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mianserin vs mirtazapine

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trainman04

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whats the difference between the two? I know Mirtazapine is the newer version of mianserin but is it more potent or not?
 
Mianserin acts on alpha receptors but as an antagonist meaning it blocks the binding of NE to alpha-1 (and hence its "activation") and by blocking alpha-2 (a presynaptic autoreceptor) it increases the release of NE into the synapse by the presynaptic neuron. Inhibition of NET also prevents the reuptake of NE into the presynaptic neuron so the increased amounts of NE being released isn't being reabsorbed and is free to then act on the alpha-adrenergic receptors (that haven't already been occupied by the Mianserin) and on the beta-adrenergic receptors.

Mirtazepine does not inhibit NET, therefore reuptake, so NE is free to be reabsorbed from the synapse into the presynaptic neuron. It also does not antagonise alpha-1 so NE is free to activate this receptor as it usually would. Antagonism at alpha-2 again increases the release of NE into the synapse.

So in summary seems to me Mianserin would have the most net increase of adrenergic neurotransmission. There's many other mechanisms of action at play here though so it's hard to call one superior to the other - that is subjective. I haven't sat down yet to really compare all the binding values and make a general statement either which way.

Edited: Got things backwards about alpha-2 the first time I posted this. I feel like I'm missing some more here, currently at work so I'm distracted and have had to keep coming back to write this.
 
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^One thing I'll note is that blockade of a2 receptors can result in increased release of various neurotransmitters (including serotonin) as a2 receptors are expressed on widely varying cell types. There is also some post-synaptic expression of a2 on pyramidal cells in cortex.
 
so mianserin is the better of the two....
Wonder why Mirtazapine was made than? to make money?

Im going for mianserin then. Im looking for the best option to block/reduce serotonin / serotonin receptors
 
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a2 blockade increases serotonin release, but be aware that both drugs can be effective for various mental illness. Don?t be tunnel visioning on the ?I have too much serotonin? thing
 
trainman04 said:
so mianserin is the better of the two....
Click to expand...

Not necessarily. "Better" is pretty subjective when it comes to psychiatric drugs. You may find Mianserin is better for your situation and hypothetically for me Mirtazepine may be the way to go. In reality, I hate both and love my Tranylcypromine, which illustrates the point pretty well. Just because it's better *for my condition* doesn't really make it a better drug period than either Mianserin or Mirtazepine.
 
I was asking this question about this time last year.

Been on mirtazapine for about 2 years - and will be on mianserin forever.

For me, serotonin made things worse. Noradrenaline is my saving grace.

Therefore, it was a pleasure to exclude the serotonin boosting value of remeron via that switch.

There was one study - is one study - which indicates mirtazapine is about equally as effective as mianserin at boosting NA, at 45 mg, vs 60 mg mianserin.
The way each felt - they're both potent - but remeron puts the smack down on 5HT release inhibition also.

Depends if you want that or not.

Remeron will also be 5HT with twice the potency it boosts NA - via some neuroscience text book I browsed at some point.

Curiousity - what country are you based that you have access to mianserin??

It's been phased out mostly.
I'm terrified to think they might stop producing it - like they did with maprotiline.
 
JohnBoy2000 said:
I was asking this question about this time last year.

Been on mirtazapine for about 2 years - and will be on mianserin forever.

For me, serotonin made things worse. Noradrenaline is my saving grace.

Therefore, it was a pleasure to exclude the serotonin boosting value of remeron via that switch.

There was one study - is one study - which indicates mirtazapine is about equally as effective as mianserin at boosting NA, at 45 mg, vs 60 mg mianserin.
The way each felt - they're both potent - but remeron puts the smack down on 5HT release inhibition also.

Depends if you want that or not.

Remeron will also be 5HT with twice the potency it boosts NA - via some neuroscience text book I browsed at some point.

Curiousity - what country are you based that you have access to mianserin??

It's been phased out mostly.
I'm terrified to think they might stop producing it - like they did with maprotiline.
Click to expand...
im in sweden.
So I dont quite understand which one do I go for the most serotonin blockage?

i wouldnt worry about them stop making Mianserin , they still make MAO inhibitors like Nardil and its been like 70 years since they released I think.

but isnt Mianserin more potent in increasing NE and blocking serotonin?


Also what do you guys think about Mianserin + wellbutrin
instead of mirtazapine + wellbutrin?
 
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I believe Mianserin is more primarily metabolized by CYP2D6, than mirtazapine, which wellbutrin is a highly potent inhibitor of.

Clinical relevance of its inhibition in mianserin metabolism has been debated, however.
I guess you won't really know until you try.

Mianserin blocks certain 5HT receptor subtypes with supposedly highly binding than mirtazapine, according to it's pharmacodynamic binding profile but - receptor occupancy studies are really the key information sources for true efficacy.

Other posters here are more knowledgeable than me on that score.
 
One thing to consider is that an inverse agonist's efficacy at activating a receptor downregulation/internalization/desensitization pathway cannot be determined by PET occupancy, so even if one drug has higher affinity for e.g. 5-HT2C, e.g. mirtazapine could possibly be a more potent inverse agonist at 5-HT2C.

Most "antagonists" can have a tinge of inverse agonism as well.
CY
 
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