米氮平的合成

1-（3-羧基吡啶-2-基）-2-苯基-4-甲基哌嗪在由硼氢化钠/氯化氢或硼氢化钠/醚合三氟化硼制得的二硼烷作用下还原，制得的1-（3-羟甲基吡啶-2-基）-2-苯基-4-甲基哌嗪在浓硫酸中脱水环合得到米氮平，两步总收率约60％。     

Phantom Limb Pain Treatment with Mirtazapine: A Case Series

Objectives: To pilot the efficacy of mirtazapine for relief of phantom limb pain (PLP); to correlate the putative drug mechanism with theoretical PLP mechanisms; and to develop a rationale for further study of mirtazapine in this population. Design: Open‐label case series. Subjects/Patients: Four individuals with PLP for at least 3 months after amputation. Methods: All subjects received oral mirtazapine between 7.5 and 30 mg/day. An 11‐point numeric rating scale (0 to 10) measured pain intensity and relief during monitored outpatient follow‐up visits. Results/Discussion: Mirtazapine use improved the PLP experienced by these subjects by at least 50%. Subjects with PLP‐related sleeping difficulties reported the greatest pain relief concomitant with improved sleep quality. One subject was able to eliminate the use of a selective serotonin reuptake inhibitor antidepressant while using mirtazapine for PLP and depression without change in mood or affect. Mirtazapine enhances noradrenergic and serotonergic activity and may modulate PLP by central mechanisms. Current concepts of the proposed pathophysiology of PLP and the hypothetical impact of mirtazapine are discussed. Conclusion: Mirtazapine may be an effective treatment for PLP that can also potentially enhance sleep and mood. This information provides preliminary reinforcement for more formal, controlled studies concerning mirtazapine use in PLP.     

米氮平治疗躯体形式障碍临床研究

目的探讨米氮平治疗躯体形式障碍的临床疗效。方法对36例躯体形式障碍患者给予米氮平治疗,剂量30mg· d-1·qn。疗程4w。于治疗前及治疗4w末采用抑郁自评量表评定临床疗效;治疗前后对躯体症状进行分级评定分析。结果治疗前后抑郁自评量表评分比较差异有显著性(P<0．05),临床总显效率85．6％;躯体症状较治疗前有显著性改善(P<0． 05)。结论米氮平治疗躯体形式障碍疗效确切,不失为一种治疗躯体形式障碍较为理想的药物。     

米氮平治疗阿尔茨海默病所致抑郁的随机对照研究

目的：比较米氮平与阿米替林治疗阿尔茨海默病（AD）所致抑郁患者的临床疗效和安全性。方法：诊断为AD抑郁患者60例，随机分为A、B2组各30例，分别采用米氮平与阿米替林治疗8周。采用汉密尔顿抑郁量表（HAMD）和副反应量表（TESS）于治疗前和治疗后2、4、6、8周末时分别评定疗效和副反应。结果：A组和B组显效率分别为83．0％和70．0％，疗效相仿；HAMD评分，A组在治疗2周末即显著下降（P〈0．01），B组在第4周才明显下降（P〈0．05）；8周末2组差异无显著性意义。副反应A组明显少于和轻于B组（P〈0．01）。结论：米氮平治疗AD抑郁安全性高、副反应轻微，且见效快。     

睾酮联合米氮平治疗慢性前列腺炎伴抑郁对照研究

目的：探讨睾酮联合米氮平治疗慢性前列腺炎伴抑郁患者的临床疗效。方法将122例慢性前列腺炎伴抑郁患者按照随机数字表法分为两组,每组61例,均口服睾酮治疗,研究组在此基础上联合米氮平治疗,观察16周。治疗前后采用慢性前列腺炎症状量表评定症状康复状况,汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况,依据躯体症状评分标准判定躯体症状康复状况。结果治疗前两组各量表及躯体症状评分比较差异均无显著性(P >0.05),治疗后两组各量表及躯体症状评分均较治疗前显著下降(P <0.01),且研究组均显著低于对照组(P <0.01)。结论睾酮联合米氮平治疗慢性前列腺炎伴抑郁症状患者临床效果显著,能有效缓解患者的焦虑抑郁情绪,更有利于促进患者的全面康复,显著优于单用睾酮治疗。     

