The efficacy of mirtazapine in agitated patients with Alzheimer’s disease: A 12-week open-label pilot study

Agitation is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of agitated patients with Alzheimer’s disease (AD). The consecutive patients with AD who have significant agitation were assigned to a 12-week open-label, prospective study. Patients received mirtazapine 15–30 mg/day. The changes in Cohen-Mansfield Agitation Inventory-Short form (CMAI-SF) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirteen of 16 (81.25%) patients completed the study. There was a significant reduction in CMAI-SF and CGI-S between the pre- and post-treatment with mirtzapaine (p < 0.001). The mean baseline score was 26.54 ( ± 5.4) and mean reduction was 10.6 ( ± 7.5) in CMAI-SF. There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of agitated patients with AD.     

国产米氮平与阿米替林治疗抑郁障碍对照研究

目的 探讨国产米氮平与阿米替林治疗抑郁障碍的临床疗效和安全性.方法 将64例抑郁障碍患者随机分为两组,每组32例,研究组口服国产米氮平治疗,对照组口服阿米替林治疗,观察6周.于治疗前及治疗1周、2周、4周、6周末采用汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应.依据汉密顿抑郁量表评分统计两组治疗前后抑郁症状检出率,同时评估两组患者服药依从性.结果 治疗后两组汉密顿抑郁量表评分均较治疗前呈持续性显著下降(P＜0.01),减分率呈持续性升高.研究组治疗1周末、2周末汉密顿抑郁量表评分较对照组下降更显著,减分率较对照组升高更显著(P＜0.05).治疗6周末除对照组自责、自杀念头症状检出率与治疗前差异无显著性外(P＞0.05),两组各种抑郁症状检出率均显著低于治疗前(P＜0.01);研究组兴趣丧失、自责、自杀念头症状检出率均显著低于对照组(P＜0.01),其他症状检出率差异均无显著性(P＞0.05).研究组不良反应发生率为21.9%,对照组为46.9%,研究组显著低于对照组(χ2=4.43,P＜0.05);服药依从性显著高于对照组(P＜0.01).结论 国产米氮平治疗抑郁障碍疗效显著,与阿米替林相当,但起效更快,安全性更高,依从性更好,优于阿米替林治疗.     

米氮平联合心理干预治疗产后抑郁对照研究

目的 探讨米氮平联合心理干预对产后抑郁患者的疗效.方法 将60例产后抑郁患者随机分为两组,每组30例,两组均采用心理干预治疗,研究组在此基础上予以米氮平药物治疗,观察8周.于治疗前及治疗1周、2周、4周、8周末采用汉密顿抑郁量表评定临床疗效.结果 治疗8周末,研究组显效率80.0%,对照组为33.3%,研究组显效率显著高于对照组(χ2=13.30,P＜0.01);两组汉密顿抑郁量表减分率均随治疗时间延长而逐渐增加,研究组治疗1周末减分率与对照组比较差异有显著性(P＜0.05),2周末起与对照组比较差异有极显著性(P＜0.01).结论 米氮平联合心理干预治疗产后抑郁具有良好疗效,优于单用心理干预治疗.     

米氮平与帕罗西汀治疗抑郁症对照研究

目的比较米氮平与氟西汀治疗抑郁症的临床疗效和安全性.方法 将60例抑郁症患者随机分为米氮平组和帕罗西汀组,分别给予米氮平和帕罗西汀治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD)及治疗中出现的症状量表(TESS)评定疗效和不良反应.结果 米氮平组和帕罗西汀组显效率分别为80.0%和76.7%.两组疗效相仿.但治疗1周后,米氮平组的有效率高于帕罗西汀组.结论 米氮平是一种起效较快,安全、有效的抗抑郁药.     

Safety of antidepressants in the elderly

Until the 1980s, the two major classes of antidepressants, the tricyclics and the monoamine oxidase inhibitors (MAOIs), were effective but had severe side effects, requiring monitoring by psychiatrists. The past several years have brought new classes of antidepressants that are safer for the patient to take and far easier for the non-psychiatrist to prescribe. Whilst this is of enormous value, it leaves the physician with the dilemma of which one to prescribe. These new antidepressants cannot safely be used interchangeably. This paper will discuss each of the antidepressants presently available, with particular emphasis on safety in the elderly. Drug interactions, side effects and particular challenges to the older patient will be described. The authors will then advise a general strategy for prescribing antidepressants.     

