mirtazapine / Generic mfg. - LARVOL DELTA

Pharmacological modulation of hyperarousal in insomnia associated with major depressive disorder: a narrative review of sedating antidepressants and orexin receptor antagonists. (PubMed, Front Psychiatry) - "Sedating antidepressants, including mirtazapine, trazodone, doxepin, and other tricyclic antidepressants, differ in dose-dependent antidepressant activity, receptor profile, and adverse-effect burden...Because clinical presentations neither establish an underlying mechanism nor reliably predict treatment response, the proposed framework should be used as a hypothesis-generating aid rather than a validated treatment algorithm. Pharmacological selection should also consider suicide risk, substance-use history, comorbid sleep disorders, concomitant central nervous system depressants, and next-day functioning."

Journal • Review • CNS Disorders • Depression • Insomnia • Major Depressive Disorder • Mood Disorders • Psychiatry • Sleep Disorder

QTc changes and early major adverse cardiovascular events associated with antidepressant treatment for major depressive disorder in adults: individual participant data network meta-regression of double blind randomised trials. (PubMed, BMJ) - "The effect of specific antidepressants on QTc interval differed between adults with depression. No evidence associated antidepressant use with early MACE and non-suicidal sudden death. To support shared decision making and taking into account the trade-off between benefits and harms, individual modifiable and non-modifiable risk factors should be considered when choosing antidepressants."

Adverse events • Clinical • Journal • Cardiovascular • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

Mirtazapine and Slow-Wave Sleep: A Focused Narrative Review of Human Polysomnographic Evidence. (PubMed, Cureus) - "Mechanistic evidence supports several biologically plausible pathways through which mirtazapine may influence sleep regulation, including histaminergic, adrenergic, and serotonergic effects; however, human PSG studies evaluate the integrated effects of the complete medication and cannot establish receptor-specific mechanisms responsible for observed sleep changes. Future studies using standardized PSG protocols, quantitative electroencephalography (EEG) analysis, larger samples, longer treatment durations, and direct dose comparisons are needed to clarify whether mirtazapine-associated alterations in sleep architecture contribute meaningfully to clinical outcomes."

Journal • Review • CNS Disorders • Depression • Insomnia • Mood Disorders • Psychiatry • Sleep Disorder

Efficacy of Mirtazapine on Tinnitus Annoyance in Patients with Panic Disorder (AAO-HNSF 2026) - "Prolonged treatment with mirtazapine in patients with PD and tinnitus could significantly reduce the number of panic attacks and tinnitus annoyance."

Clinical • CNS Disorders • Depression • Mood Disorders • Otorhinolaryngology

Depression in Parkinson's Disease: Real-World Prescribing Patterns and Treatment Dynamics from a Nationwide Greek Cohort. (PubMed, Mov Disord Clin Pract) - "In PD depression, AAP outlast SSRIs in real-world persistence and non-SSRIs are more commonly switched or augmented."

Journal • Real-world evidence • CNS Disorders • Depression • Mood Disorders • Movement Disorders • Parkinson's Disease • Psychiatry

Mirtazapine in Treating Functional Dyspepsia: A Systematic Review and Meta-Analysis. (PubMed, Gastroenterology Res) - "Given the limited therapeutic options for refractory FD, mirtazapine may warrant consideration in select patient populations. However, larger and more methodologically uniform trials are needed to better define its role before considering clinical use."

Journal • Retrospective data • CNS Disorders • Dyspepsia • Gastrointestinal Disorder

Psychotropic Polypharmacy in Alzheimer's Disease: A Potentially Inappropriate Medication Perspective in Older Adults. (PubMed, Curr Alzheimer Res) - "This review specifically examines anticholinergic drugs, antipsychotics, benzodiazepines and Z-drugs, tricyclic antidepressants, and select newer antidepressants-including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), mirtazapine, trazodone, and paroxetine-guided by the 2023 American Geriatrics Society (AGS) Beers Criteria®. Current evidence indicates that these medications may contribute to cognitive decline through anticholinergic burden, sedation, and pharmacodynamic interactions with cholinesterase inhibitors, such as donepezil and memantine...This study also summarizes current nonpharmacological strategies and proposes a structured clinical medication review framework. Overall, this review highlights the importance of minimizing inappropriate psychotropic use in AD, prioritizing non-pharmacological interventions, and conducting individualized risk-benefit assessments in clinical practice."

Journal • Alzheimer's Disease • Anesthesia • CNS Disorders • Dementia • Psychiatry

One Health prescribing - development of enantioselective liquid chromatography - tandem mass spectrometry methods to inform chiral switch of prescription pharmaceuticals. (PubMed, Anal Methods) - "Application of the methodology to wastewater samples revealed several analytes were in non-racemic composition including citalopram, fluoxetine, mirtazapine, desmethylmirtazapine, and ritalinic acid. Furthermore, to the best of our knowledge this is the first study to report the enantiomeric composition of baclofen, amlodipine, hydroxyatenolol and ritalinic acid in wastewater. Further application of these newly developed methods can help develop more accurate environmental risk assessments of pharmaceutical enantiomers to inform the proposed chiral switch decision making process in healthcare."

