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Last update 25 Jan 2025

Mirtazapine

Last update 25 Jan 2025

Overview

R&D Status

Clinical Result

Translational Medicine

Overview

Basic Info

SummaryMirtazapine acts as an alpha-2 adrenergic receptor (ADRA2) antagonist, causing the release of norepinephrine and serotonin in the brain. These neurotransmitters are essential in regulating mood and emotions. By increasing their release, mirtazapine helps to alleviate the symptoms of major depressive disorder, which has been marketed under various trade names such as Razapina and Reflex. Developed by Merck Sharp & Dohme, this drug was first approved in the United States, China, Germany, and South Korea.This drug is available in tablet form and should be taken orally. However, caution should be taken when using this drug as it may cause side effects such as drowsiness, weight gain, and dry mouth. Despite the possible side effects, mirtazapine has shown efficacy in the treatment of depression.

Drug Type

Small molecule drug

Synonyms

1,2,3,4,10,14b-Hexahydro-2-methylpyrazino(2,1-a)pyrido(2,3-c)benzazepine, 6-Azamianserin, Avanza

+ [23]

Target

ADRA2

Mechanism

ADRA2 antagonists(Adrenergic receptors alpha-2 antagonists)

Therapeutic Areas

Nervous System Diseases

Active Indication

Depressive Disorder, MajorDepressive Disorder

Inactive Indication

Fibromyalgia

Originator Organization

Merck Sharp & Dohme Corp.

Active Organization

Organon NVOrganon Pharma Pty Ltd.

Organon & Co.

+ [5]

Inactive Organization-

Drug Highest PhaseApproved

First Approval Date

US (14 Jun 1996),

Depressive Disorder

Regulation-

Structure/Sequence

Molecular FormulaC17H19N3

InChIKeyRONZAEMNMFQXRA-UHFFFAOYSA-N

CAS Registry85650-52-8

172

Clinical Trials associated with Mirtazapine

TCTR20240427006

/ Not yet recruitingPhase 1IIT

A Bioequivalence study of a randomized, open-label, single dose, two-way crossover design with two-period, two-treatment and two-sequence of Mirtazapine ODT 30 mg relative to Remeron SolTab 30 mg in healthy Thai volunteers under fasting condition

Start Date25 Mar 2025

Sponsor / Collaborator

Bio-innova Co., Ltd

KCT0010033

/ Not yet recruitingPhase 4IIT

The effect of mirtazapine on depression and insomnia in Parkinson’s disease

Start Date02 Jan 2025

Sponsor / Collaborator-

NCT06760975

/ Not yet recruitingNot ApplicableIIT

Comparative Effects of Vestibular Habituation and Ocular Reflex Exercises on Gait Stability, Dizziness Severity, and Fear of Fall in Elderly Population With Vertigo

The aim of this study is to determine the comparative effects of vestibular Habituation and ocular reflex exercises on Gait stability, Dizziness severity, and fear of fall in elderly population with vertigo

Start Date31 Dec 2024

Sponsor / Collaborator

Riphah International University

100 Clinical Results associated with Mirtazapine

100 Translational Medicine associated with Mirtazapine

100 Patents (Medical) associated with Mirtazapine

2,746

Literatures (Medical) associated with Mirtazapine

21 Jan 2025·Journal of Comparative Effectiveness Research

A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis.

Article

Author: Cummings, Tammy H ; Pittman, Ryan D ; Magagnoli, Joseph ; Sutton, S Scott

Aim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods: This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138 patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated using sertraline as the reference. Results: Of the patients, 39.6% required augmentation, 18.1% changed antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124 and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD change risk (aHR 1.34, 95% CI: 1.29-1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI: 0.83-0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86-0.92). Mirtazapine users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12-1.18) and hospitalization (aHR 1.14, 95% CI: 1.07-1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71-0.84). Conclusion: Antidepressant choice significantly influences treatment outcomes in older adults with MDD. Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial to improving outcomes in this population.

