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Mirtazapine's Adrenergic activity in Anxiety Disorders

mirtazapine anxiety depression seretonin antagonist norepinephrine alpha

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#1 Wicksy

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Posted 18 September 2020 - 11:02 AM

Mirtazapine is an antagonist of the Adrenergic Alpha 2 receptor - this elicits an increase in noradrenergic activity. Wouldn't this cause an increase in anxiety? Or is it the eventual down-regulation of the receptor that may be efficacious regarding this mechanism. I understand that it also antagonizes many serotonin receptors as well as histamine. However, there is a definite stimulating component that comes with acute administration of higher doses - I'm just wondering if this would be cumulative and potentially harmful for those sensitive to added stimulation - OR - if this actually leads to a reduction in overall stimulus activity, thus increasing the threshold for various social/endogenous forms of stimulation that result in norepinephrine release.


I also have the understanding that it is proven to decrease cortisol and put the handle on glutamate - I'm just not sure how to make sense of this drug. My knowledge of pharmacology is mediocre. But if someone can explain to me how it's activity on the A2 receptor can aid anxiety it would be extremely helpful to me. My nervous system is fried, and I'm trying to figure out how to get back on track. 


- currently taking - Lexapro 12.5mg, Ativan 1mg per day, Lithium Carbonate 500mg, Mirtazapine 22.5mg (after 3 days of 30mg I was EXTREMELY anxious and in borderline panic, yet my anhedonia and drive, cognition and zest for life felt as if they were coming back) 


Very interested to hear people thoughts on the various receptor sites mentioned. A deeper understanding of this topic would aid me in bettering myself, so I can be a better person, a better boyfriend & lover, a better son, and better brother and so forth. This has been a long standing condition, it is quite tragic and those close to me have suffered because of it, so aiding my knowledge would not only help me but those also close to me and the ones a love but continue to hurt, through being stuck under the rock of brain shattering anxiety, cognitive and depression. 




#2 DaveX

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Posted 29 September 2020 - 02:19 PM

I doubt Mirtazapine is very helpful. I also had taken it, and it did me no good whatsoever. Most of the studies I've seen of it are very odd, devoid of any mechanistic explanation or plausibility and merely vaguely statistical. For example, it is supposed to be a preferred treatment of akathisia, however I got akathisia parallel to it and something else. It only got a little better without it or anything else.

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Also tagged with one or more of these keywords: mirtazapine, anxiety, depression, seretonin, antagonist, norepinephrine, alpha

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