Journal

Effect of Mirtazapine on Energy Intake in Patients with Anorexia Associated with NSCLC (IASLC-WCLC 2022) - "Patients with cancer-related anorexia can improve nutritional intake with the addition of mirtazapine, which promotes energy consumption reflected in diverse macronutrients."

Clinical • Anorexia • Cachexia • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor

Mirtazapine as Appetite Stimulant in Patients With Non-Small Cell Lung Cancer and Anorexia: A Randomized Clinical Trial. (PubMed, JAMA Oncol) - P=N/A | "The addition of mirtazapine in the treatment of patients with advanced NSCLC and anorexia may help these patients achieve their energy requirements and improve health-related quality of life, specifically emotional and cognitive functioning. ClinicalTrials.gov Identifier: NCT04748523."

Clinical • Journal • Anorexia • Cachexia • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Sarcopenia • Solid Tumor

The Effect of Psychotropic Agents on Sick Sinus Syndrome: A Case Report. (PubMed, Cureus) - "A review of her regimen identified several cardiac safety concerns: quetiapine's potential interference with flecainide, hydroxyzine-associated QT prolongation, and bupropion's CYP2D6 inhibition that could increase flecainide levels. Management prioritized minimizing arrhythmogenic risk by discontinuing quetiapine, restricting hydroxyzine to low doses, and continuing melatonin, supplemented by stress testing and reassessment of psychotropic options. This case highlights the importance of careful psychotropic selection in patients with SSS, favoring lower-risk agents, such as mirtazapine, which is one of the safest among several possible alternatives, while maintaining close ECG monitoring and coordinated cardiology and psychiatry collaboration to reduce drug-drug interactions and optimize safety."

Journal • Cardiovascular • CNS Disorders • General Anxiety Disorder • Insomnia • Mood Disorders • Psychiatry • Sleep Disorder • Ventricular Tachycardia

Efficacy and safety of low-dose mirtazapine in diabetic pruritus: a randomised controlled trial (EASD 2026) - "Low-dose mirtazapine (7.5 mg) significantly improves pruritus severity in patients with diabetic pruritus without adversely affecting glycaemic parameters over 12 weeks. Its dual action on histaminergic and serotonergic pathways makes it a systemic therapeutic option for diabetic pruritus requiring pharmacological intervention."

Clinical • Diabetes • Metabolic Disorders

Discontinuing Psychotropic Medication Before Psychotherapy for PTSD (clinicaltrials.gov) - P=N/A | N=100 | Not yet recruiting | Sponsor: Academic Centre for Dentistry in Amsterdam

New trial • CNS Disorders • Mood Disorders • Post-traumatic Stress Disorder

Too High: Rick Simpson Oil and Cannabinoid Hyperemesis Syndrome (ACG 2026) - "Antispasmodics were ineffective, and mirtazapine was discontinued due to mouth swelling...Patients with chronic pain and difficult-to-explain gastrointestinal symptoms may seek symptom relief through cannabis concentrates like RSO, which is promoted as a treatment for numerous conditions, from pain to cancer. Clinicians should consider CHS beyond its classic young male demographic and ask any patient with nausea and vomiting about ingested cannabis, oils, and concentrates."

Back Pain • Gastroenterology • Gastrointestinal Disorder • Immunology • Musculoskeletal Pain • Rare Diseases • Substance Abuse

Rumination Syndrome in a Young Male Without Classic Risk Factors Initially Misdiagnosed as Refractory Gastroparesis (ACG 2026) - "Symptoms progressed despite proton pump inhibitor therapy and metoclopramide, with frequent daily episodes of effortless regurgitation intermixed with forceful vomiting, often without preceding nausea...Multiple therapies including ondansetron, haloperidol, nortriptyline, and mirtazapine, provided minimal or transient relief...Delayed recognition led to extensive diagnostic testing, prolonged hospitalization, severe malnutrition, and temporary enteral feeding support. Earlier recognition may help avoid unnecessary interventions and improve outcomes."

Clinical • CNS Disorders • Depression • Diabetes • Fibromyalgia • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Metabolic Disorders • Musculoskeletal Pain • Obesity • Rare Diseases

Mirtazapine in Treating Functional Dyspepsia: A Systematic Review and Meta-Analysis (ACG 2026) - "Across three RCTs, mirtazapine significantly reduced global FD symptoms compared with baseline symptoms. The pooled effect size demonstrated a large benefit, with a SMD of -1.38 (95% CI at -1.99 to -0.77). Heterogeneity was substantial (I² = 65.7%), which likely reflects variation in enrolled populations and dosing."

Retrospective data • Review • CNS Disorders • Dyspepsia • Gastrointestinal Disorder

When Constipation Becomes a Renal Emergency: Stercoral Proctocolitis With Fecaloma-Induced Bilateral Hydroureteronephrosis and Obstructive Acute Kidney Injury (ACG 2026) - "Her medications included hydroxyzine, carbamazepine, mirtazapine, primidone, pregabalin, deutetrabenazine, and venlafaxine, contributing to a high anticholinergic burden. Massive fecal impaction causing stercoral proctocolitis and obstructive uropathy. Figure Footnote: The distended colon compresses the distal ureters resulting in bilateral hydroureteronephrosis (arrows)."

