• 생물정신의학
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• 제8권1호
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• pp.162-166
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• 2001

The mirtazapine is a relatively new antidepressant that has noradrenergic and specific serotonin antagonist action(NaSSAs). This has been known as one of the most safest drugs because of its few side effects. Until now, there have been only one case report that mirtazapine causes a EPS side effect(restless leg syndrome). But the peculiar mechanism of this drug makes it impossible to explain the exact reasons why the mirtazapine could induce EPS symptoms. Authors observed three cases of mirtazapine induced akathisia. We could not explain the phenomenon the other way except akathisia. So here we presents the three case of mirtazapine induced akathisia and a few possible hypothesis of this phenomenon.

• Biomolecules & Therapeutics
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• 제14권1호
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• pp.40-44
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• 2006

Mirtazapine is an antidepressant agent with dual action on both the noradrenergic and serotonergic neurotransmitter systems. A simple high performance liquid chromatographic method has been developed and validated for the quantitative determination of mirtazapine in human plasma. A reversed-phase Cl8 column was used for the determination of mirtazapine with a mobile phase composed of 0.01M ammonium acetate solution (pH 4.2) and acetonitrile (75:25, v/v%) at a flow rate of 1.2 mL/min. Terazosin hydrochloride was used as an internal standard. The fluorescence detector was set at excitation and emission wavelengths of 290 and 350 nm, respectively. Intra- and inter-day precision and accuracy were acceptable for all quality control samples including the lower limit of quantification of 3 ng/mL. Mirtazapine was stable in human plasma under various storage conditions. This method was used successfully for a pharmacokinetic study using plasma samples after oral administration of a single 30 mg dose as mirtazapine base to 8 healthy volunteers. The maximum plasma concentration of mirtazapine was $64.1{\pm}28.0ng/mL$ at 1.8 h, and the area under the curve and elimination half-life were calculated to be $674.1{\pm}218.5ng\;h/mL\;and\;23.4{\pm}3.8h$, respectively.

• 생물정신의학
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• 제22권4호
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• pp.179-186
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• 2015

Objectives Adrenergic alpha 1 and 2 receptors work as pathways to control the serotonergic neuron moderation and mirtazapine acts as antagonist of these receptors. The adrenoreceptor alpha 1a (ADRA1A) gene, which encodes adrenergic alpha 1 receptor, has Arg-347Cys genetic polymorphism and the polymorphism has strong relationship with many neuro-psychiatric diseases. In this study, we explored the relationship between ADRA1A R347C polymorphism and mirtazapine treatment response in Koreans with major depression. Methods 352 patients enrolled in this study, and the symptoms were evaluated by 17-item Hamilton Depression Rating (HAMD-17) scale. After 1, 2, 4, 8, and 12 weeks of mirtazapine treatment, the association between ADRA1A R347C polymorphism and remission/response outcomes was evaluated. Results Treatment response to mirtazapine was significantly better in T allele carriers than C allele homozygotes after 12 weeks of mirtazapine monotherapy. The percentile decline of HAMD-17 score in T allele carriers was larger than that of C allele homozygotes. ADRA1A R347C genotypes were not significantly associated with remission. Conclusions The result showed that treatment response to mirtazapine was significantly associated with ADRA1A R347C genetic polymorphism. T allele carriers showed better treatment response than C allele homozygotes. It can be supposed that T allele carriers have a trend of better treatment response to mirtazapine monotherapy.

• 수면정신생리
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• 제10권2호
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• pp.113-115
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• 2003

몽유병은 수면수반증으로 분류되는데, 항우울제와 기타 향정신약물에 의해 이차적으로 유발될 수 있다는 보고들이 있었다. 그러나, NaSSA(noradrenergic and specific serotonergic antidepressant)계열인 mirtazapine에 의해 유발된 몽유병에 대한 보고가 없었다. 저자들은 우울증 환자에서 mirtazapine 사용에 의한 몽유병 1예를 경험하였기에 관련 문헌들을 고찰하고 보고하는 바이다.