01 Jan 2025·EUROPEAN JOURNAL OF PHARMACOLOGY

Modulation of morphine antinociceptive and rewarding effect by mirtazapine in an animal model of osteoarthritic pain

Article

Author: E M, Sánchez-Robles ; N, Paniagua ; D, Pascual ; M, Molina-Álvarez ; C, Rodríguez Rivera ; R, Girón ; M M, García ; C, Goicoechea ; A, González ; E, Herradón ; V, López-Miranda

People with chronic pain mitigate their suffering by the action of opioids. Adverse reactions aside, opioids are not exempt from potential complications like addiction and abuse, which have posed a global public health problem lately. Finding new therapeutic strategies to improve analgesia and to reduce opioid side effects has become a priority. In this regard, the association of different adjuvant therapies has been postulated. Despite preclinical and clinical evidence supporting the use of antidepressants as analgesics, it is not clear whether they could help reduce the risk of addiction in combination with opioids. To further explore this idea a model of chronic osteoarthritis pain was employed, and a combination of mirtazapine and morphine was used in a chronic regimen in male and female rats. The effects on the development of tactile allodynia, movement-evoked pain, reward, analgesic tolerance, naloxone-induced withdrawal symptoms, impaired locomotor activity and anxiety were evaluated under a 25-day experimental protocol. Additionally, protein expression of μ-opioid receptors and clusterin (related with substance abuse) was evaluated in plasma and in brain structures of the reward system. Chronic morphine caused analgesic tolerance, reward and naloxone-induced withdrawal symptoms. The combination reduced the analgesic tolerance and prevented the development of withdrawal symptoms but showed sex-based differences regarding reward. Increased levels of clusterin in plasma were observed in females treated with morphine, but not with combined therapy. The combination of mirtazapine and morphine could be a promising strategy to improve the management of long-term opioid treatment and its risk of abuse, especially in females.

01 Jan 2025·JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS

MALDI-TOF MS-based SNP assay used to determine the appropriate antidepression for Chinese patients

Article

Author: Huang, Shanqing ; Gan, Tongying ; Shang, Dewei ; Guo, Zhihao ; Zhang, Zi

Medicine remains the preferred primary treatment for depression, although some patients show remarkable individual variations in achieving satisfactory clinical outcomes during medication. Genetic polymorphisms cause approximately 40 % of individual differences in treatment response. Therefore, this study aimed to develop a technique to identify single nucleotide polymorphisms (SNPs) associated with the metabolism, effectiveness, and side effects of antidepressant medications in Chinese patients. Bibliometrics was used to search literature related to "depression" and "SNP" in Web of Science. The obtained SNP information was screened using the PharmGKB database. By designing and optimizing primers and conducting a compound amplification system, a method was established based on MALDI-TOF MS to detect polymorphisms associated with the antidepressant drugs, including sertraline, fluoxetine, citalopram, escitalopram, venlafaxine, fluvoxamine, paroxetine, and mirtazapine. The accuracy and sensitivity of the established method were verified by Sanger sequencing. A total of 10,043 articles were screened from the database, and 46 SNPs with a mutation frequency of >1 % in Asian populations and annotated with relevant clinical drugs were extracted from the PharmGKB database. This method was compared with the results of Sanger sequencing, and the accuracy of the detection results was 100 %. The MALDI-TOF MS-based SNP assay developed in this study can be a fast, convenient and effective way for patients to find the right medication for themselves. Moreover, we found that this SNP assay holds the promise of being a potential reference tool for assessing individualised differences in drug efficacy, not only for screening the causes of poor antidepressant efficacy in patients after taking medication, but also for advising physicians to understand individualised differences in drug efficacy.

