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Mirtazapine (Remeron)

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Definitions
  • Remission: PHQ-9 < 5
  • Some Improvement: Any drop in the PHQ-9 score
  • No Improvement: No drop in PHQ-9 score
  • Partial Response: A drop of 5 or more points in the PHQ-9 score at week 6 compared to week 1
  • Non-Response: A drop of <5 points in PHQ-9 score at week 6 compared to week 1

Note
  • At CDPs 2,3,4,5,6 and 7 consider switching antidepressant  if side effects are intolerable FIBSER.pdf
  • CANMAT 2016 guidelines suggest switching to antidepressant with evidence of superior efficacy (escitalopram, mirtazapine, sertraline and venlafaxine)
  • For assistance with switching please go to SwitchRx 
  • Lower doses or less frequent dosage increases may be better for anxious, medically compromised, geriatric patients or those experiencing tolerable side effects
  • In cases of non-response reassess diagnosis, check for non-adherence and assess for impact of psychosocial factors
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