Efficacy and safety of add on low-dose mirtazapine in depression

Abstract

Objectives:Although antidepressant medications are effective, they have a delayed onset of effect. Mirtazapine, an atypical antidepressant is an important option for add-on therapy in major depression. There is insufficient data on mirtazapine in Indian population; hence this study was designed to study the add-on effect of low-dose mirtazapine with selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD) in Indian population.Materials and Methods:In an open, randomized study, 60 patients were divided into two groups. In Group A (n=30) patients received conventional SSRIs for 6 weeks. In Group B (n=30) patients received conventional SSRIs with low-dose mirtazapine for 6 weeks. Patients were evaluated at baseline and then at 1, 2, 3, 4, 5, and 6 weeks.Results:There was significant improvement in Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg depression rating scale (MADRS) scores (P<0.05) in both groups. Mirtazapine in low dose as add on therapy showed improvement in scores, had earlier onset of action, and more number of responders and remitters as compared to conventional treatment (P<0.05). No serious adverse event was reported in either of the groups.Conclusion:Low-dose mirtazapine as add-on therapy has shown better efficacy, earlier onset of action and more number of responders and remitters as compared to conventional treatment in MDD in Indian patients.

Curcumin Attenuates Chronic Unpredictable Mild Stress-Induced Depressive-Like Behaviors via Restoring Changes in Oxidative Stress and the Activation of Nrf2 Signaling Pathway in Rats

“…According to the WHO's prediction, depression is expected to become the world's second leading cause of disability by 2020 [ 2 ], leading to a huge social and economic burden on the modern society [ 3 ]. In currently clinical practice, many chemical treatments are used for depression, such as tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors [ 4 , 5 ]. However, the existing treatments were not effective to all patients [ 6 ] and also accompanied with unwanted side effects [ 7 , 8 ].…”

A systematic review and meta-analysis of trials of treatment of depression from India

“…Besides imipramine other drugs which have been evaluated include amitriptyline (5 trials), sertraline (4 trials), citalopram (3 trials), sintamil (3 trials), venlafaxine (3 trials), mirtazapine (3 trials), escitalopram (3 trials), milnacipran (2 trials), ECT (2 trials), and rTMS (3 trials). Two trials used Selective Serotonin Reuptake Inhibitors (SSRIs) as a class for evaluation of efficacy of “add-on” antidepressants[ 63 64 ] to various SSRIs and one trial has compared sertraline in depressed postmyocardial infarction patients with no therapy. [ 65 ] One trial each evaluated moclobamide, duloxetine, fluoxetine, bupropion, nortriptyline, fluphenazine add-on to nortriptyline, 5 hydroxytryptophan, duloxetine, niamide, phenelzine, centpropazine, iprindole, protriptyline, alprazolam, and sudarshan kriya.…”

“…The Jadad scores ranged from 0 to 5 with a median of 2 (mean of 1.97, mode 2). Newer studies had explicitly used intention-to-treat analysis,[ 34 50 54 58 59 63 64 ] while the older studies had not relied on such statistical procedures. [ 29 30 32 33 36 40 43 47 48 ] When correlation of the year of publication was drawn with risk of bias (measured with Jadad scale), there was no statistically significant correlation (Kendall tau correlation of −0.031, P=0.813).…”

“…Active rTMS was found to be superior to sham rTMS with effect size of 0.74 (CI 0.396-1.084) based on three studies[ 60 61 62 ] with a cumulative sample of 104 and considerable degree of heterogeneity (I 2 =54.89). Bupropion,[ 63 ] mirtazapine,[ 64 ] and fluphenazine[ 51 ] were found to be effective as an add-on treatment for depression (effect sizes of 0.859, 0.232, and 0.650, respectively). The forest plot of the included studies is shown in Figure 1 .…”

Effect of Five-Consecutive-Day Exposure to an Anxiogenic Stressor on Sleep-Wake Activity in Rats

“…There are many therapeutic options for treating depression such as psychotherapy (i.e., interpersonal, psychodynamic, and cognitive behavioral therapy; Buchheim et al, 2012), drug treatment (i.e., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, monoamine oxidase inhibitors, and tricyclics; Guelfi et al, 1992; Frazer, 1997; Pinder, 1997; Matreja et al, 2012), physical procedures (i.e., electroconvulsive therapy, Vagus nerve stimulation, acupuncture, and repetitive transcranial magnetic stimulation; Rush et al, 2005; Allen et al, 2006; Rachid and Bertschy, 2006; Gaynes et al, 2011; Martinez-Amoros et al, 2012), and general life changes (i.e., improvements in diet, exercise, and sleep; Bountziouka et al, 2009; Vallance et al, 2011). However, the efficacy of these treatment options has been shown to vary greatly, which warrants a better understanding of the etiology and pathophysiological mechanisms of depression and its associated symptoms.…”