News (Medical) associated with Mirtazapine

06 Aug 2024

·www.fiercepharma.com

Novartis and Viatris sued by estate of Henrietta Lacks, whose cells were extracted for research in 1951

A statue of Henrietta Lacks is the first public sculpture of a Black woman made by a Black woman in the U.K. Lacks' cancer cells changed the course of modern medicine after they were taken from her without her consent or knowledge in 1951. Lacks' estate has sued four biopharma companies, including Novartis and Viatris on Monday, for allegedly profiting off discoveries made with Lacks' cells The family of a Baltimore woman whose cells were extracted for medical research without her consent more than 70 years ago has filed another lawsuit against drugmakers that allegedly profited from the discoveries they made using her genetic material.The family of Henrietta Lacks has sued Novartis and Viatris, seeking a jury trial and the “full amount” of profits obtained through their use of the “stolen” cells, according to the lawsuit, which was filed Monday in federal court in Baltimore.“Medical research has a long, troubled history of exploiting Black individuals, and Henrietta Lacks’s story is a stark reminder of this legacy,” Ben Crump, a civil rights attorney representing the family, said in a release. “It is time for these corporations to be held accountable for their unjust enrichment and to provide the Lacks family with the recognition and compensation they deserve.”The lawsuit is the third filed by the family against a pharma company. Last year, Thermo Fisher came to a settlement for an undisclosed sum. Days later, the Lacks’ estate filed a similar suit against Ultragenyx over its production of viral vectors.Novartis said that it doesn’t comment on litigation. Viatris did not respond to a request for comment.The lawsuits harken to an era when racism was rampant in the healthcare system. They also open difficult questions for courts to consider as Lacks’ case traces to 1951 when doctors didn’t need patients' permission to harvest their cells. Lacks was a young mother of three in Baltimore when she developed cervical cancer. Tissue taken from a biopsy—before she died that same year at age 31—was saved and became the first human cells to grow and reproduce in lab dishes. Dubbed HeLa cells, they became the first “immortal human cell line” and important building blocks for scientific studies around the world, leading to the discovery of the polio and COVID vaccines, breakthroughs in genetic mapping and scores of other medical innovations.While Johns Hopkins never profited from HeLa cells, companies and other research organizations have developed thousands of patents using HeLa cells. Novartis holds “hundreds” of those patents, according to the lawsuit.“Novartis has utilized Mrs. Lacks’s genetic material extensively as a fundamental component in their research and development processes,” the lawsuit reads. “By using these cells, Novartis can efficiently test and refine their pharmaceutical compounds, accelerating the development of new drugs.”Novartis and Viatris have always been aware of the origin of Lacks’ cells, according to the lawsuit. In a 2021 website posting, the company cited Lacks’ story in announcing an initiative to address health disparities through “holistic community-based collective action.”Among the products Novartis has developed using HeLa cells, according to the lawsuit, are herpes drug Famvir, CAR-T therapy Kymriah and gene therapy Zolgensma. Viatris treatments cited in the suit include the depression drug mirtazapine and herpes drug Denavir.