• 생명과학회지
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• 제31권7호
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• pp.662-670
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• 2021

카할세포는 위장관 근육의 pacemaker 세포이다. 이번 연구는 생쥐 소장에서 얻은 카할세포를 배양하여 노르아드레날린성 및 세로토닌성 항우울제인 미르타자핀의 효과를 조사했다. 전기생리학적인 방법을 이용하여 카할세포의 pacemaker potential의 변화를 측정하였다. 미르타자핀은 농도 의존적 방식으로 카할세포 탈분극을 일으켰다. Y25130 (5-HT3 수용체 길항제), RS39604 (5-HT4 수용체 길항제) 또는 SB269970 (5-HT7 수용체 길항제)은 미르타자핀에 의한 카할세포 탈분극에 영향을 미치지 않았다. 또한, 무스카린성 M2 수용체 길항제인 메톡 트라민은 미르타자핀에 의한 카할세포의 탈분극에 영향을 미치지 않은 반면, 무스카린성 M3 수용체 길항제인 4-DAMP는 카할세포의 탈분극을 억제하였다. GDP-β-S를 피펫을 통해 카할세포내로 넣었을 때, 미르타자핀에 카할세포 탈분극이 억제되었다. 외부에 칼슘이 없는 용액 또는 소포체의 Ca²⁺-ATPase 억제제인 thapsigargin이 있는 경우 미르타자핀에 의한 카할세포 탈분극이 나타났다. 또한, protein kinase C (PKC) 억제제인 칼포스틴 C 또는 chelerythrine은 미르타자핀에 의한 탈분극을 억제했습니다. 이러한 결과는 미르 타자핀이 카할세포에서 G 단백질 및 PKC 경로에 의한 무스카린성 M3 수용체 활성화를 통해 탈분극을 조절 함을 알 수 있다. 따라서 미르타자핀이 카할세포를 통해 위장관 운동성을 조절할 수 있음을 시사한다.

• Molecular & Cellular Toxicology
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• 제5권4호
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• pp.346-353
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• 2009

Drug metabolism is a critical determinant of the therapeutic and adverse effects of many psychotropic drugs. The metabolism depends on the pharmacokinetics of a drug, which includes its absorption, distribution, and elimination. Psychotropic drugs are metabolized mainly by cytochrome P450 (CYP) enzymes; about 20 of these enzymes exist and they are often responsible for the rate-limiting step of drug metabolism. CYP2D6 is the best-characterized P450 enzyme that exhibits polymorphism in humans. This study determined the relationship between the CYP2D6*10 (P34S) polymorphism and the response to mirtazapine in 153 Koreans with major depressive disorder (MDD). The genotype frequencies were compared using logistic regression analysis, and between-genotype differences in the decrease in the 21-item Hamilton Depression (HAMD21) score over the 12-week treatment period were analyzed using a linear regression analysis. The proportion of remitters was lower in patients with MDD possessing the S allele than in P allele carriers after 2 weeks of mirtazapine treatment. Similarly, the reductions in the HAMD21 and Clinical Global Impression (CGI) scores in S allele carriers were smaller than those in patients with the P allele after 2 weeks of mirtazapine treatment. In the analysis of depression symptoms, the sleep and delusion scores had smaller reductions in S allele carriers. Based on the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), the psychic adverse effects of mirtazapine were associated with CYP2D6 P34S, while weight gain was not. These results suggest that CYP2D6 P34S affects the outcome of mirtazapine treatment in patients with MDD, and that this polymorphism may be a good genetic marker for predicting the clinical outcome of mirtazapine treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제13권10호
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• pp.4897-4900
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• 2012

Objective: In this study, anticancer effects of mirtazapine on rats were investigated in an adenocarcinoma model induced by N-methyl-N-nitro-N-nitrosoguanidine (MNNG) and compared with those of cisplatin. Materials and Methods: For this purpose, 10 mg/kg doses of mirtazapine were administered orally to one group of rats, while 1 mg/kg doses of cisplatin were administered intraperitoneally to another group. At 1 hour after administration, 200 mg/kg doses of MNNG were given orally to both groups. MNNG administration was repeated once every 10 days through 3 months, after which period, gastric tissue was taken and pathologically evaluated. Results: Mirtazapine prevented adenocarcinoma induction by MNNG in rats to a greater extent than cisplatin. Some of the rats receiving cisplatin demonstrated severe dysplasia in gastric samples and others exhibited mild dysplasia. Rats given mirtazapine were not observed to suffer severe dysplasia, only mild dysplasia being observed. Conclusion: For adenocarcinoma induced by MNNG on rats, mirtazapine was determined more effective than cisplatin. In order to make statement about mechanism of anticancer activity of mirtazapine, wider studies are required.

