Nasdep

✅ Treats depression
✅ Improves mood
✅ Relieves anxiety
✅ Enhances sleep quality
✅ Regulates appetite

Nasdep contains Mirtazapine

Artikelnummer: Ej tillgängligt Kategori: Kategoriöversikt, Kroniska tillstånd, Behandling av situationell ångest Tagg: Mirtazapine, Nasdep

✓ Medicinskt granskad av Morgan Ellis — Apoteksforskare · 8 års erfarenhet · Senast granskad: maj 2026

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⚡ Quick Answer — What is Nasdep?

Nasdep innehåller mirtazapine 30 mg from a WHO-GMP certified manufacturer (Lupin Pharmaceuticals) — a tetracyclic NaSSA antidepressant with a unique mechanism: alpha-2 adrenergic auto- and hetero-receptor antagonism boosts both noradrenaline and serotonin release while 5-HT2 / 5-HT3 antagonism redirects activated serotonin away from the receptors that cause SSRI side effects. Standard dose: 15–45 mg at bedtime (start 15 mg, target 30–45 mg). Strongly favoured when MDD presents with insomnia, low appetite, weight loss, or treatment-resistant agitated depression. Paradoxical sedation pattern: more sedating at low doses (15 mg) than at full dose (45 mg) because higher doses recruit more noradrenergic activity. Significant weight gain — the most of the antidepressants alongside paroxetine.

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Important — this is not a situational-anxiety medication. Nasdep is a tetracyclic noradrenergic and specific serotonergic antidepressant (NaSSA), prescribed and titrated over weeks for major depressive disorder (MDD), particularly with prominent insomnia, low appetite, weight loss, or agitation. It is inte the right drug for acute, performance-related anxiety (flying, public speaking, exams) — for those use cases beta-blockers (propranolol), benzodiazepines, or hydroxyzine are clinically appropriate. If you do not have a diagnosed mood, anxiety, or psychiatric disorder, do not start this medication.

FDA black-box warning — suicidality. All antidepressants carry an FDA black-box warning for increased risk of suicidal thinking and behaviour in children, adolescents, and young adults under 25, particularly during the first weeks of treatment or after dose changes. Family members and prescribers should monitor closely for worsening mood, agitation, or suicidal ideation in this age group.

What Is Nasdep?

Nasdep is an oral tablet of mirtazapine 30 mg manufactured by Lupin Pharmaceuticals. Mirtazapine (US brand Remeron) is a tetracyclic noradrenergic and specific serotonergic antidepressant (NaSSA) launched by Organon in 1994. Its mechanism is unlike any other antidepressant in routine use: rather than blocking reuptake, it antagonises pre-synaptic alpha-2 adrenergic receptors on noradrenergic neurons (boosting noradrenaline release) and on serotonergic nerve terminals (hetero-receptor effect, boosting serotonin release), while simultaneously antagonising 5-HT_2A, 5-HT_2C, and 5-HT₃ receptors. The 5-HT₂ and 5-HT₃ blockade redirects the augmented serotonin away from the receptors responsible for SSRI side effects (sexual dysfunction, anxiety, GI upset).

It is a strong H₁ antihistamine, which drives sedation and appetite stimulation.

Approved Indications

Major depressive disorder (MDD) — particularly when insomnia, low appetite, weight loss, or agitation are prominent
Off-label: anxiety disorders (GAD, social anxiety, PTSD), chronic insomnia (low dose 7.5–15 mg), refractory itch, chronic nausea, anorexia/cachexia, hot flashes
Treatment-resistant depression: combined with venlafaxine (“California rocket fuel”) under specialist supervision

Dosing

Indikation	Start	Målgrupp	Maximum	Anteckningar
MDD	15 mg at bedtime × 1 week	30–45 mg at bedtime	45 mg/day	Higher doses recruit more noradrenergic activity — paradoxically less sedating
Off-label insomnia	7.5–15 mg at bedtime	7.5–15 mg at bedtime	—	Limit to short-term; weight gain is real even at low dose
Elderly	7.5–15 mg at bedtime	15–30 mg at bedtime	30 mg/day	Reduce starting dose; greater orthostasis and sedation
Hepatic / renal impairment	15 mg at bedtime	Up to 30 mg/day	—	Reduced clearance — slower up-titration

