ABSTRACT

Antidepressants are widely used to treat depression, anxiety, insomnia, and other mental disorders. In addition, due to non-psychotropic pharmacological effects in neurology and other divisions of clinical medicine, antidepressants are prescribed for additional indications, and in some cases they are used, including in the treatment of pain syndromes, they are used off-label. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are considered as first-line antidepressants; along with these medicines, trazodone, vortioxetine, agomelatine, bupropion and mirtazapine are often used in clinical practice. Serious prospects in the treatment of chronic pain syndrome are associated with the combined drug Dorsumio, containing the central muscle relaxant tizanidine and the antidepressant mirtazapine. The article discusses in sufficient detail the use of mirtazapine both as part of combined drug and as monotherapy, and also provides an analysis of existing approaches to switch from one antidepressant to another in the cases of insufficient efficacy or poor tolerability.

KEYWORDS: depression, anxiety, insomnia, COVID-19, menopause, chronic pain, antidepressants, SSRIs, SNRIs, trazodone, vortioxetine, agomelatine, bupropion, mirtazapine, tizanidine

For citation: Sivolap Yu. P., Portnova A.A. Mirtazapine: the Entry, the Exit and the Switch to. A  Review. Comorbidity Neurology. 2025; 2 (2): 54-61. https://doi.org/10.62505/3034-185x-2025-2-2-54-61

*For correspondence: Yury P. Sivolap, Dr. Sci. (Med.), Professor of the Department of Psychiatry, Psychotherapy and Psychosomatic Pathology, Faculty of Continuing Medical Education, P. Lumumba Peoples' Friendship University of Russia, Moscow, Russia, e-mail: yura-sivolap@yandex.ru

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ADDITIONAL INFORMATION

Yury P. Sivolap, Dr. Sci. (Med.), Professor of the Department of Psychiatry, Psychotherapy and Psychosomatic Pathology, Faculty of Continuing Medical Education, P. Lumumba Peoples' Friendship University of Russia, Moscow, Russia. E-mail: yura-sivolap@yandex.ru. ORCID: https://orcid.org/0000-0002-4494-149X

Anna A. Portnova, Dr. Sci. (Med.), Chief Researcher, Research and Clinical Center of Pediatric Psychoneurology. E-mail: aapserbsky@yandex.ru. ORCID: https://orcid.org/0000-0001-5938-0202

Author contributions. All authors confirm that their authorship complies with the international ICMJE criteria (all authors made a significant contribution to the development of the concept, the conduct of the study and the preparation of the article, read and approved the final version before publication). Special contributions: Sivolap Yu.P. – conceptualization, methodology, investigation, data curation, writing – original draft; Portnova A.A. – formal analysis writing – review & editing.

Funding. This study was  supported by external sources of funding.

Disclosure. The authors declare apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Yury P. Sivolap, Anna A. Portnova