Mianserin added to tricyclic antidepressants in depressed patients not responding to a tricyclic antidepressant alone: A randomized, placebo-controlled, double-blind study

Abstract

Medhus A, Heskestad S, Tjemsland L. Mianserin added to tricyclic antidepressants in depressed patients not responding to a tricyclic antidepressant alone. A randomized, placebo-controlled, double-blind study. Nord J Psychiatry 1994;48:355-358. Oslo. ISSN 0803-9488.The purpose of this study was to investigate whether depressed patients not responding to tricyclic antidepressants (TCA) would respond on addition of 3060 mg mianserin. Thirtyseven in-and out-patients still fulfilling DSM-III criteria for a major depressive episode after at least 4 weeks of treatment with 150 mg-TCA were randomly allocated to two groups receiving in addition either mianserin or placebo. The study was conducted double-blind and lasted for 3 weeks. There was a significantly better improvement in the mianserin-TCA group than in the placebo-TCA group after 3 weeks of treatment as measured on the Montgomery-Asberg's Depression Scale and the Global Assessment Scale. There were no differences in side effects between the two groups. Three patients did not complete the study.Our data indicate that mianserin may be added to a tricyclic antidepressant in non-responders with improved antidepressive effect and that this is a safe strategy for augmentation therapy with regard to side effects.Nord J Psychiatry Downloaded from informahealthcare.com by University of North Carolina on 12/15/14For personal use only.

Combining antidepressants: a review of evidence

“…There are two double-blind controlled studies of TCAs used in combination with mianserin (Lauritzen 1992;Medhus 1994). These reported encouraging results, although the numbers were small (total n = 57) and the treatment period was brief.…”

Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve Practice

“…Another double-blind study (n = 31) has shown higher response rates among patients treated with fluoxetine plus mianserin than among those treated with fluoxetine alone at initiation of treatment [58]. Mianserin augmentation has been reported anecdotally to be effective in depressed patients unresponsive to TCA alone [145], and fluoxetine nonresponders achieved greater efficacy when mianserin was added to fluoxetine than when placebo was added [146]. A more recent study found adding mianserin in sertraline nonresponders had no advantage over adding placebo [147], but the initial trial with sertraline monotherapy was too brief and a dose increase of sertraline was carried out 2 weeks prior to randomization, thereby confounding the results.…”

Treatment strategies in patients with major depression not responding to first-line sertraline treatment

“…Finally, although the SSRIs sertraline and fluoxetine presumably have equivalent efficacy (Aguglia et al 1993), they are different compounds, perhaps with differential potentials when combined with mianserin. Previous studies have indicated that the addition of mianserin to a TCA may increase the antidepressant response (Lauritzen et al 1992;Medhus et al 1994). …”