Mirtazapine Clinical Suitability — MRCPsych Paper B MCQ

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EasyMood DisordersMirtazapine Clinical SuitabilityMRCPsych Paper B

In an adult for whom mirtazapine is otherwise an appropriate antidepressant, which accompanying symptom profile makes its adverse-effect profile potentially advantageous?

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Correct answer: B — Insomnia, reduced appetite and weight loss

Explanation lettering: D = shown as A · A = shown as C · E = shown as D · C = shown as E

Mirtazapine is particularly useful when depression is accompanied by insomnia, reduced appetite and weight loss. Its histamine H1-antagonist activity is associated with sedation, while increased appetite and weight gain are very common treatment effects. These properties can therefore be advantageous in option B, although daytime sedation and excessive weight gain require monitoring. Options A and C already include increased appetite and weight gain, which mirtazapine may worsen. Option D includes reduced appetite and weight loss, but pre-existing hypersomnia makes additional sedation undesirable. Option E offers no symptom-specific advantage from mirtazapine's sedating and appetite-enhancing profile. Antidepressant selection should still reflect shared decision-making, comorbidity, risk and patient preference.

Reference: Electronic Medicines Compendium, Mirtazapine 45 mg tablets, Summary of Product Characteristics, sections 4.8 and 5.1, revised 2024. https://www.medicines.org.uk/emc/medicine/23045/spc