@DaveFoster I know you are experienced with, and knowledgeable about mirtazapine; could you share your opinion of mianserin? Do you have any experience with it? Have you ever considered taking it instead of mirtazapine?
Since mianserin is a 5-ht2b antagonist, I think it might be safer to use for moderate to long term, what do you think? How would their effects on the human mind and the body differ in general, in your opinion?
Also, for long term use (say, for years), which one of these (Cyproheptadine, Lisuride, Metergoline, Mirtazapine, Mianserin) would you choose? I know the purpose of using them would effect the judgement on choice, but lets say that you are using them for the beneficial effects in general. I have also migraine prophylaxis in my mind, and these are all known to be effective in that respect.
How would you rate these agents in terms of their safety in long term use?
As a side note, this article suggests mirtazapine's 5-HT2B "antagonism" is partly responsible for its effectiveness in migraine prophylaxis:
"Decreased frequency of migraines with mirtazapine can be explained by 5-HT2 (especially 5-HT2B) and histamine blockade because migraine initiation is thought to be a consequence of their activation. Furthermore, the activation of 5HT1 receptors (notably 5-HT1B, 5-HT1D and 5-HT1F) by mirtazapine could possibly treat migraine through the contraction of distended meningial and cerebral vessels and the reduction of neurogenic inflammation. The theoretical effect of mirtazapine on migraines is two-fold: (i) prevention of migraine initiation through 5-HT2and histamine inhibition and (ii) treatment of migraine through 5-HT1 activation.
We are unable to fully explain the reoccurrence of migraines at a higher mirtazapine dose in our patient.However, at higher doses, mirtazapine causes less daytime somnolence and sedation, and possibly less histamine blockade. Because histamine is a NO-releasing agent, its presence at higher doses may explain migraine headaches reoccurrence in our patient."
Lévy, E., & Margolese, H. C. (2003). Migraine headache prophylaxis and treatment with low-dose mirtazapine. International Clinical Psychopharmacology, 18(5), 301–303. doi:10.1097/00004850-200309000-00
Since mianserin is a 5-ht2b antagonist, I think it might be safer to use for moderate to long term, what do you think? How would their effects on the human mind and the body differ in general, in your opinion?
Also, for long term use (say, for years), which one of these (Cyproheptadine, Lisuride, Metergoline, Mirtazapine, Mianserin) would you choose? I know the purpose of using them would effect the judgement on choice, but lets say that you are using them for the beneficial effects in general. I have also migraine prophylaxis in my mind, and these are all known to be effective in that respect.
How would you rate these agents in terms of their safety in long term use?
As a side note, this article suggests mirtazapine's 5-HT2B "antagonism" is partly responsible for its effectiveness in migraine prophylaxis:
"Decreased frequency of migraines with mirtazapine can be explained by 5-HT2 (especially 5-HT2B) and histamine blockade because migraine initiation is thought to be a consequence of their activation. Furthermore, the activation of 5HT1 receptors (notably 5-HT1B, 5-HT1D and 5-HT1F) by mirtazapine could possibly treat migraine through the contraction of distended meningial and cerebral vessels and the reduction of neurogenic inflammation. The theoretical effect of mirtazapine on migraines is two-fold: (i) prevention of migraine initiation through 5-HT2and histamine inhibition and (ii) treatment of migraine through 5-HT1 activation.
We are unable to fully explain the reoccurrence of migraines at a higher mirtazapine dose in our patient.However, at higher doses, mirtazapine causes less daytime somnolence and sedation, and possibly less histamine blockade. Because histamine is a NO-releasing agent, its presence at higher doses may explain migraine headaches reoccurrence in our patient."
Lévy, E., & Margolese, H. C. (2003). Migraine headache prophylaxis and treatment with low-dose mirtazapine. International Clinical Psychopharmacology, 18(5), 301–303. doi:10.1097/00004850-200309000-00
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