Selection of an Antidepressant: Mirtazapine

The number of antidepressants has expanded dramatically in the last decade as a result of the abilityto design psychiatric medications in a rational manner. This paper provides a broad overview ofthese options while focusing on the most recently approved antidepressant, mirtazapine. The paperdiscusses the five major features that a physician needs to consider when selecting a medication for apatient: safety, tolerability, efficacy, payment, and simplicity. These five features are summarized bythe mnemonic STEPS. The paper also proposes a pharmacologically based classificatory system thatdivides current antidepressants into eight groups based on the mechanism of action thought to underlietheir antidepressant efficacy. Such a classificatory system can serve as an organizing principle forthe practicing physician.