SETTING
Community settings and care homes in 26 UK centers.
PARTICIPANTS
People with probable or possible Alzheimer's disease and agitation.
MEASUREMENTS
Primary outcome included incremental cost of participants' health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants' and unpaid carers' gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
RESULTS
One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
CONCLUSIONS
On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Topics: Caregivers; Cost-Benefit Analysis; Dementia; Humans; Mirtazapine; Quality of Life
PubMed: 35852256
DOI: 10.1017/S1041610222000436 -
Journal of Clinical PsychopharmacologyAbout one third of depression patients do not respond to the first antidepressant trial. Difficult-to-treat depression was suggested to characterize the often chronic...
BACKGROUND
About one third of depression patients do not respond to the first antidepressant trial. Difficult-to-treat depression was suggested to characterize the often chronic and severe course of disease. Previous data indicate that tranylcypromine is effective in case of treatment-refractory depression. Many antidepressants are contraindicated in combination with tranylcypromine and other monoamine-oxidase inhibitors because of the risk of serotonin syndrome. The combination of tranylcypromine and amitriptyline was reported to be efficacious and safe in patients with electroconvulsive therapy-resistant major depression.
METHODS
In this retrospective chart review, we report a series of 3 cases, in which patients with electroconvulsive therapy-resistant depression were treated with the combination of tranylcypromine and mirtazapine. There are no published clinical data on this combination yet. Disease severity and treatment response were retrospectively assessed with the Clinical Global Impression-Severity and Improvement Scales.
RESULTS
All 3 patients had severe difficult-to-treat depression with chronic course of disease and several times of inpatient treatment without achieving remission. The combination treatment was tolerated well, although the patients had somatic comorbidities. One patient developed mild and self-limiting neuroleptic malignant syndrome in the long-term course after dose increase of concomitant aripiprazole. All 3 patients showed either much or very much improvement.
CONCLUSIONS
Under tight clinical controls in inpatient setting and after exhausting of alternatives, the combination of tranylcypromine and mirtazapine could be considered in patients, who do not achieve adequate improvement through common treatment options recommended in the guidelines. The combination has to be ceased, if symptoms of possible serotonin syndrome occur.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Depressive Disorder, Treatment-Resistant; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mirtazapine; Retrospective Studies; Tranylcypromine; Treatment Outcome
PubMed: 34369903
DOI: 10.1097/JCP.0000000000001452 -
Journal of Affective Disorders Jan 2018Many studies have reported that selective serotonin reuptake inhibitors (SSRI) are associated with an increased risk of bleeding. Mirtazapine and bupropion, which... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many studies have reported that selective serotonin reuptake inhibitors (SSRI) are associated with an increased risk of bleeding. Mirtazapine and bupropion, which commonly lack serotonin reuptake inhibition, have been recommended as alternatives for patients who are at risk for bleeding. However, the evidence for these recommendations is insufficient.
METHODS
We conducted a systematic search, systematic review, and meta-analysis to investigate an evidence-based approach for the bleeding risks of mirtazapine and bupropion. From 1946 to May 2017, a total of 3981 studies were searched from PubMed, Embase, and the Cochrane Library. Among the studies, two independent reviewers selected studies per predefined eligibility criteria.
RESULTS
A total of five meta-analyses were conducted. Patients taking mirtazapine were at a greater risk of gastrointestinal bleeding (OR = 1.17, 95% CI = 1.01-1.38) than those who did not take antidepressants. No differences were observed in the bleeding risk between mirtazapine and SSRI or between bupropion and SSRI.
LIMITATIONS
The number of studies included in the meta-analysis was small.
CONCLUSION
Our results suggest that it is premature to recommend mirtazapine and bupropion for patients who have a bleeding risk. More studies with larger sample sizes and longitudinal follow-ups are warranted.
Topics: Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Bupropion; Databases, Factual; Depressive Disorder, Major; Gastrointestinal Hemorrhage; Humans; Mianserin; Mirtazapine; Risk Factors
PubMed: 28841484
DOI: 10.1016/j.jad.2017.08.002 -
Balkan Medical Journal May 2016Mirtazapine is a tetracyclic antidepressant that enhances both noradrenergic and serotonergic transmission. The most common cause of papilledema is increased...
BACKGROUND
Mirtazapine is a tetracyclic antidepressant that enhances both noradrenergic and serotonergic transmission. The most common cause of papilledema is increased intracranial pressure due to brain tumor. Also it may occur as a result of idiopathic intracranial hypertension (IIH, pseudo tumor cerebri). Moreover, papilledema may also develop due to retinitis, vasculitis, Graves' disease, hypertension, leukemia, lymphoma, diabetes mellitus and radiation.
CASE REPORT
In this article, a patient who developed papilledema while under treatment with mirtazapine (30 mg/day) for two years and recovered with termination of mirtazapine treatment was discussed to draw the attention of clinicians to this side effect of mirtazapine.
CONCLUSION
Idiopathic intracranial hypertension and papilledema due to psychotropic drugs has been reported in the literature. Mirtazapine may rarely cause peripheral edema. However, papilledema due to mirtazapine has not been previously reported. Although papilledema is a very rare side effect of an antidepressant treatment, fundoscopic examinations of patients must be performed regularly.
PubMed: 27308085
DOI: 10.5152/balkanmedj.2016.150151 -
Biomedicine & Pharmacotherapy =... May 2023Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible lung disease with a poor prognosis. There is currently no definitive cure for IPF. The present...
Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible lung disease with a poor prognosis. There is currently no definitive cure for IPF. The present study establishes a platform for the development of a novel therapeutic approach for the treatment of PF using the atypical antidepressant, mirtazapine. In the endotracheal bleomycin rat model, mirtazapine interfered with the activation of NLRP3 inflammasome via downregulating the NLRP3 on the gene and protein expression levels. Accordingly, the downstream mediators IL-1β and IL-18 were repressed. Such observation is potentially a direct result of the reported improvement in oxidative stress. Additionally, mirtazapine corrected the bleomycin-induced disparities in the levels of the fibrogenic mediators TGF-β, PDGF-BB, and TIMP-1, in consequence, the lung content of hydroxyproline and the expression of α-SMA were reduced. Besides, mirtazapine curbed the ICAM-1 and the chemotactic cytokines MCP-1 and CXCL4. This protective property of mirtazapine resulted in improving the BALF total and differential cell counts, diminishing LDH activity, and reducing the BALF total protein. Moreover, the inflammation and fibrosis scores were accordingly lower. To conclude, we reveal for the first time the efficacy of mirtazapine as a potential treatment for PF. The combination of social isolation, sleep problems, breathing difficulties, and fear of death can lead to psychological distress and depression in patients with IPF. Hence, mirtazapine is a promising treatment option that may improve the prognosis for IPF patients due to its antifibrotic effects, as well as its ability to alleviate depressive episodes.
Topics: Rats; Animals; Inflammasomes; Mirtazapine; Antidepressive Agents, Second-Generation; Bleomycin; NLR Family, Pyrin Domain-Containing 3 Protein; Lung; Fibrosis; Idiopathic Pulmonary Fibrosis; Antidepressive Agents
PubMed: 36934553
DOI: 10.1016/j.biopha.2023.114553 -
Expert Review of Respiratory Medicine Feb 2019Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in... (Review)
Review
Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain may have a role. Antidepressants have been proposed; however, current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost, and wide availability, along with additional potential benefits. Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018. Expert opinion: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomized controlled trials required to determine its efficacy and safety in this setting.
Topics: Adrenergic alpha-2 Receptor Antagonists; Dyspnea; Histamine H1 Antagonists; Humans; Mirtazapine; Quality of Life; Serotonin Antagonists; Treatment Outcome
PubMed: 30596298
DOI: 10.1080/17476348.2019.1563486 -
Indian Journal of Ophthalmology Jun 2015Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from...
Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from increased intraocular pressure. This clinical condition can lead to permanent damage in vision, thus causing blindness by generating progressive and irreversible optic neuropathy if left untreated. There are several reasons of AAC, including several types of local and systemic medications; mainly sympathomimetics, cholinergics, anti-cholinergics, mydriatics, anti-histamines, antiepileptics like topiramate, tricyclic and tetracyclic antidepressants, serotonin reuptake inhibitors, antipsychotics, sulfa-based drugs and anticoagulants. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is an atypical antidepressant with a complex pharmacological profile. This case report describes a patient with major depressive disorder, who experienced AAC after the first dosage of mirtazapine treatment, and highlights the importance of close monitoring of individuals under antidepressant treatment particularly immediately after initiation of the drug.
Topics: Adult; Antidepressive Agents, Tricyclic; Depressive Disorder, Major; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Mianserin; Mirtazapine
PubMed: 26265648
DOI: 10.4103/0301-4738.162612 -
Pharmacological Reports : PR Jun 2020Experimental and clinical studies indicate that neuronal death with the presence of high levels of reactive oxygen species are present in depressed patients and...
BACKGROUND
Experimental and clinical studies indicate that neuronal death with the presence of high levels of reactive oxygen species are present in depressed patients and antidepressants might display neuroprotective effects against them. However, the mechanisms underlying antidepressant neuroprotection are not completely understood. In our previous study, we showed that mirtazapine modulated the expression of pro- and anti-apoptotic proteins in mouse brain structures, but there are no data in human cells. Thus, this work was designed to study the possible neuroprotective properties of mirtazapine and imipramine, two commercially available antidepressants with different primary mechanisms of action, in human neuroblastoma SH-SY5Y cells against an oxidative insult.
METHODS
SH-SY5Y cells were preincubated with mirtazapine and imipramine (1-20 μM) for 24 h, then hydrogen peroxide (HO) was added into the medium containing the antidepressants for additional 24 h, and MTT assay was carried out subsequently. Also, to elucidate the molecular mechanism underlying the neuroprotective properties of antidepressants, we investigated the effects of mirtazapine and imipramine (2 μM) in pro- and anti-apoptotic proteins gene expression in SH-SY5Y cells.
RESULTS
Mirtazapine (1 and 2 μM) and imipramine (1and 2 μM) protected against hydrogen peroxide-induced cellular viability impairment. Most importantly, both compounds reduced p53 mRNA expression, but only imipramine enhanced the Bcl-2/Bax ratio.
CONCLUSIONS
The obtained data indicate that mirtazapine and imipramine have neuroprotective effects against H2O2-induced cell death. Although both antidepressants reduced Bax and p53 mRNA expression, only the protection mediated by imipramine might be due to its ability to enhance Bcl-2/Bax ratio.
Topics: Apoptosis; Cell Line, Tumor; Cell Survival; Humans; Imipramine; Mirtazapine; Neuroblastoma; Neuroprotective Agents; Oxidative Stress; Reactive Oxygen Species; Tumor Suppressor Protein p53; bcl-Associated Death Protein
PubMed: 32240535
DOI: 10.1007/s43440-019-00009-w