Biverkningar

Side-effect profile by mechanism

Mechanism	Effects	Anteckningar
H₁ blockade	Sedation, weight gain (appetite stimulation)	Weight gain is significant — commonly 4–7 kg in 6 months. Sedation paradoxically reduces at higher doses
Alpha-1 blockade	Orthostatic hypotension, dizziness	Particularly in elderly — check lying / standing BP
Anticholinergic (mild)	Dry mouth	Less than TCAs
5-HT₃ antagonism	Anti-emetic; reduced GI upset	Why mirtazapine causes much less nausea than SSRIs / SNRIs
Annat	Increased cholesterol, triglycerides, glucose	Metabolic monitoring useful at 6–12 months
Sällsynt	Agranulocytosis (1/1000)	Stop and check FBC if persistent fever, sore throat, mucosal ulceration in first 6 weeks
Sällsynt	Hyponatraemia (SIADH)	Older adults at greatest risk
Sällsynt	Restless legs, vivid dreams	Patient counselling

The Mirtazapine Sedation Paradox

Many patients are confused that mirtazapine 15 mg is more sedating than mirtazapine 30–45 mg. This is real and well-described pharmacologically: at low doses, H₁ blockade dominates (sedating). At higher doses, the noradrenergic boost from alpha-2 antagonism is more activating, partly offsetting the antihistamine sedation. So patients started at 15 mg who feel too groggy can sometimes be helped by going up to 30 mg, not down. This is counterintuitive and worth explaining when prescribing.

Läkemedelsinteraktioner

Absolut kontraindikation: MAOIs (14-day washout). Serotonin syndrome risk is lower than for SSRIs because mirtazapine does not increase synaptic serotonin via reuptake inhibition, but the warning still stands.

Additive CNS depression: alcohol, benzodiazepines, opioids, sedating antihistamines, sleep medications.

CYP2D6 / CYP3A4 substrate: levels rise with strong inhibitors; combination with paroxetine, fluoxetine, ketoconazole, ritonavir requires care.

Vanliga frågor

How long does Nasdep take to work?

Sleep and appetite often improve within 1–2 weeks. Full mood response in MDD typically appears at 4–6 weeks. Many prescribers consider mirtazapine for patients with insomnia and weight loss because the favourable side effects work for them rather than against them.

Why does Nasdep cause weight gain?

Mirtazapine is a strong H₁ antihistamine and 5-HT_2C antagonist — both stimulate appetite. Weight gain is dose-independent and often substantial (4–7 kg in 6 months). For patients with depression-related weight loss this is therapeutic; for others it is the main reason to switch.

Can I take Nasdep for sleep without depression?

It is sometimes used at low dose (7.5–15 mg) for chronic insomnia in patients where other sleep medications have failed. It is not first-line because the weight gain and sedation persist long-term.

Why does the dose paradox happen?

At 15 mg, H₁ blockade (sedating) dominates. At 30–45 mg, the noradrenergic boost from alpha-2 antagonism is more activating — partly offsetting the antihistamine sedation. Patients can sometimes resolve groggy 15 mg by going up to 30 mg.

Does Nasdep cause sexual side effects?

Much less than SSRIs — the 5-HT₂ antagonism redirects serotonin away from the receptors responsible for SSRI sexual dysfunction. Mirtazapine is sometimes added to or substituted for SSRIs specifically to relieve sexual side effects.

Can Nasdep be combined with venlafaxine?

Yes — the venlafaxine + mirtazapine combination is informally called “California rocket fuel” and is one of the most-evidenced strategies for treatment-resistant depression. Done under specialist supervision.

Is Nasdep safe in pregnancy?

Limited safety data — not first-line. SSRIs (sertraline preferred) have larger registry data. Discuss individually with the prescriber.

What happens if I miss a dose?

Take it as soon as you remember unless close to the next dose — never double up. Mirtazapine has a long half-life (20–40 h), so a single missed dose rarely matters.

How should Nasdep be stopped?

Mirtazapine has a milder discontinuation syndrome than SSRIs/SNRIs. Taper by 15 mg every 2–4 weeks. Sleep and appetite changes may rebound — expect this.

How should Nasdep be stored?

Store at 15–30 °C in the original blister packaging away from moisture and sunlight. Keep out of reach of children.

Medical disclaimer: Information on this page is intended for adults using prescribed psychiatric medication and is not a substitute for individualised medical care. Antidepressants, antipsychotics, and related medications can interact with other drugs, alcohol, and pre-existing conditions. Discuss any new medication, dose change, or planned discontinuation with a qualified prescriber. If you experience suicidal thoughts, mania, severe akathisia, signs of serotonin syndrome (high fever, confusion, muscle rigidity, rapid heart rate), or neuroleptic malignant syndrome, seek emergency care immediately.