To further Laurie’s point regarding
depression in the elderly, I wanted to discuss mirtazapine (Remeron) as my clinical
site uses this drug often in elderly patients with depression with related
anorexia and insomnia.
Remeron belongs to the tetracyclic
drugs and is indicated for major depressive disorder (depressed or dysphoric mood
occurring nearly daily for a period of at least two weeks which inhibits normal
function) which can include symptoms such as fatigue, decreased ability to
concentrate or think, suicidal ideation, depressed mood, anhedonia,
and appetite and/or weight changes (REMERON ®(mirtazapine)
The starting dose is 15mg
daily usually near to bedtime, and can go as high at 45mg daily. Special
attention should be pain when prescribing for the elderly and those with
impaired renal or hepatic function, as clearance may be lessened. (REMERON
®(mirtazapine) Tablets, 2018).If the patient is switching from
an MAOI, 14 days should be placed between discontinuation and starting of
remeron (REMERON ®(mirtazapine) Tablets, 2018).
office I am in currently likes to utilize remeron for patients with decreased
appetite and sleep problems as part of their depressive disorder. Some of the
main side effects include somnolence, increased appetite and weight gain (REMERON
®(mirtazapine) Tablets, 2018).
Mirtazapine can show improvements
of depression as early as 1-2 weeks after initiation and to be just as
effective as SSRIs and amitriptyline, but with less undesirable side effects
(showing in one study remission in the first two weeks), and can be very
efficient in those with anxiety, the geriatric population, resistant depression
and alcohol dependence. Along with the added benefits/side effects of increase
appetite, weight gain and improved sleep, it can also improve symptoms of
nausea (Alam, Voronovich & Carley, 2013).
Specifically in the elderly
population, mirtazapine was well tolerated, effective and had a faster rate of
symptom improvement by 14 days when compared to paroxetine (Alam, Voronovich
& Carley, 2013).
Another study also suggests that those with Alzheimer’s associated
severe agitation can have an improvement of symptoms with mirtazapine (Alam,
Voronovich & Carley, 2013).
I am a big fan of any drug that can
address multiple issues at once, especially a drug with minimal undesirable effects,
which is also effective and definitely will be adding this one to my toolbox.
Tablets. (2018). Retrieved from https://www.rxlist.com/remeron-drug.htm
Alam A., Voronovich Z., & Carley J. (2013). A review of
therapeutic uses of mirtazapine in psychiatric and medical conditions. Prim
Care Companion CNS disord. 15(5). Doi:10.4088/PCC.12r01525