[The place of mianserin among the antidepressants (author's transl)]

Abstract

The originality of mianserin lies mainly in its chemical formula ; it is a tetracyclic piperazino-azepine compound. Moreover its pharmacological profile differs from that of other antidepressant drugs because it is devoid of central anticholinergic effects, it inhibits 5-hydroxytryptophane (the precursor of serotonine) and contrary to the tricyclics it does not affect the re-uptake of the amine-transmitters but increases the turnover of noradrenaline. It has been shown in a clinical trial that mianserin induces a hypomania in some manic-depressed patients. Regarding the antidepressive effect, mianserin is superior to placebo and as effective as imipramine and amitriptyline. It simultaneously works on anxiety, psychomotoric retardation and suicidal tendency; sleep improves under mianserin's influence. The value of mianserin is proved by its safety in use. It has no cardiotoxic effect and does not interact with coumarin-type anticoagulants. Since there are no anticholinergic effects, mianserin can be given to patients suffering from glaucoma or prostatic hypertrophy. Finally it appears that mianserin lowers the suicidal risk through its sedative properties.