Mirtazapine treatment and sexual functions: Results of a Hungarian,multicentre, prospective study in depressed out-patients

Since many antidepressants can cause sexual dysfunction, the aim of this study was to follow-up sexual functions during mirtazapine (RemeronSolTab®) treatment. One hundred and two (44 male and 58 female) outpatients with major depression were recruited to this prospective, observational, non-interventional study. The screening was followed by three visits, during which the 17-HAMD, CGI and 9-BDI scales were used. The change of sexual life was monitored by a self-completing questionnaire, based on the modified Psychotropic-Related Sexual Dysfunction Questionnaire. During the treatment both the depression rating scales and the CGI have shown a significant improvement and significant amelioration of previous sexual problems was found; patients were evaluating their sexual life better and better. Our results indicated that mirtazapine is an effective tool for depressed patients who suffer from sexual dysfunction.     

Effects of imipramine and mirtazapine on operant performance in rats

The effects of the tricyclic antidepressant imipramine and the atypical antidepressant mirtazapine were compared on the performance of rats in three operant procedures: a differential reinforcement of low rates schedule (DRL), a delayed matching to position (DMTP), and simultaneous visual discrimination tasks. Both compounds improved performance in the DRL task in a similar dose-related manner. Imipramine, but not mirtazapine, disrupted performance in the visual discrimination task. Imipramine reduced accuracy and increased response latencies and missed trials. Neither compound effected accuracy in the DMTP; both compounds caused some slowness of responding and imipramine caused several animals to fail to respond in a manner similar to that observed in the visual discrimination task. These data suggest that although imipramine and mirtazapine are similarly effective in putative tests of antidepressant activity, imipramine has a greater tendency to disrupt other aspects of cognitive performance, as well as exert generally depressive effects on operant responding.     

Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo- and propranolol-controlled trial.

BACKGROUND: Preliminary evidence indicates a beneficial effect of serotonin 2A (5-HT(2A)) receptor antagonists in antipsychotic-induced akathisia (AIA). We investigated the antiakathisia effect, safety, and tolerability of low-dose mirtazapine, an agent with marked 5-HT(2A) antagonism. METHODS: In a 7-day double-blind trial, 90 antipsychotic-treated patients meeting DSM-IV criteria for AIA were randomly assigned to mirtazapine (n = 30; 15 mg), propranolol (n = 30; 80 mg), or placebo (n = 30). Primary outcome measures were between-group differences in Barnes Akathisia Scale (BAS) global scores and in the proportion of responders (reduction of > or = 2 points on BAS). Analysis was by intention to treat. RESULTS: Twenty-four patients (26.6%) who were assigned treatment did not complete the study (7 mirtazapine, 8 propranolol, 9 placebo), due to lack of response (n = 19) and adverse events (n = 5). Both mirtazapine and propranolol significantly reduced AIA severity (BAS: -34% mirtazapine and -29% propranolol vs. placebo -11%; p = .012 and p = .023, respectively). Thirteen (43.3%) mirtazapine and 9 (30.0%) propranolol-treated patients versus 2 (6.7%) placebo-treated patients responded (the corresponding odds ratios 10.7 [95% confidence interval (CI), 2.1-53.3] and 6.0 [95% CI, 1.1-30.7]). Five (16.7%) of 30 propranolol-treated patients and none in the mirtazapine and placebo groups (p = .0195 for both) prematurely discontinued the study due to clinically significant hypotension or bradycardia. CONCLUSIONS: The comparable efficacy and better tolerability of low-dose mirtazapine versus propranolol, the current first-line treatment for AIA, position mirtazapine as a favorable candidate for the treatment of acute AIA and may improve current therapeutic practices.