The antidepressant action of mirtazapine is best explained by:

• A Reuptake inhibition of dopamine and noradrenaline
• B Irreversible inhibition of monoamine oxidase A
• C Competitive antagonism at 5-HT2A receptors alone
• D Selective blockade of presynaptic alpha-2 autoreceptors, increasing noradrenaline and serotonin release ✓

Explanation

Mirtazapine blocks central presynaptic alpha-2 adrenergic autoreceptors and heteroreceptors, disinhibiting release of both noradrenaline and serotonin. It also blocks 5-HT2 and 5-HT3 receptors, giving sedation and appetite stimulation through H1 blockade. Option A describes bupropion-like reuptake inhibition, which mirtazapine does not possess, making it the key distractor to eliminate.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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