The effect of mirtazapine in panic disorder: an open label pilot study with a single-blind placebo run-in period

Abstract

In this open label pilot study, we studied the efficacy of mirtazapine (Remeron) in panic disorder. Twenty-eight patients with a DSM-IV diagnosis of panic disorder, with or without agoraphobia (10 males/18 females), were included and 19 patients completed the study. The 15-week trial started with a 3-week single-blind placebo run-in period. After this run-in period, the 12-week active treatment phase started. As primary efficacy measures, we studied the decrease in the number of full symptom panic attacks and the number of patients completely free of panic during the last 3 weeks of the study. Seventy-four percent of the patients were considered responders, according to a decrease of at least 50% in panic attack frequency. All primary and secondary efficacy measures showed a significant improvement from the second week of active treatment onwards to endpoint. The main side-effects were different from the usual side-effects in selective serotonin reuptake inhibitors (SSRIs) (initial drowsiness, weight gain and pain in the legs). The results of this open label study in panic disorder suggest that mirtazapine seems to be a fast and effective treatment alternative for SSRIs in panic disorder.

Novel Antidepressants and Panic Disorder: Evidence beyond Current Guidelines

“…In a first case series, very good response rates were found [18] . Similar results were observed in a following study [19] in a larger sample. The analyses also showed a consistent reduction in many psychological scales such as the Hamilton scale for depression (HAM-D) [20] (p !…”

“…The most commonly reported side effects ( 1 10%) related to mirtazapine were drowsiness [19,25,26] , weight gain [19,25,26] , blurred vision [25] , increased appetite [19] , muscle pain [19] and tiredness [19] . Further side effects ( !…”

“…Sexual dysfunction was not assessed in any study. Less than 10% of the patients treated with mirtazapine discontinued the trials prematurely, particularly because of weight gain [19,25,26] , excessive sedation and headache [24] .…”

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

“…The drug has proven its good efficacy as an antidepressant 19,20,33,34 as well as in panic disorders 38,39 . As a potentially beneficial drug for use in chronic pain, it might thus be favoured by patients and their treating physicians and our study results may reflect this.…”

Panic Attacks During Escalation of Mirtazapine

“…4 Mirtazapine has shown favorable results in 4 open-label studies and a case series. [5][6][7][8][9] However, there is a case report of a panic attack that occurred during the discontinuation of mirtazapine. 10 The panic attacks were unexpected but could have occurred due to increasing serotonergic transmission that produced a short-lived anxiety similar to that sometimes seen when using serotonin reuptake inhibitors.…”