MIRTAZAPINE

What is mirtazapine (Remeron)?

Used for depression, mirtazapine is a medication belonging to the tetracyclic antidepressant drug class. Mirtazapine is different than other antidepressants in that it works on alpha-2 adrenergic receptors. Inhibition of these receptors results in an increased availability of both serotonin and norepinephrine. Serotonin is a molecule in the body that aids in mood, sexual desire, sleep, digestion, wound healing, bone health, and blood clotting [1]. It is often referred to in psychology as the “happy” chemical. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure [2].

How can mirtazapine be used in long-COVID?

Mirtazapine may also benefit the long-COVID patient population. Many of those diagnosed with long-COVID suffer from “brain fog,” memory problems, difficulty concentrating, and forgetfulness. The proposed reason is that during a COVID-19 infection, the body’s immune response becomes activated, causing heavy amounts of inflammation, including in the central nervous system (CNS) [3]. Those with long-COVID live in a state of inflammation, manifesting as the symptoms associated with “brain fog.”

In addition to aiding in several bodily processes, serotonin also protects against viral inflammation by blocking certain viruses (like HIV-1) from entering the cells. It can also decrease cytokine production, promoting the immune response [3]. Currently, its use is limited to depression. There is no evidence to support the use of mirtazapine in treating COVID-19 itself. However, it may be beneficial if more studies are conducted to examine its effects.

References:

^{1 https://my.clevelandclinic.org/health/articles/22572-serotonin}

²https://americanaddictioncenters.org/antidepressants-guide/ndris

³https://www.medtextpublications.com/open-access/long-covid-is-there-a-role-for-antidepressants-1249.pdf