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Mirtazapine Attenuates Hypothalamic-pituitary-adrenocortical Axis Hyperactivity in Depressed Patients
A DGReview of :"Attenuation of hypothalamic-pituitary-adrenocortical hyperactivity in depressed patients by mirtazapine"
Psychopharmacology
04/17/2003
By Anne MacLennan
German clinicians have found that mirtazapine rapidly attenuates the dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system seen in depressed patients.
They note, however, that this effect of mirtazapine is not necessarily related to clinical improvement.
Previous research suggested that dysregulation of the HPA system might play an important role in the pathophysiology of depression, and that normalization of HPA axis hyperactivity precedes successful treatment with antidepressants, write Dr. Cornelius Schüle and colleagues at the Department of Psychiatry at University of Munich.
Previous studies demonstrated that mirtazapine acts as an antagonist at presynaptic beta 2 receptors and at post-synaptic 5-hydroxytryptamine (5-HT) and histamine H1 receptors. In addition, it has been shown to have an acute inhibiting effect on cortisol secretion in healthy subjects.
Dr. Schüle and colleagues investigated whether mirtazapine might reduce HPA axis hyperactivity in patients with depression, and whether this is related to treatment outcome.
They enrolled 40 patients who met Diagnostic and Statistical Manual - Revision IV criteria for a major depressive episode, and who were treated with mirtazapine 45 mg daily for 5 weeks. The combined dexamethasone suppression/corticotropin releasing hormone stimulation (DEX/CRH) test was carried out 1 week before and 1 week after the start of mirtazapine treatment.
The clinicians found that mirtazapine effectively reduced the overshoot of cortisol and adrenocorticotropin in the DEX/CRH test in the first week among patients who either responded or did not respond to treatment.
Dr. Schüle and colleagues conclude, "Apparently, mirtazapine rapidly attenuates HPA axis hyperactivity in depressed patients via direct pharmaco-endocrinological effects. However, this amelioration of HPA system dysregulation is not necessarily related to clinical improvement."
Psychopharmacology 2003;166:271-275.
"Attenuation of hypothalamic-pituitary-adrenocortical hyperactivity in depressed patients by mirtazapine"
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