PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. Antidepressants - mianserin.

PsychoTropicalResearch, serotonin and serotonin syndrome research.

Antidepressants - mianserin

Antidepressants - mianserin

Date Created: 27/09/1999   Last Modified: 19/01/2002   Last Checked: 05/04/2003

See also comments in the note on mirtazapine (which is 6-aza-Mianserin).

Mianserin has been around for about thirty years now. Although mianserin has enjoyed considerable useage and popularity over its lifespan there is substantial doubt about its anti-depressant effectiveness; the recent references (below) provide evidence which suggest that interpretation has a substantial foundation. It is also consonant with the opinion and experience of many clinicians who regard it as ineffective and of little or no use for the treatment of depression. Its share of the total antidepressant market has declined steadily and inexorably over the last decade. It now has a fraction of 1% of the total antidepressant market.

*** I do not think there is any good evidence that mianserin is an antidepressant at all, see 'Antidepressants Efficacy'.

Mianserin is a potent anti-histamine (it is therefore very sedative and causes weight gain) but does not have any activity as a re-uptake inhibitor (see receptor affinities). Most other drugs that are not effective monoamine re-uptake inhibitors have the same doubt about the evidence for their effectiveness in depression; viz nefazodone, trazodone, trimipramine, doxepin.

Taking account of all the evidence, and in view of the suggestion that mianserin has a higher risk of causing life-threatening neutropenia than alternatives, it is hard to imagine a clinical situation in which its properties would represent a logical optimal choice.