Trade name: Miansec, Lerivon, Deprexolet, Miansegen
Mechanism of Action: Focus on Neurotransmitter Regulation
Mianserin is a tetracyclic antidepressant with a unique mechanism of action and pronounced sedative properties. It is often compared to mirtazapine, as both drugs act on alpha-2 adrenergic receptors. However, there are significant biochemical and clinical differences between them. Unlike monoamine reuptake inhibitors, mianserin enhances serotonin and norepinephrine activity by blocking presynaptic alpha-2 adrenergic receptors. This reduces negative feedback and promotes increased neurotransmitter release. Additionally, the drug influences a broad range of serotonin receptors (more broadly and strongly than mirtazapine) and actively blocks H1 histamine receptors.
Clinical Effects
Key therapeutic effects of mianserin include relief from depression (especially anhedonic types), pronounced sedation, improved sleep structure, and partial anxiety reduction. Its overall antidepressant potency is considered lower than that of mirtazapine, but its specific impact on anhedonia — the inability to feel pleasure or emotional “emptiness” — makes it valuable in certain clinical contexts.
The tranquilizing effect of mianserin is most pronounced at the beginning of treatment and may diminish over time. It is important to note that sedation and anxiolysis are not synonymous: while mianserin reliably induces sleep, it does not always alleviate anxiety.
Sleep Disorders: How Mianserin Works
Mianserin is often used to treat sleep disturbances. At low doses (up to 30 mg), it acts as a sleep aid, particularly effective against night-time awakenings and early morning waking. However, its effect on sleep onset is weaker — especially when insomnia is anxiety-driven.
Peak effect occurs 2–4 hours after administration, which is important when planning the timing of the dose. Its action can last up to 10 hours, so morning drowsiness is common. In the early weeks of treatment, daytime sleepiness may occur due to changes in REM sleep patterns, but this typically resolves as the body adapts.
Main Indications
- Involutional and somatized depression
- Disorders with anhedonia and low mood
- Insomnia with nocturnal awakenings
- Reactive and anxious-depressive states
- Migraine prevention (in selected cases)
Side Effects
The most frequent and noticeable side effect of mianserin is drowsiness, which can be beneficial or problematic depending on the situation. Weight gain is also relatively common and may be more pronounced than with mirtazapine. Unlike mirtazapine, mianserin does not improve libido and in some cases may reduce it.
A rare but serious complication is a reduction in white blood cell count (leukopenia), which may present as frequent infections. Additionally, abrupt discontinuation of the drug can lead to a prolonged withdrawal syndrome, so dosage reduction should always be gradual.
Dosage and Administration
Mianserin is taken once daily — in the evening, due to its sedative effects. Its half-life is approximately 32 hours, and steady-state concentrations are reached in 2–3 weeks.
Sleep-promoting effects occur at doses up to 30 mg. For an antidepressant effect, 60–90 mg is typically required. The dose is usually increased every few days in 15 mg increments. If there is no improvement after 2–3 weeks, titration continues up to the maximum recommended dose (90 mg).
One of mianserin’s advantages is its generally better initial tolerability compared to many other antidepressants, including mirtazapine.
Conclusion
Mianserin can be a valuable tool in the treatment of depression, particularly when accompanied by sleep disturbances and anhedonia. Its strong sedative properties make it especially useful in cases of chronic insomnia. However, caution is advised when using it during the day due to the risk of excessive drowsiness. At the Plexus Center for Psychiatry and Psychotherapy in Warsaw, we tailor treatment to each patient’s clinical picture, biological profile, and sensitivity to therapy. Consultations are available in Polish and Russian — both in person in Warsaw and online.