Effect of combined treatment with mirtazapine and risperidone on the MK-801-induced changes in the object recognition test in mice

BackgroundSeveral clinical reports have suggested that the mirtazapine-induced augmentation of risperidone activity may effectively improve treatment of the negative and certain cognitive symptoms of schizophrenia.MethodsThe aim of the present study was to evaluate the effect of mirtazapine and risperidone, given separately or jointly, on the impact of MK-801(an NMDA receptor antagonist), given prior to the first introductory session, on the object recognition memory in mice. To this end, we used the object recognition test in which animals were tested for the ability to discriminate between an old, familiar and a novel object. Mirtazapine (2.5 or 5 mg/kg) and risperidone (0.01 mg/kg) were given 30 min before MK-801, and MK-801 (0.1 or 0.2 mg/kg) was administered 30 min before the first introductory session. Memory retention was evaluated 1.5 h after the introductory session.ResultsThe obtained results showed that MK-801 (0.2 mg/kg) decreased memory retention when given before the introductory session. Co-treatment with risperidone (0.01 mg/kg) and mirtazapine (2.5 or 5 mg/kg) abolished the effect of MK-801, whereas those drugs given separately did not change the action of MK-801.ConclusionsThe obtained results suggest that mirtazapine may enhance the antipsychotic-like effect of risperidone in the animal test modeling some cognitive symptoms of schizophrenia. Further studies are necessary to elucidate its mechanism of action.     

艾司西酞普兰联合米氮平治疗难治性抑郁症患者的疗效观察

目的探讨艾司西酞普兰联合米氮平治疗难治性抑郁症患者的疗效和安全性。方法将64例难治性抑郁症患者随机分为研究组和对照组各32例,研究组予艾司西酞普兰联合米氮平治疗,对照组单用艾司西酞普兰,观察8周。于治疗前及治疗2周、4周、8周末采用汉密顿抑郁量表（HAMD）评定临床疗效,副反应量表（TESS）评定不良反应。结果治疗4周末、8周末两组问HAMD的减分率差异有统计学意义（P〈0．05）,研究组较对照组的HAMD总分下降显著。两组不良反应均轻微,副反应量表（TESS）评分两组差异无统计学意义（P〉0,05）。结论艾司西酞普兰联合米氮平治疗难治性抑郁症安全有效。     

Two randomized placebo-controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive sleep apnea

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.     

米氮平联合心理干预治疗抑郁症对照研究

目的 探讨米氮平联合心理干预治疗抑郁症的临床疗效.方法 将82例抑郁症患者随机分为观察组47例、对照组35例,两组均每晚口服米氮平治疗,观察组在此基础上联合心理干预治疗,观察8周.于治疗前及治疗8周末采用汉密顿抑郁量表评定临床疗效.结果 治疗前两组汉密顿抑郁量表评分差异无显著性(P＞0.05);治疗8周末,两组汉密顿抑郁量表评分均较治疗前显著下降(t=21.03、11.90,P＜0.01),但观察组较对照组下降更显著(t=8.21,P＜0.01);观察组总有效率为95.74%,对照组为74.29%,观察组显著高于对照组(χ2=7.95,P＜0.01).结论 米氮平联合心理干预治疗能有效改善抑郁症患者的抑郁状态,提高临床疗效,有利于患者快速获得全面的康复,显著优于单用米氮平治疗.     

Mirtazapine-induced acute angle closure

Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from increased intraocular pressure. This clinical condition can lead to permanent damage in vision, thus causing blindness by generating progressive and irreversible optic neuropathy if left untreated. There are several reasons of AAC, including several types of local and systemic medications; mainly sympathomimetics, cholinergics, anti-cholinergics, mydriatics, anti-histamines, antiepileptics like topiramate, tricyclic and tetracyclic antidepressants, serotonin reuptake inhibitors, antipsychotics, sulfa-based drugs and anticoagulants. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is an atypical antidepressant with a complex pharmacological profile. This case report describes a patient with major depressive disorder, who experienced AAC after the first dosage of mirtazapine treatment, and highlights the importance of close monitoring of individuals under antidepressant treatment particularly immediately after initiation of the drug.