Meta‐analysis of randomized, double‐blind, dacebo‐controlled, efficacy and safety studies of mirtazapine versus amitripcyline in major depression

Abstract

A meta‐analysis was performed on efficacy and safety data from 4 randomized, double‐blind, 6‐week, single‐center studies comparing mirtazapine (n= 194; 5–35 mg/day) with amitriptyline, (n= 193, 40–280 mg/day) and placebo (n= 193) in outpatients with a DSM‐III diagnosis of major depressive episode. On all the main cllicacy variables both active drugs consistently produced significantly greater improvements and significantly greater percentages of responders or remitters than placebo. The meta‐analysis of adverse events shows that mirtazapine was better tolerated than amitriptyline, particularly with respect to anticholinergic and cardiac adverse events. There were no differences between mirtazapine and placebo regarding the incidence of serotonergic adverse events. In conclusion, the results of this meta‐analysis demonstrate that mirtazapine is as effective as amitriptyline but has a better tolerability profile.

Sexual functioning in depressed outpatients taking mirtazapine

“…Mirtazapine is an atypical antidepressant with α2 adrenergic and serotonergic 5-HT2 and 5-HT3 receptor-blocking activity [Stahl et al, 1998]. It does not decrease and theoretically may increase sexual desire, arousal, and/or function.…”

Drug treatment of depression in the 2000s: an overview of achievements in the last 10 years and future possibilities

“…Bech used the same four placebo-controlled trials with amitriptyline as an active control as Stahl et al, and an additional three placebo-controlled studies without an active control (Stahl et al 1997;Bech 2001). His main aim was to show whether mirtazapine (and amitriptyline) possesses a 'pure' antidepressive activity.…”

“…In the meantime two further meta-analyses (beside that of Kasper (1995) (Stahl et al 1997). On all main efficacy variables both active drugs consistently produced significantly greater improvements and significantly greater percentages of responders and remitters than placebo.…”

The effect of mirtazapine in patients with chronic pain and concomitant depression

“…As a matter of clinical pragmatism, all available evidence must be considered in seeking potential alternatives to 'approved' regimens, in particular if side effects of antidepressive drugs inhibit their application, but an antidepressive/analgesic treatment is strongly indicated. Mirtazapine seems to be a more tolerable drug than the traditional TCAs, particularly because it lacks the anticholinergic side effects [40][41][42][43] . In our study, mirtazapine showed a low overall drop-out rate for a central-acting compound (15%) and a highly-acceptable adverse effect profile which is reflected by the low rate of unexpected adverse events (< 7%) compared to levels reported for other antidepressants such as milnacipran, fluoxetine or TCA 44,45 .…”