Mirtazapine versus fluoxetine in the treatment of panic disorder

Abstract

Mirtazapine is an antidepressant whose side effect profile differs from that of first-line agents (selective serotonin reuptake inhibitors) used in the treatment of panic disorder. The present study compared the effect of mirtazapine and fluoxetine in the treatment of panic disorder in a double-blind, randomized, flexible-dose trial conducted with outpatients. After a 1-week single-blind placebo run-in, 27 patients entered an 8-week double-blind phase in which they were randomly assigned to treatment with either mirtazapine or fluoxetine. Both groups improved significantly in all but one efficacy measure (P£0.01). ANOVA showed no significant differences between the two treatment groups in number of panic attacks, Hamilton Anxiety Scale or Sheehan Phobic Scale, whereas measures of patient global evaluation of phobic anxiety were significantly different between groups (F 1,20 = 6.91, P = 0.016) favoring mirtazapine. For the 22 patients who completed the study, the mean daily dose of mirtazapine was 18.3 ± 1.3 vs 14.0 ± 1.0 mg for fluoxetine at the endpoint. Weight gain occurred more frequently in the mirtazapine group (50 vs 7.7%, P = 0.04) and nausea and paresthesia occurred more often in the fluoxetine group (P = 0.01). Results suggest that mirtazapine has properties that make it attractive for the treatment of panic disorder.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…The drug is not available in the US, but again is available in many other countries. Á In a small double-blind comparison of mirtazapine and fluvoxamine, no differences were found between the two drugs (Ribeiro et al 2001) (C1). Á The anticonvulsant valproate (valproic acid) was effective in one very small DBPC crossover study (Lum et al 1990).…”

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…(Batelaan et al, 2012). The findings of randomised comparator-controlled studies provide some evidence for beneficial effects with mirtazapine [II] (Ribeiro et al, 2001) and moclobemide [II] (Kruger and Dahl, 1999;Tiller et al, 1999). The relative efficacy and tolerability of differing pharmacological treatments is uncertain, but there may be efficacy advantages for venlafaxine, and tolerability disadvantages for fluvoxamine and reboxetine [I (M)] (Andrisano et al, 2013).…”

Panic Attacks During Escalation of Mirtazapine

“…4 Mirtazapine has shown favorable results in 4 open-label studies and a case series. [5][6][7][8][9] However, there is a case report of a panic attack that occurred during the discontinuation of mirtazapine.…”