Mirtazapine

INTRODUCTION

Indications

Major Depressive Disorder. Unlabeled Use: Panic Disorder. Generalized Anxiety Disorder (GAD). Posttraumatic Stress Disorder (PTSD).

Action

Potentiates the effects of norepinephrine and serotonin. Therapeutic Effects: Antidepressant action, which may develop only after several weeks.

Adverse Reactions/Side Effects

CNS: drowsiness, abnormal dreams, abnormal thinking, agitation, anxiety, apathy, confusion, dizziness, malaise, weakness. EENT: sinusitis. Resp: dyspnea, increased cough. CV: edema, hypotension, vasodilation. GI: constipation, dry mouth, increased appetite, abdominal pain, anorexia, elevated liver enzymes, nausea, vomiting. GU: urinary frequency. Derm: pruritus, rash. F and E: increased thirst. Hemat: AGRANULOCYTOSIS. Metab: weight gain, hypercholesterolemia, increased triglycerides. MS: arthralgia, back pain, myalgia. Neuro: hyperkinesia, hypesthesia, twitching. Misc: flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of agranulocytosis, including fever, sore throat, mucosal lesions, signs of infection, and bruising. Report these signs to the physician immediately.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment, and in children and teenagers. Notify physician or other mental health care professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• Monitor any confusion, anxiety, agitation, apathy, or other alterations in mental status. Notify physician promptly if these symptoms develop (See Appendix D).

• Assess changes in motor activity or muscle function. Report severe or problematic twitching, increased muscle tone, or changes in muscle activity and motor abnormalities (hyperkinesia, hypokinesia).

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness and syncope.

• Assess any back, joint, or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies (See Appendix E).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

• Help patient explore nonpharmacologic methods reduce depression and other psychologic disorders (exercise, counseling, support ...