# A nurse is teaching a 74-year-old client newly prescribed mirtazapine 7.5 mg PO at bedtime for depression with poor appetite and insomnia. Which statement indicates effective teaching?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391733&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is teaching a 74-year-old client newly prescribed mirtazapine 7.5 mg PO at bedtime for depression with poor appetite and insomnia. Which statement indicates effective teaching?

## Option

1. "I will need to follow a strict tyramine-free diet."
2. "I should expect this medication to help me sleep and may improve my appetite." **✔ Correct answer**
3. "I should stop the medication immediately if I gain any weight."
4. "I will take this medication in the morning to avoid feeling drowsy at night."

**Correct answer: 2**

## Explanation

Correct (2): Mirtazapine is unique among antidepressants for its strong sedation and appetite stimulation at low doses (≤15 mg) due to potent H1 histamine and 5-HT2A/2C blockade. These properties are clinically exploited in older adults with comorbid depression, insomnia, and weight loss. (1) Incorrect — bedtime dosing is essential for the sedative benefit. (3) Tyramine restriction applies to MAOIs. (4) Weight gain is often a desired effect in this client and not a reason to stop.

## In-depth explanation

Memory Tip Mirtazapine = "MORE sedation at LOWER dose" — paradoxical because higher doses recruit more noradrenergic activity. Clinical Practice Guide Useful niche: depressed elderly with anorexia and insomnia where SSRI weight loss/insomnia side effects would be harmful.

## Clinical scenario

Scenario 74-year-old female with major depression, weight loss, and chronic insomnia. Provider prescribed mirtazapine 7.5 mg PO HS, chosen for its sedation and appetite stimulation at low dose.

## Key concepts

- **Tetracyclic antidepressant** — Mirtazapine's drug class; blocks alpha-2, 5-HT2A/2C, 5-HT3, and H1 receptors — producing sedation, appetite increase, and antiemetic effect.
- **Histamine H1 blockade** — Mechanism of mirtazapine's sedation and appetite stimulation; most prominent at low doses before noradrenergic effects dominate.
- **Geriatric depression** — Depression in adults ≥65 — often presents with somatic complaints, weight loss, insomnia, and cognitive slowing rather than overt sadness.

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