A double-blind, randomized comparison of fluvoxamine with mianserin in depressive illness

Abstract

The efficacy and CNS effects of the selective 5-HT re-uptake inhibitor fluvoxamine were compared with mianserin in depressed hospital out-patients in a double-blind randomized trial. Patients had to meet DSM-III criteria for Major Depressive Episode and achieve a score of at least 30 on the Montgomery-Asberg Depression Rating Scale (MADRS) after a 1-week placebo baseline period. Active treatment was for 6 weeks with an initial dose of either 100 mg fluvoxamine or 60 mg mianserin; after 1 week the dosage could be increased to 300 mg or 180 mg, respectively. Data from 63 patients (30 received fluvoxamine) were analyzed. The treatment groups were comparable with regard to age and history and severity of depression. Efficacy assessments showed similar improvements with each drug; MADRS scores improved by 65.6% with fluvoxamine and by 60.8% with mianserin. There were no significant differences between treatments at any assessment. Sedative effects were assessed using the Leeds Sleep Evaluation Questionnaire and the Digit Symbol Substitution Test. Mianserin caused a shift towards sedation in the first week in all visual analogue scales; getting to sleep and sleep quality were improved but waking was more difficult than with fluvoxamine. Similarly, the mianserin group performed less well on the Digit Symbol Substitution Test. The study confirmed that both drugs are effective treatments for depressive illness but that mianserin gives rise to sedation during the first week.

Suicide: Risk factors and prevention in refractory major depression

“…In contrast, studies by Nathan et al (1990), comparing fluvoxamine and desipramine, did not note a difference in response of either depression or suicidal ideation. The same was true for Perez and Ashford's (1990) study comparing fluvoxamine and mianserin.…”

Subjective assessment of the effects of CNS‐active drugs on sleep by the Leeds sleep evaluation questionnaire: a review

“…As can be seen in Figures 5 and 6 the treatment of depressed patients with antidepressants was associated with normalization of sleep as patients became less depressed. It should be pointed out that while the antidepressants may have sleep negating effects as seen in healthy volunteers (see for example Figure 4), in the course of antidepressant treatment, the improvement in sleep quality as the trial progresses may mainly reflect the improvement in affec- tive state (Perez and Ashford, 1990;Stephenson et al, 2000). Interestingly, patients treated with some antidepressants (fluvoxamine) appear to have enhanced improvement of sleep than with other drugs.…”

Cognition and depression: the effects of fluvoxamine, a sigma‐1 receptor agonist, reconsidered

“…Fluvoxamine significantly improved performance in the digit symbol substitution test ( p ¼ 0.02 vs. baseline) in a double-blind, randomised study (Perez and Ashford, 1990). In another study in 51 patients hospitalised for a major depressive episode, 4 weeks treatment with fluvoxamine resulted in significant symptomatic remission with higher total Wechsler IQ scores and a lower incidence of cognitive impairment in treatment responders (Mandelli et al, 2006).…”