Effectiveness of mirtazapine in the treatment of depression with associated somatic symptoms.
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INTRODUCTION: A assess the efficacy of mirtazapine in the treatment of depression with somatic symptoms in a 3-months follow-up study. MATERIAL AND METHODS: DESIGN: multicenter, prospective, observational, open-label, and non controlled study. SAMPLE: seven hundred and eleven patients recruited in outpatient psychiatric consultations by 98 psychiatrists nationwide. INSTRUMENTS: 17-Item Hamilton Depression Rating Scale (HAMD-17) and Standardized Polyvalent Psychiatric Interview (SPPI), somatic symptoms section. Patients were assessed pretreatment and at 15, 30 and 90 days post-treatment. RESULTS: Severity of depression assessed by HAMD-17 significantly decreased (p<0.0001) from 23.27 in the pretreatment assessment to 6.75 at 3 months post-treatment. Severity of somatic symptoms assessed by EPEP significantly decreased (p<0.0001) from 7.68 in the pre-treatment assessment to 2.28 at 3 months post-treatment. Mirtazapine modifies attribution of somatic symptoms in somatizers: in pretreatment assessment, 41.3 % of the sample attributed somatic symptoms to a psychological origin, while at 3 months post-treatment this percentage significantly increased (p<0.05) to 63.94%. Nearly half of the sample (48.52%) took benzodiazepines at the start of the study; but at 3 months post-treatment only 6.71% of the patients needed them. The incidence of adverse effects was 13.36% of the patients. From the total dropouts 4% were due to adverse events. CONCLUSIONS: Mirtazapine is an effective and safe antidepressant for the treatment of depression with somatic symptoms and is able to modify attribution of somatic symptoms in somatizing patients. (+info)
Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial.
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Enhancing effect of mirtazapine on cognitive functions associated with prefrontal cortex in patients with recurrent depression.
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INTRODUCTION: We put forward a hypothesis that a therapeutic administration of mirtazapine to depressed patients, due to pharmacological profile of the drug, could enhance cognitive functions associated with prefrontal cortex activity. METHODS: The study was performed on depressed patients receiving mirtazapine for the period of 6 months. Neuropsychological assessments after 3 and 6 months of treatment were performed by the Wisconsin Card Sorting Test, N-back test, TMT and Stroop tests. RESULTS: During acute depressive episode, a significant impairment on all neuropsychological tests was evident. Substantial improvement in performance has been noted after 3 and 6 months of mirtazapine treatment, and, after 6 months, a majority of the investigated patients achieved the results within the range of matched healthy control subjects. Improvement on neuropsychological tests after treatment with mirtazapine showed no correlation with the degree of amelioration of depression. DISCUSSION: Mirtazapine may exert a favorable influence on cognitive functions associated with prefrontal cortex in depressed patients. The lack of direct correlation with improvement of depressive symptoms suggests that mirtazapine may possess specific pro-cognitive properties. (+info)
Neonatal recurrent prolonged hypothermia associated with maternal mirtazapine treatment during pregnancy.
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We present a case of recurrent hypothermia in concordant monozygotic twins born to a mirtazapine treated mother. The twins were born at 35 weeks gestation at birth weights of 2426 g and 2355 g. Both twins presented with recurrent hypothermia continuing until day 10 of life. Possible etiologies of hypothermia were excluded. The degree of prematurity and the weight of the twins were not consistent with prolonged thermal instability. The twins' mother was treated with mirtazapine during the entire pregnancy. Due to its serotonin and alpha 2 receptors antagonism mirtazapine is known to influence thermoregulation in adult humans and other mammals. We suggest that maternal mirtazapine treatment during pregnancy was associated with recurrent hypothermia in both identical twins. (+info)
Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea.
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OBJECTIVE: Mirtazapine is an a2A antagonist and mixed 5-HT2/5-HT3 antagonist that has been proposed as a potential treatment for obstructive sleep apnea (OSA). A small, randomized, controlled trial has previously found an approximate halving in the severity of OSA with daily doses of 4.5 and 15 mg. We aimed to confirm and extend these findings in 2 randomized placebo-controlled, proof-of-concept trials. METHODS: Two randomized, double-blind, placebo-controlled trials of mirtazapine for OSA (apnea-hypopnea index 10-40/h). Study 1: 3-way crossover, dose-finding study testing the self-administration of mirtazapine (7.5, 15, 30, and/or 45 mg) or placebo 30 minutes prior to bedtime for 2 weeks at each dose. Twenty patients were randomly assigned to 1 of 6 different dose-sequence groups, with each patient exposed to a maximum of 3 doses. Study 2: 3-arm, randomized, parallel-group trial of mirtazapine at 15 mg or mirtazapine 15 mg + Compound CD0012 or placebo for 4 weeks in 65 patients with OSA. RESULTS: Two patients withdrew from Study 1 after complaints of unacceptable lethargy. Fifteen patients were withdrawn from study 2, 7 after complaints of unacceptable lethargy or other side-effects. No measurement of sleep apnea improved due to mirtazapine in either study. Weight gain was significantly greater on mirtazapine than on placebo in both trials. CONCLUSIONS: Mirtazapine did not improve sleep apnea in either trial. Mirtazapine caused weight gain, which may further worsen OSA. Therefore, mirtazapine is not recommended for the treatment of OSA. (+info)
Employing mirtazapine to aid benzodiazepine withdrawal.
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Insomnia and depression are frequently encountered in patients during withdrawal from substances. While there are no approved medications for treating them, off-label attempts to address these phenomena with mirtazapine have shown some promising results. This case describes the use of mirtazapine as an aid in benzodiazepine withdrawal and its potential benefits in alleviating insomnia and depression in a 32-year-old man. It was found to ameliorate sleep myoclonus that was thought to be associated with his withdrawal syndrome. It is hoped this report will generate interest and stimulate further research in this area of psychopharmacology. (+info)
Contents of general practitioner-patient consultations in the treatment of depression.
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