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.     

Pharmacotherapy for the treatment of depression in patients with alzheimer’s disease: a treatment-resistant depressive disorder

Introduction: Pharmacotherapy for the treatment of depressive disorders in Alzheimer’s Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8–12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects.

Areas covered: The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine.

Expert opinion: The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.     

米氮平联合乌灵胶囊及单一米氮平治疗抑郁和焦虑障碍共病的疗效对照

目的:比较米氮平联合乌灵胶囊及单一米氮平抗抑郁和焦虑障碍共病的作用和不良反应。方法:67例同时符合抑郁症与焦虑障碍诊断标准的门诊患者,分别随机给予口服米氮平联合乌灵胶囊(简称A组)和单一口服米氮平(简称B组)。研究全程为期6周,禁止应用任何抗精神病药物及安定类药物。入组前、治疗后的第1、2、4、6周进行HAMD、HAMA、TESS评定。第6周末复查血尿常规、肝肾功能、心电图。结果:治疗第1周A组HAMD得分下降比B组明显,有显著差异(P<0.05);而HAMA得分下降更为明显,差异非常显著(P<0.01)。从治疗的第2周开始A组HAMD、HAMA得分下降均比B组来的显著,差异非常显著(P<0.01)。经过6周的治疗,A组临床治愈19例,临床有效29例;B组临床治愈16例,临床有效28例。2组患者的临床治愈率、临床有效率均无显著性差异(P>0.05)。2组患者不良反应发生率无显著性差异(P>0.05)。结论:米氮平联合乌灵胶囊能迅速缓解焦虑障碍及抑郁症状,对抑郁和焦虑障碍共病的患者,乌灵胶囊可以作为一种安全有效增效剂来使用。     

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。     

丁螺环酮联合米氮平与正念认知疗法对高血压合并抑郁症患者血压、HAMD17评分的影响

目的观察丁螺环酮联合米氮平与正念认知疗法治疗对高血压合并抑郁症患者血压、17项汉密尔顿抑郁量表(HAMD17)评分的影响。方法选取高血压合并抑郁症患者112例,随机分为对照组和观察组各56例。对照组给予药物治疗(丁螺环酮+米氮平),观察组在对照组基础上给予正念认知疗法,比较两组血压变化情况、HAMD17评分、不良反应发生率以及生活质量。结果观察组干预后血压改善优于对照组,HAMD17评分和不良反应发生率低于对照组(P＜0.05);观察组干预后生活质量高于对照组(P＜0.05)。结论丁螺环酮联合米氮平与正念认知疗法可有效改善高血压合并抑郁症患者血压变化情况,减轻抑郁症状,降低不良反应发生率,改善生活质量。     

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.     

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。