Novel antidepressants - Mirtazapine (Remeron)
Novel antidepressants Mirtazapine (Remeron)
Pros
- Different mechanism of action may provide a good augmentation strategy to SSRIs. Is a 5HT2 and 5HT3 receptor antagonist
- Can be utilized as a hypnotic at lower doses secondary to antihistaminic effects
Cons
- Increases serum cholesterol by 20% in 15% of patients and triglycerides in 6% of patients
- Very sedating at lower doses. At doses 30mg and above it can become activating and require change of administration time to the morning.
- Associated with weight gain (particularly at doses below 45mg
Novel antidepressants - Buproprion (Wellbutrin)
Buproprion (Wellbutrin)
Pros
- Good for use as an augmenting agent
- Mechanism of action likely reuptake inhibition of dopamine and norepinephrine
- No weight gain, sexual side effects, sedation or cardiac interactions
- Low induction of mania
- Is a second line ADHD agent so consider if patient has a co-occurring diagnosis
Cons
- May increase seizure risk at high doses (450mg+) and should avoid in patients with Traumatic Brain Injury, bulimia and anorexia.
- Does not treat anxiety unlike many other antidepressants and can actually cause anxiety, agitation and insomnia
- Has abuse potential because can induce psychotic sx at high doses