Cell TherapyPatent InfringementImmunotherapy

26 May 2023

·www.drugs.com

The Most Common Depression Medications, Explained

FRIDAY, May 26, 2023 -- You've been diagnosed with depression. What's next? The cornerstone of treatment remains antidepressants, so it's likely your doctor will prescribe one for you, but which one might be best? You will join millions around the world who struggle with how to treat the mental health disorder. An estimated 3.8% of the global population experiences depression, according to the World Health Organization . The numbers are staggering, but when depression is left untreated, it can impair daily functioning, raise the risk of suicide and lower quality of life. Fortunately, there are many different types of antidepressants available, each with unique mechanisms of action, benefits and potential side effects. Here, experts will explore the most commonly prescribed depression medications, how they work and their common side effects. Depression medications Dr. Abid Nazeer, founder, chief medical officer and medical director of Advanced Psych Solutions in Naperville, Ill., stated, “If you don’t treat depression, there’s a risk that you may get through the day, but it will feel like a struggle. If it’s been adequately treated, you can have a much better day.” Meanwhile, Pardis Khosravi , a psychologist and clinical director at Children’s Health Council in California, said, “Depression is not something you can 'power through' or think your way out of with positive thoughts. It is a medical illness that left untreated can have a profound impact on your health, quality of life and daily functioning. Untreated depression increases the likelihood of risky behaviors such as substance use, self-harm and suicidal ideation and/or behaviors.” Although alternative therapies can be successful in treating depression, medication might become necessary in certain situations when other treatments have failed, depression symptoms interfere considerably with daily life, there is a history of mental health issues, or when a person feels too exhausted to pursue non-medication treatments. Here are some of the most common depression medications: Selective serotonin reuptake inhibitors (SSRIs) SSRIs are a class of medications used to treat depression by elevating serotonin levels in the brain, a crucial neurotransmitter that facilitates communication between nerve cells. The Mayo Clinic indicates that SSRIs prevent serotonin reabsorption into neurons, ensuring that more of the chemical messenger remains available to enhance signaling between brain cells. Additionally, SSRIs are known as selective agents because they primarily impact serotonin rather than other neurotransmitters. These SSRIs have received approval from the U.S. Food and Drug Administration for the treatment of depression: Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft) While SSRIs effectively treat depression, they may also cause various side effects. Per an article published in the Primary Care Companion to the Journal of Clinic Psychology , SSRIs' most common side effects include gastrointestinal problems, sexual dysfunction, weight gain and sleep disturbances. Gastrointestinal side effects include nausea, diarrhea and abdominal pain, while sexual dysfunction includes decreased libido, erectile dysfunction and difficulty achieving orgasm. In rare cases, SSRIs may increase the risk of suicidal ideation, particularly in young people, some research has shown. Antidepressant medications SSRIs are not the only medications for depression: Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) work by affecting other neurotransmitters. SSRIs generally have fewer side effects than these older antidepressants and are typically the first-line treatment for depression. However, the choice of medication depends on individual needs, and health care providers may recommend different types of antidepressants based on the patient's specific symptoms and medical history. Monoamine oxidase inhibitors (MAOIs) MAOIs are another type of antidepressant medication that blocks the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine and dopamine. By increasing the levels of these neurotransmitters, MAOIs can alleviate symptoms of depression. Some of the most common MAOIs include: Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan) Selegiline (Emsam) — available as a transdermal patch These medications can be effective in treating depression. However, the Mayo Clinic states that they are generally not considered first-line therapy due to their potential for serious side effects and interactions with certain foods and medications. Atypical antidepressants According to Mental Health America , atypical antidepressants are a diverse class of medications used to treat depression that do not fit neatly into other categories of antidepressants. They work by targeting multiple neurotransmitters in the brain, including serotonin, norepinephrine and dopamine, to improve mood and ease symptoms of depression. Some of the most commonly used atypical antidepressants include: Bupropion (Wellbutrin) Mirtazapine (Remeron) Trazodone (Desyrel) Vilazodone (Viibryd) Vortioxetine (Trintellix) Bupropion is known for its unique mechanism of action, which involves increasing the levels of norepinephrine and dopamine in the brain. Mirtazapine works by increasing the release of both serotonin and norepinephrine, while trazodone primarily affects serotonin levels. Vilazodone and vortioxetine are newer medications that target multiple neurotransmitters and effectively treat depression. These medications may be useful for individuals who have not responded to other types of antidepressants or who experience side effects from other medications. SOURCES: Abid Nazeer, MD, founder, chief medical officer and medical director, Advanced Psych Solutions, Naperville, Ill.; Pardis Khosravi, psychologist and clinical director, Children’s Health Council, Palo Alto, Calif. Posted May 2023

Drug Approval

10 Nov 2022

·www.businesswire.com

Worldwide Depression Treatment Industry to 2032 - by Products, Disease, Distribution Channel and Region - ResearchAndMarkets.com

