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Duloxetine-mirtazapine combination in depressive illness: The case for Limerick ‘rocket fuel’

Published online by Cambridge University Press:  13 June 2014

David Meagher
Affiliation:
Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland
Noel Hannan
Affiliation:
Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland
Maeve Leonard
Affiliation:
Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland

Abstract

The use of complex psychopharmacological regimens is increasingly advocated in more difficult to treat depressive illness. The combination of venlafaxine with mirtazapine – ‘California rocket fuel’ is one such example involving an SNRI combined with a NaSSA. We describe two cases that highlight the potential usefulness of duloxetine used in combination with mirtazapine that also emphasise the danger of drug-induced hypomanic switching. This combination may have a specific role for carefully selected patients but caution is needed given the potential to induce profound alterations in mental state.

Type
Case Reports
Copyright
Copyright © Cambridge University Press 2006

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References

1.Fawcett, J, Barkin, RL. Efficacy issues with antidepressants. J Clin Psychiatry 1997: 58(6): 32–9.Google ScholarPubMed
2.O'Reardon, JP, Amsterdam, JD. Treatment-resistant depression:progress and limitations. Psychiatr Ann 1998: 28; 633–40.CrossRefGoogle Scholar
3.Fava, D, Davidson, KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin N Am 1996; 19: 179200.CrossRefGoogle ScholarPubMed
4.Taylor, D, Paton, C, Kerwin, R. The South London and Maudsley NHS Trust 2005-2006 Prescribing Guidelines: 8th Edition. Taylor and Francis, Oxon, UK, 2005.CrossRefGoogle Scholar
5.National Institute of Clinical Excellence. Depression: management of depression in primary and secondary care. Clinical Guideline 23, 12 2004.Google Scholar
6.Stahl, SM. Essential Psychopharmacology: Neuroscientific basis and practical applications (2nd edition). Cambridge University Press, 2000.Google Scholar
7.Aydemir, O, Taskin, EO, Deveci, A. Mirtazapine augmentation in treatment-resistant major depressive disorder: an open-label, six week trial. European Neuropsychopharmacology 2005; 15(3): 401–2.Google Scholar
8.Blier, P, Tremblay, PM, Ward, HE, Hebert, C, Bergeron, R. Antidepressant drug combination from treatment initiation to improve therapeutic response in major depression. European Neuropsychopharmacology 2005; 15(3): 449450.Google Scholar
9.Carpenter, LL, Yasmin, S, Price, LH. A double-blind, placebo-controlled study of antidepressant augmentation with Mirtazapine. Biol Psychiatry 2002; 51:183188.CrossRefGoogle ScholarPubMed
10.Carpenter, LL, Jocic, Z, Hall, JM, Rasmussen, SA, Price, LH. Mirtazapine augmentation in the treatment of refractory depression. J Clin Psychiatry 1999; 60: 4549.CrossRefGoogle ScholarPubMed
11.Hannan, N, Akinpeloye, H, Hamzah, Z, Meagher, D. Venlafaxine-mirtazapine combination in the treatment of persistent depressive illness. J Psychopharmacology (in press).Google Scholar
12.Klotz, U. Tramadol – the impact of its pharmacokinetic and pharmacodynamic properties on the clinical management of pain. Arzneimittelforschung 2003; 53: 681–7.Google ScholarPubMed
13.Hopwood, SE, Owesson, CA, Callado, LF, et al.Effects of chronic tramadol on preand post-synaptic measures of monoamine function. J Psychopharmacol 2001; 15: 147153.CrossRefGoogle Scholar
14.Houlihan, DJ. Serotonin syndrome resulting from co-administration of tramadol, venlafaxine, and mirtazapine. Ann Pharmacother 2004; 38: 411–3.CrossRefGoogle Scholar
15.Perahia, D, Pritchett, YL, Walker, D, et al.Comparing duloxetine and venlafaxine in the treatment of major depressive disorder using a global benefit-risk approach. Presented at the New Clinical Drug Evaluation Unit (NCDEU), 06 6-9, 2005, Florida.Google Scholar
16.de Montigny, C, Silverstone, PH, Debonnel, G, Blier, P, Bakish, D. Venlafaxine in treatment-resistant major depression: a Canadian multicenter, open-label trial. J Clin Psychopharmacol 1999: 19; 401–6.CrossRefGoogle ScholarPubMed
17.Mitchell, PB, Schweitzer, I, Burrows, G, Johnson, G, Polonowita, A. Efficacy of venlafaxine and predictors of response in an open-label study of patients wfth treatment-resistant majo depression. J Clin Psychopharmacol 2000: 20; 483–7.CrossRefGoogle Scholar
18.Wohlreich, MM, Mallinckrodt, CH, Watkin, JG, Wilson, MG, Greist, JH, Delgado, PL, Fava, M. Immediate switching of antidepressant therapy:results from a clinical trial of duloxetine. Ann Clin Psychiatry 2005: 17; 259–68.CrossRefGoogle ScholarPubMed
19.Bymaster, FP, Dreshfield-Ahmad, LJ, Threlkeld, PG, et al.Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology 2001; 25: 871880.CrossRefGoogle ScholarPubMed
20.Bhanji, NH, Margolese, HC, Saint-Laurent, M, Chouinard, G. Dysphoric mania induced by high-dose mirtazapine: a case for ‘norepinephrine syndrome’. Int Clin Psychopharmacol 2002; 17: 319322.CrossRefGoogle ScholarPubMed
21.Goldberg, JF, Truman, CJ. Antidepressant-induced mania: an overview of current controversies. Bipolar Disord 2003; 5: 407420.CrossRefGoogle ScholarPubMed
22.Martin, A, Young, C, Leckman, JF, Mukonoweshuro, C, Rosenheck, R, Leslie, D. Age effects on antidepressant-tnduced mannis conversion. Arch Pediatr Adolesc Med 2004: 158; 773–80.CrossRefGoogle Scholar
23.Hadjipavlou, G, Mok, H, Yatham, LN. Bipolar II disorder: an overview of recent developments. Can J Psychiatry 2004: 49; 802–12.CrossRefGoogle ScholarPubMed
24.Simpson, SG, McMahon, FJ, McInnis, MG, MacKinnon, DF, et al.Diagnostic reliability of bipolar II disorder. Arch Gen Psychiatry 2002: 59; 736–40.CrossRefGoogle ScholarPubMed
25.Hirschfeld, RM, Williams, JB, Spitzer, RL, Calabrese, JR, Flynn, L, et al.Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire Am J Psychiatry 2000: 157; 1873–5.CrossRefGoogle ScholarPubMed
26.Sheiton, RC. The dual-action hypothesis: does pharmacology matter? J Clin Psychiatry 2004(17): 65; 510.Google Scholar