TREATMENTS FOR DEPRESSION

DRUG:- MIANSERIN

What is mianserin used for ?

Mianserin is used to improve mood in people who are feeling low or depressed.

There are many other antidepressants. All these drugs seem to be equally effective at the proper dose but have different side effects to each other. If one drug does not suit you, it may be possible to try another.

How does mianserin work ?

The brains has many naturally occurring chemical messengers. Two of these are called serotonin (sometimes called 5-HT) and noradrenaline. They are both important in the areas of the brain that control mood and thinking. It is known that these chemicals are not as effective or active as normal in the brain when someone is depressed. Mianserin increases the amount of these chemical messengers released in the brain. This can help correct the lack of action of these messengers and help to improve mood.

How should I take mianserin ?

Mianserin tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. They should be swallowed whole and not chewed as they have a special coating which helps to reduce side-effects. Crushing or chewing will cause the drug to be released too soon and you may get some side-effects, such as a numb mouth.

When should I take my mianserin ?

Take your mianserin as directed on the medicine label. Try to take them at regular times each day. Taking them at mealtimes may make it easier to remember as there is no problem about taking this drug with or after food. If the instructions say to take it once a day this is usually best at bedtime as it may make you drowsy at first. Mianserin is not, however, a sleeping tablet.

How long will mianserin take to work ?

It may take as long as two weeks or more before the tricyclics start to have any effect on your mood, and a further three or four weeks for this effect to be reaching its maximum. Unfortunately in some people the effect may take even longer to occur e.g. several months, especially if you are older.

How long will I need to keep taking mianserin for ?

This should be discussed with your doctor as people respond differently. Some people may need to continue taking them for months or even years. It is usually necessary to take them for at the very least a month after you have got. Usually it is best to take them for at least 6 to 12 months to make sure you are fully over your illness. If you have been depressed more than once, it is best to keep taking an antidepressant for several years as this will reduce the chance of you becoming ill again.

Is mianserin addictive ?

Mianserin is not really addictive, but if you have it for eight weeks or more you may get some mild "withdrawal" effects if you stop it suddenly. At worst these may include sickness, anorexia, headache, giddiness, 'chills' and sleeplessness. For further discussion, click here.

Can I stop taking mianserin suddenly ?

It is unwise to stop taking it suddenly, even if you feel better. Your depression can return if treatment is stopped too early. You might also experience some mild withdrawal symptoms (as explained above). When the time comes your doctor will usually withdraw the drug slowly e.g. by reducing the dose every few weeks. You should discuss this with your doctor.

What should I do if I forget to take a dose ?

Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember.

What sort of side-effects might occur ?

Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk )

Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk )

Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet.

Will mianserin make me drowsy ?

Mianserin may well make you feel drowsy. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times. It is not, however, a sleeping tablet, although if you take mianserin at night it may help you get to sleep.

Will mianserin cause me to put on weight ?

It is not thought that mianserin causes any changes in weight. If you do start to have problems with your weight, however, tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Will mianserin affect my sex life?

Drugs can affect desire (libido), arousal (erection) and orgasmic ability. It is not thought that mianserin has an significant effect on any of these.

Can I drink alcohol while I am taking mianserin ?

You should avoid alcohol except in true moderation while taking mianserin as it may make you feel more sleepy. This is very important if you need to drive or operate machinery. You must seek advice on this.

Are there any foods or drinks that I should avoid ?

You should have no problems with any food or drink other than alcohol (see above).

Will mianserin affect my other medication ?

You should have no problems if you take other medications although a few problems can occur. Mianserin can "interact" with some treatments for epilepsy, anxiety and some sleeping tablets although your doctor should know about these. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctors instructions very carefully. Make sure your doctor knows about all the medicines you are taking. Some other medicines e.g. some antihistamines (e.g. for hay fever) can make you drowsy. Combined with mianserin this could make you even drowsier. There has been much concern about the safety of St. John's wort with antidepressants. Until more information is available, you should avoid taking St. John's wort along with any other antidepressant. You should tell your doctor before starting or stopping these or any other drugs.

If I am taking a contraceptive pill, will this be affected ?

It is not thought that the pill is affected by mianserin.

What if I want to start a family or discover I'm pregnant?

It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:

Mianserin is not classified, as it is not available in the USA. There is no evidence of a teratogenic effect, but you should still seek personal advice from your GP, who may then if necessary seek further specialist advice.

Will I need a blood test ?

You may need to have a blood test every four weeks when you start your mianserin tablets to make sure that they are not upsetting your blood system. This is usually only needed during the first three months of treatment.

Can I drive while I am taking mianserin ?

You may feel drowsy and/or suffer from blurred vision at first when taking any of these drugs. Until these wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times or reflexes. It is against the law to drive or attempt to drive when unfit through drugs or to be in charge of a vehicle when unfit through drugs.

It is against the law to drive, attempt to drive or be in charge of a vehicle when unfit, either through illness or from the side effects of medication. Under UK law, it is the drivers responsibility to let the DVLA and insurance company know if you may be "unfit" to drive. If you do not, and you have an accident, it could effect your insurance cover. Your doctor will be able to advise you, and may wish to access the UK Driver and Vehicle Licensing Agency (DVLA) guidelines website, which has the current DVLA guidelines on anxiety/depression, psychotic disorders, mania and other conditions. If your doctor advises you not to drive, and you continue to do so, the doctor can inform the DVLA directly, as he or she would be lawfully responsible were you to have an accident. Once told, the DVLA may wish to carry out an enquiry, but you are entitled to drive until there a decision is made.

Email your comments or feedback.
Several developments have been as a result of feedback from visitors.

No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support.

Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site.  

Email your comments or feedback.
Many developments have been as a result of feedback from visitors.

No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support.

Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site.