Mirtazapine in Routine Psychiatric Practice

Overview

60 psychiatrists cooperated in a study of the effects of mirtazapine in 284 depressed patientstreated in routine psychiatric out-patient clinics. The severity of the disease was rated by theClinical Global Impression (CGI) scale during pretreatment, after the first and third weeks andafter six weeks treatment. The gender and age of the patients was comparable to the figuresfound in prevalence studies, abroad. There were 10 drop-outs, 9 because of adverse events, 1because of insufficient therapeutic effects. The dosage in the majority of patients was 30 mg/day,the mean dose was 32.11 mg/day. The dose was higher in patients with a greater severity of theillness according to the CGI. When treatment with mirtazapine was started, 188 patients were ontheir previous antidepressants, whereas only 34 were getting them during posttreatment. Thenumber of patients with anxiolytics decreased from 36 to 12. Gender and age were not related tothe effects of the treatment.93.3% of the patients were rated as at least „moderately ill“ (CGI score 4 or higher) before treat-ment with mirtazapine, their number decreased to 54.9% already after the first week, and to 7%after treatment. Doctors were satisfied with the results in 95.12% of patients, the relative numberof patients expressing satisfaction was 94.7%. Post hoc comparison with 1404 patients treatedunder the same conditions with SSRI showed that 80.3 % had a CGI score 4 or higher duringpreatreatment. 12% had such a score after 6 weeks of treatment. The therapeutic effect of mirtaza-pine appeared earlier and the number of patients who responded favourably to mirtazapine wasgreater compared to SSRIs. Adverse events were rare and mild. Somnolence and tiredness at thebeginning were the most common adverse events, in 6.67 and 5.69% patients respectively. Onlytwo patients (0.7%) complained about sexual dysfunction.

Key words:
mirtazapine, serotonin, clinical global impression (CGI), sexual dysfunction.