A multicentre placebo‐controlled trial comparing the efficacy of mianserin and chlordiazepoxide in general practice patients with primary anxiety

Abstract

In a double-blind multicentre trial in general practice, 144 patients with primary anxiety received daily treatment with mianserin or chlordiazepoxide, 30-60 mg, or placebo. There were no statistically significant differences in efficacy between the three treatments in the 106 patients who completed the 6-week trial. However, there was a substantial trend in favour of mianserin (P = 0.1), but not chlordiazepoxide, over placebo as assessed by the difference in overall improvement on the Hamilton Anxiety Scale. This trend may be clinically significant since more patients dropped out from the placebo group because of lack of effect or deterioration than did from the active treatment groups, particularly during the latter part of the trial. Side effects occurred to a similarly low extent with all treatments, except that mianserin caused more weight gain and, initially, more drowsiness than placebo, while placebo produced more nausea and vomiting. Taken together with the evidence from previous trials in patients with anxiety, these results support the notion that mianserin has anxiolytic properties.

Mianserin‐induced 5‐HT2 receptor downregulation results in anxiolytic effects in the elevated plus‐maze test

“…It has been demonstrated repeatedly that mianserin has clinically significant anxiolytic effects at least equal to those of the benzodiazepines [Murphy 1978;Bjertnaes et al, 1982;Kahn et al, 1986;Khan et al, 1983;Granier et al, 1985;Sorensen et al, 19851, although the anxiolytic effects of mianserin have only been reported once prior to this study [Bodnoff et al, 19891 in animals. A possible explanation is that, prior to 1989, mianserin was only tested acutely, where it did not appear to produce any systematic effect (Fig.…”

Drug‐induced Obesity

“…In a subgroup of the patients, who were reintroduced to the pharmacological treatment, body weight increased by 3 to 12 kg (65). However, in other larger human studies comparing various anxiolytics with other psychotropic drugs in subjects without severe physical handicaps, weight gain has not been reported as a side effect (66,67). Weight loss has also been described (68).…”

Screening the Receptorome Yields Validated Molecular Targets for Drug Discovery

“…Thus, mirtazepine alone among the newer generation of antidepressants has been most commonly associated with weight gain [113] and is the only one among the serotonin-selective reuptake inhibitors (SSRI's), dual 5-HT/NE reuptake inhibitors (SNRI's) and others (including bupropione and nefazadone) to have high H1-receptor affinity ( Table 1). Finally, mianserin, an older antidepressant with a novel mechanism of action which causes weight gain [117], also has a pharmacological profile predictive of weight gain in humans. two tricyclic antidepressant medications long associated with weight gain-imipramine [114,115] and amitriptyline [116]have a pharmacological profile predictive of weight gain.…”