Acute Kidney Injury • Bipolar Disorder • Cardiovascular • CNS Disorders • Constipation • Endocrine Disorders • Epilepsy • Gastroenterology • Gastrointestinal Disorder • Hypotension • Infectious Disease • Inflammatory Bowel Disease • Movement Disorders • Nephrology • Parkinson's Disease • Renal Disease

From Flares to Fewer ED Visits: Outcomes of Mirtazapine Usage in Gastroparesis (ACG 2026) - "The median age of the identified patients was 41 years, 85.7% female, 84% identified as white (Table 1). Idiopathic gastroparesis was the most common etiology (75%). Common comorbidities amongst patients included tobacco smoking history (88%) and marijuana use (58%)."

Gastrointestinal Disorder

TNA-LBP: Treating Negative Affect in Low Back Pain Patients (clinicaltrials.gov) - P2 | N=308 | Completed | Sponsor: Ajay Wasan, MD, Msc | Phase classification: P2/3 ➔ P2

Phase classification • Back Pain • Lumbar Back Pain • Musculoskeletal Pain • Pain

Patient characteristics, treatment patterns and clinical response in patients with treatment resistant depression starting a new treatment in the clinical setting: a multicenter, observational study in Portugal. (PubMed, Front Psychiatry) - "TRD treatments initiated at baseline were varied; the most common treatments initiated or ongoing at baseline were mirtazapine (43.1%), venlafaxine (42.5%), quetiapine (25.5%), and trazodone (20.9%). Outcomes for patients with TRD in real-world clinical practice remain poor, with most patients not responding after 20 weeks of treatment. Treatment heterogeneity highlights a lack of clinical consensus, and the need for novel therapeutics and improved treatment protocols for TRD in real-world clinical practice in Portugal."

Clinical • Journal • Observational data • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

Guidelines for Prevention and Management of Complications of Injection Drug Use- A WikiGuidelines Group Consensus Statement. (PubMed, Am J Med) - "Patients with stimulant use disorder, specifically amphetamine use disorder, should be offered mirtazapine. Further, patients who inject drugs with hepatitis C should be offered treatment, which can be completed in a variety of low-barrier settings. Several other questions did not meet the threshold for clear recommendations; and therefore, clinical reviews are offered instead."

Journal • Review • Hepatitis C • Infectious Disease • Inflammation • Psychiatry • Substance Abuse

Severe Mirtazapine Overdose in a 4-Year-Old Girl. (PubMed, J Clin Psychopharmacol) - No abstract available

Journal

Progressive multifocal leukoencephalopathy associated with rituximab treatment (PubMed, Laeknabladid) - "Rituximab therapy was discontinued and mirtazapine initiated. PML occurring in association with rituximab therapy is exceedingly rare. The potential for disease attenuation with new immunomodulating therapies underscores the importance of considering PML in immunosuppressed patients presenting with rapidly progressive central nervous system deficits."

Journal • ANCA Vasculitis • CNS Disorders • Rare Diseases • Vasculitis

Abemaciclib-Associated Psychosis: A Case Report of a Rare Neuropsychiatric Adverse Effect during Breast Cancer Treatment. (PubMed, Case Rep Oncol) - "Her prior treatment had included adjuvant carboplatin and paclitaxel chemotherapy with brachytherapy, and her endocrine therapy was switched from anastrozole to letrozole at the time abemaciclib was added...Treatment with mirtazapine, olanzapine, and clonazepam resulted in the complete resolution of psychotic symptoms, and abemaciclib was permanently discontinued. After approximately 9 months, she was able to discontinue psychiatric medications without relapse of her psychotic symptoms. This case highlights the importance of recognizing rare but serious neuropsychiatric adverse effects of abemaciclib and emphasizes the need for careful monitoring and multidisciplinary management."

Adverse events • Journal • Breast Cancer • CNS Disorders • Endometrial Cancer • HER2 Breast Cancer • HER2 Negative Breast Cancer • HER2 Positive Breast Cancer • Hormone Receptor Breast Cancer • Hormone Receptor Positive Breast Cancer • Mood Disorders • Oncology • Psychiatry • Solid Tumor • HER-2

The Role of Mirtazapine in the Pathogenesis and Therapy of Chronic Liver Disease. (PubMed, Curr Med Chem) - "These effects may exacerbate the metabolic burden in patients with CLD, thereby limiting its clinical utility. Therefore, when prescribing this agent to patients with comorbid depression, clinicians must carefully balance its anti-inflammatory and anti-fibrotic benefits against metabolic risks to achieve rational individualized medication."

Journal • CNS Disorders • Depression • Fibrosis • Hepatocellular Cancer • Hepatology • Immunology • Liver Failure • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Oncology • Psychiatry • Solid Tumor