On this episode of the real-life pharmacology podcast, I'm going to cover mertazapine,

which the brand name is Remeron.

Now, this drug, how it works is it blocks alpha-2 receptors within the central nervous system,

or it's an antagonist.

And this can ultimately increase norapinephrine and serotonin release.

Now this mechanism is slightly different from serotonin re-uptake inhibitors and SNRIs like serotonin and norophenreupine reuptake inhibitors.

So it does work slightly differently.

One other thing with the mechanism that's unique,

and I'll talk a little bit about the side effects with the medication as well, but myrtazapine can block

H-1 receptors. So that means it has antihistamine activity and can give it some sedative type

properties, which I'll talk about a little bit more as I'm getting into the side effects.

Now, thinking about, you know, kind of how the drug works, what it's acting upon in the central

nervous system, we can probably theorize that this drug is going to be indicated for the use of depression, treating depression,

and certainly it is. With the adverse effect profile of sedation, this drug is often used for

insomnia as well. And because of that antihistamine effect,

we may also see some weight gain.

Now, that can definitely be problematic in some patients,

let's say type 2 diabetic who's overweight already,

or, you know, younger females and males that have been gaining weight,

you know, that's a big problem, a potential adverse effect that's significant.

In our geriatric patient population, if we have trouble with patients who are anorexic,

they have trouble eating, really have poor appetite,

...