Mianserin hydrochloride

How it works

It enhances central noradrenergic transmission largely through antagonism of presynaptic alpha-2 adrenoceptors, and also blocks several serotonin and histamine receptors.

Prescribing in practice

• Mianserin can cause bone marrow suppression including agranulocytosis, so any signs of infection such as fever, sore throat or stomatitis should prompt an urgent full blood count and review.
• It is sedating, which may be useful where insomnia accompanies depression but increases the risk of drowsiness and falls, particularly in older people.
• As with all antidepressants, monitor for suicidal thoughts and behaviour, especially early in treatment and in younger adults.

Monitoring

A full blood count should be checked if signs of infection develop, and patients should be monitored for mood changes and emergent suicidal ideation during treatment.

Counselling the patient

• Report any fever, sore throat, mouth ulcers or other signs of infection without delay.
• This medicine can make you drowsy, so take care with driving and alcohol.
• Do not stop the medicine abruptly; your prescriber will advise on tapering.

Evidence & guidelines

Mianserin is an established antidepressant, and the requirement to investigate signs of infection because of the risk of blood dyscrasias is reflected in its product information.