DUBLIN--( BUSINESS WIRE )--The "Depression Treatment Market" report has been added to ResearchAndMarkets.com's offering. A recent market study published on the depression treatment market offers a global industry analysis for 2012-2021 and an opportunity assessment for 2022-2032. The report consists of a comprehensive assessment of the most important market dynamics. On conducting thorough research on the historical as well as current growth parameters of the depression treatment market, growth prospects of the market are obtained with maximum precision. The report features unique and salient factors that may make a huge impact on the development of the depression treatment market during the forecast period. It can help market players modify their manufacturing and marketing strategies to envisage maximum growth in this market in the coming years. The report provides detailed information about the current and future growth prospects of the depression treatment market in the most comprehensive way for a better understanding of readers. Companies Mentioned Viatris (Mylan Pharmaceuticals Inc.) Sunovian Pharmaceuticals AbbVie Inc. (Allergan Inc.) Jubilant Generics Limited Sanis Health Inc. Abbott Laboratories Aurobindo Pharma Torrent Pharmaceuticals Teva Pharmaceuticals Sun Pharmaceuticals (Apotex Holdings Inc.) Apotex Corporation Alembic Pharmaceuticals Limited Pfizer Inc. Cardinal Health Hikma Pharmaceuticals Zydus Lifesciences (Cadila) Cipla Ltd Dr. Reddy's Laboratories Merck & Co. Eli Lily & Co GlaxoSmithKline Takeda Pharmaceuticals BrainsWay Ltd. Nexstim Plc Magstim Ltd. Neuronetics Inc. Salience TMS Neuro Solutions MagVenture MAG & More GmbH Neurosoft Ltd. Key Segments of the Depression treatment Market This study on the depression treatment market offers information divided into four important segments - products, disease, distribution channel and region. This report offers comprehensive data and information about the important market dynamics and growth parameters associated with these categories. By Products Drugs Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Selective Norepinephrine Reuptake Inhibitors (SNRIs) Desvenlafaxine succinate Duloxetine Levomilnacipran Venlafaxine Bupropion Mirtazapine Monoamine oxidase inhibitors (MAOIs) Phenelzine Tranylcypromine Antipsychotics Lithium carbonate Aripiprazole Brexipiprazole Quetiapine Trazodone Others TMS Devices rTMS Devices dTMS Devices By Disease Major Depression Persistent Depressive Disorder Bipolar Disorder Seasonal Affective Disorder (SAD) Postpartum Depression Premenstrual Dysphoric Disorder (PDD) Situational Depression Atypical Depression Treatment-Resistant Depression By Distribution Channel Hospitals Retail Pharmacies Drug Stores e-commerce Specialty Clinics Region North America Latin America Europe East Asia South Asia Oceania Middle East and Africa (MEA) For more information about this report visit https://www.researchandmarkets.com/r/2h2zat

Generic Drug

100 Deals associated with Mirtazapine

External Link

KEGG	Wiki	ATC	Drug Bank
D00563	Mirtazapine	N06AX11	DB00370

R&D Status

Approved

10 top approved records.

to view more data

Indication	Country/Location	Organization	Date
Depressive Disorder, Major	NL	Organon NV	12 Jan 1998
Depressive Disorder	US	Organon USA LLC	14 Jun 1996

Developing

10 top R&D records.

to view more data

Indication	Highest Phase	Country/Location	Organization	Date
Fibromyalgia	Phase 2	JP	Meiji Seika Pharma Co., Ltd.	28 Jun 2010

Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04748523 (Pubmed \| JAMA Oncol) Manual	Not Applicable	Anorexia \| Non-Small Cell Lung Cancer First line	86	Mirtazapine 15 mg	visbckujsb(umqemfhesk) = There was no difference in appetite scores in patients who received mirtazapine or placebo after 4 and 8 weeks czsovgvomd (dmypazmmwa ) View more	Positive	01 Mar 2024
				Placebo
ISC2024	Not Applicable	Acute Ischemic Stroke	-	SSRI/SNRI	wgpkixebef(adthjtjcrq): RR = 1.29 (95% CI, 1.11 - 1.5)	-	01 Feb 2024
				Dual Antiplatelet Therapy (DAPT)
ISC2024	Not Applicable	Hemorrhagic stroke	-	Selective Serotonin/Serotonin & Norepinephrine Reuptake Inhibitors (SSRI/SNRI)	ymtlxyjgkm(xsmdhdbpqp): RR = 1.33 (95% CI, 1.22 - 1.45)	Negative	01 Feb 2024
				Serotonergic Antidepressants (No AD)
NCT00878540 (Pubmed \| Naunyn Schmiedebergs Arch Pharmacol)	Phase 1	-	12	Mirtazapine 30 mg	cmfortxckl(bevzgowavz) = fitcxhisom zpyvbhcdab (wscsqwhzvs, [ - 11.4; 2.6])	-	09 Mar 2023
NCT04155008 (CTgov)	Phase 4	Malnutrition \| Lung Cancer \| Anorexia ... View more	1	Nutrition Intervention (Patients With Fair to Good Appetite)	whgvlylrtb(igztkiqugk) = wjikihtmdv jtamewqlqa (rlscnuookj, omddbbomio - sdydxxglpk) View more	-	16 Nov 2022
				Nutrition Intervention+Mirtazapine+Dexamethasone+Dronabinol (Patients With Poor to Fair Appetite)	whgvlylrtb(igztkiqugk) = stinswvgvk jtamewqlqa (rlscnuookj, debsoeuhbp - eetopaaoug) View more
NCT03921151 (CTgov)	Phase 1/2	Cocaine-Related Disorders	90	Mirtazapine 15 MG Oral Tablet (Cocaine-dependent)	vhnnlbwxka(rsmbtmrkfa) = eudpjcxloa pyegfsnqah (jqhudbdtmw, unbmsozsuy - aqlqnmcqev) View more	-	22 Nov 2021
				Mirtazapine 15 MG Oral Tablet (Non-drug Using Healthy Controls)	vhnnlbwxka(rsmbtmrkfa) = rudgolnmma pyegfsnqah (jqhudbdtmw, cbgrinxrmi - wcsyatwcae) View more
NCT04799782 (CTgov)	Phase 2	Spinal Cord Injuries \| Sleep Apnea, Central	18	Mirtazapine (Mirtazapine)	ndcpxdgaiv(ysgjsuaxqa) = zshapynuzp xiryiqtual (sxzehdjrxx, mmgeykjgaq - cpoidjlctz) View more	-	20 Apr 2021
				Placebo (Placebo)	ndcpxdgaiv(ysgjsuaxqa) = hsdvcaltak xiryiqtual (sxzehdjrxx, pyvvcmdzrg - ujrpiefdlc) View more
NCT02336750 (Pubmed) Manual	Phase 3	Nausea \| Vomiting	95	aprepitant+dexamethasone+5-HT3 receptor antagonist+mirtazapine	wwptcvcmdz(xtxqmeqlwx) = iaztotbquw mvdtwvzouo (jovzoxegar )	Superior	01 Apr 2020
				aprepitant+dexamethasone+5-HT3 receptor antagonist	wwptcvcmdz(xtxqmeqlwx) = latwfkytqx mvdtwvzouo (jovzoxegar )
NCT01888835 (Pubmed \| JAMA Psychiatry)	Phase 2	-	241	Mirtazapine	gouovnhibj(qcjkyeaajy) = gjwtfvwdii cjrfbaoaha (nmgesfzaqj ) View more	Positive	11 Dec 2019
				Placebo	dxzcnhyoih(juhdkxlzdu) = nrlsuvdaje jnrmrpeock (qqswjllgdj )
NCT01302964 (CTgov)	Phase 3	Autism Spectrum Disorder \| Anxiety Disorders \| Pervasive child development disorders	30	Mirtazapine (Mirtazapine)	aetfixjcou(srqblyzfon) = xbvaqyrkjb bhjbimtprp (qtchuctvet, ohirrfvshg - wgjryowgaq) View more	-	07 Nov 2018
				Placebo (Placebo)	aetfixjcou(srqblyzfon) = snbhsefovv bhjbimtprp (qtchuctvet, ouypvxsuwf - ciicwjtgrn) View more

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Mirtazapine

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