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By Frank C. Seitz

A pragmatic, compassionate, and funny examine behavioral/psychological suggestions in taking good care of sufferers. Covers rigidity, continual ache, melancholy, suicide, alcoholism, drug abuse, sleep problems, family violence, sexual abuse, and developmental phases of lifestyles.

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Higher doses do not appear to produce significantly greater sedation. Weight Gain The weight gain associated with mirtazapine use may be partially caused by increased appetite. 7 kg over the first 28 weeks of treatment has been reported in several controlled 40 studies (Bremner 1995; Smith et al. 1990). 3 kg after 40 weeks (Thase et al. 2000). Agranulocytosis In preliminary clinical trials, 2 of 2,796 mirtazapine-treated patients developed agranulocytosis, and 1 developed severe neutropenia. All 3 patients recovered after medication discontinuation, and other possible etiologies were present in at least 1 of these individuals.

In a controlled study, Fava and colleagues (2000) found that 27 paroxetine was associated with greater weight gain than were fluoxetine and sertraline. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Case reports have indicated an association between SSRIs and the syndrome of inappropriate secretion of antidiuretic hormone. Symptoms include lethargy, headache, hyponatremia, increased urinary sodium excretion, and hyperosmotic urine. Acute treatment of this syndrome should consist of discontinuation of the drug as well as restriction of fluid intake.

Bupropion’s lack of significant cardiovascular or respiratory toxicity means that it is rarely lethal in overdose. 37 Drug Interactions The combination of bupropion with an MAOI is potentially dangerous, but less so than the combination of serotonergic drugs and MAOIs. Although the practice is not recommended, MAOIs and bupropion have been combined in patients with refractory depression. In vitro data suggest that bupropion is metabolized by CYP 2B6. Bupropion inhibits CYP 2D6. Because of the risk of dosedependent seizures, caution is warranted when bupropion is combined with other medications that might inhibit its metabolism.

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