Mirtazapine and Bupropion – Test Prep and Practice Pearls

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Mirtazapine is a unique antidepressant often chosen when depression occurs alongside insomnia or poor appetite. Its antihistamine activity makes it sedating, particularly at lower doses, and it commonly increases appetite and weight. Unlike many SSRIs, mirtazapine has a lower risk of sexual dysfunction and gastrointestinal side effects because it blocks 5-HT2 and 5-HT3 receptors. It is frequently dosed at bedtime and can be especially useful in older adults or medically ill patients who need both mood improvement and help with sleep or weight gain.

Bupropion is an activating antidepressant that works by increasing norepinephrine and dopamine activity rather than serotonin. It is often preferred in patients with fatigue, low motivation, hypersomnia, or concerns about sexual dysfunction and weight gain. Bupropion is also approved for smoking cessation. Common adverse effects include insomnia, anxiety, dry mouth, and headache. A major clinical pearl is its dose-related seizure risk, making it contraindicated in patients with seizure disorders or eating disorders such as anorexia nervosa or bulimia.

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