• Bulletin of the Korean Chemical Society
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• 제23권11호
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• pp.1623-1628
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• 2002

Tetracyclic pyrido[2,3-b]azepine derivatives 4a-d and 4f as analogues of mirtazapine were synthesized via N-acyliminium ion cyclization by using aromatic rings such as benzene and thiophene ring as a ${\pi}-nucleophile$, and evaluated for the binding affinity for ${\alpha}2-adrenoceptor$. Among tested compounds, 2,3,9,13b-tetrahydro-1H-benzo[f]pyrrolo[2,1-a]pyrido[2,3-c]azepine (4a) was the most potent (Ki = 0.26 ${\mu}M)$ but showed about 3-fold less binding affinity than mirtazapine (Ki = 0.08 ${\mu}M)$ for a2-adrenoceptor.

• 생물정신의학
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• 제23권4호
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• pp.140-147
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• 2016

Objectives To determine the relationship between the Alu insertion/deletion (I/D) polymorphism in the tissue-type plasminogen activator (tPA) gene and the clinical outcome of mirtazapine treatment in Korean major depressive disorder (MDD) patients. Methods We enrolled 422 patients in this study. Symptoms were evaluated using the 21-item Hamilton Depression Rating (HAMD-21) Scale. After 1, 2, 4, and 8 weeks of mirtazapine treatment, the association between the Alu I/D polymorphism in the tPA gene and remission/response outcomes were evaluated. Results The proportion of I/I homozygotes in responders was higher than that in non-responders, whereas the proportion of D/D homozygotes in responders was lower than that in non-responders at 8 weeks of treatment (p = 0.032, OR = 1.57). The percentage decline of HAMD-21 scores in I allele carriers was larger than that of D/D homozygotes at 2 and 8 weeks of treatment (p = 0.035 and 0.007, respectively). I allele carriers were associated with remission at 8 weeks of treatment (p = 0.047, OR = 2.2). Conclusions These results show that treatment response and remission to mirtazapine were associated with the Alu I/D polymorphism of the tPA gene. This suggests the Alu I/D polymorphism may be a potential genetic marker for the prediction of therapeutic response to mirtazapine treatment in patients with MDD.

• 정신신체의학
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• 제11권1호
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• pp.44-51
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• 2003

연구목적: 대부분의 항우울제들은 성기능과 관련된 부작용을 나타낸다고 보고 되고 있으며 특히 국내에서 venlafaxine과 mirtazapine의 성기능과 관련된 부작용에 대한 연구 및 보고는 미비한 상태이다. 본 조사는 성기능 장애에 대한 구체적인 설문지를 이용하여 선택적 세로토닌 재흡수 차단제(SSRI), venlafaxine, 그리고 mirtazapine과 연관된 성기능 부작용의 빈도와 양상 등 성기능 부작용의 연관성을 조사하였다. 방 법: 122명의 불안장애, 우울장애 환자들을 대상으로 성기능 장애의 유무, 치료자에게의 보고 여부, 성욕의 감소, 절정감 또는 사정의 지연, 조기 사정 또는 절정감, 절정감 또는 사정의 결여, 남성에서의 발기부전 또는 여성에서의 질분비 감소, 성교통, 성기능 부작용에 대한 환자의 허용도 등의 항목으로 이루어진 설문지를 이용하여 항우울제와 연관된 성기능의 장애에 대하여 횡단면 조사를 시행하였다. 각각의 환자들에서 성기능 부작용척도, 우울척도(BDI)를 측정하였으며 항우울제의 종류, 용량 및 사용기간, 우울정도와의 관련성을 조사하였다. 결 과: 성기능 부작용의 전체 빈도는 122명 중 46명(37.7%)였으며, 성별에 따른 성기능 부작용의 발생빈도는 유의한 차이는 없었다(p=.746). 항우울제의 종류별 성기능 부작용의 양상에 대한 분석은 paroxetine, venlafaxine, mirtazapine의 세가지 약물군을 비교하였으며 성기능 부작용의 빈도는 약물간의 차이를 보이고 있었으나 통계적으로 유의한 의미는 없었다(p=.065). 또한 세 약물 군에서 성기능 부작용의 심각도를 측정하였으며 약물 간에 통계적으로 유의한 차이를 보이지 않았다. 결 론: 본 조사에서 약물군과 성기능 부작용과의 통계적인 유의성은 없었지만 성기능의 장애는 정신과적 약물과 밀접한 연관이 있을 것으로 생각되며 앞으로 다양한 항우울제의 약물의 투여전과 후의 성기능 평가를 통한 전향적인 연구가 필요할 것으로 생각된다.