This is a presynaptic alpha2-adrenoreceptor antagonist, increases central noradrenergic and serotonergic neurotransmission. It has few antimuscarinic effects, but causes sedation during initial treatment.

Indications: Major depression

Cautions & Contra-indications: cardiac disorders, hypotension, history of urinary retention, susceptibility to angle-closure glaucoma, diabetes mellitus, psychoses (may aggravate psychotic symptoms), history of seizures or bipolar depression; hepatic impairment; renal impairment; pregnancy; breast-feeding; Patients should be advised to report any fever, sore throat, stomatitis or other signs of infection during treatment. Blood count should be performed and the drug stopped immediately if blood dyscrasia suspected.

Side Effect: Increased appetite and weight gain, oedema, dizzeness, headache, abnormal dreams, mania, suicidal behavior, seizures, tremor, myoclonus, paraesthesia, arthralgia, myalgia, akathisia, rash, and blood disorders including reversible agranulocytosis.

Dose: Initialy 15 mg daily at bed time increased within 2– 4 weeks according to response.Max.45 mg daily as single dose at bed time or in 2 divided doses.