Treatment of episodes of major depression.
For this indication, competent medicine agencies globally authorize below treatments:
For: Adults (18-64) Elders (65+)
Regimen A: Oral, 15 milligrams, once daily at the end of the day, over the duration of 2 to 4 weeks. Afterwards, oral, between 15 and 45 milligrams, once daily at the end of the day, over the duration of 6 months.
Regimen B: Oral, 30 milligrams, once daily at the end of the day, over the duration of 2 to 4 weeks. Afterwards, oral, between 30 and 45 milligrams, once daily at the end of the day, over the duration of 6 months.
The effective daily dose is usually between 15 and 45 mg; the starting dose is 15 or 30 mg.
Mirtazapine begins to exert its effect in general after 1-2 weeks of treatment. Treatment with an adequate dose should result in a positive response within 2-4 weeks. With an insufficient response, the dose can be increased up to the maximum dose. If there is no response within a further 2-4 weeks, then treatment should be stopped.
Patients with depression should be treated for a sufficient period of at least 6 months to ensure that they are free from symptoms.
It is recommended to discontinue treatment with mirtazapine gradually to avoid withdrawal symptoms.
The recommended dose is the same as that for adults. In elderly patients an increase in dosing should be done under close supervision to elicit a satisfactory and safe response.
Mirtazapine has an elimination half-life of 20-40 hours and therefore is suitable for once daily administration. It should be taken preferably as a single night-time dose before going to bed. Mirtazapine may also be given in two divided doses (once in the morning and once at night-time, the higher dose should be taken at night).
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