Remission with mirtazapine and selective serotonin reuptake inhibitors: a meta-analysis of individual patient data from 15 controlled trials of acute phase treatment of major depression.

Abstract

Antidepressants that enhance both serotonergic and noradrenergic neurotransmission may be more effective than selective serotonin reuptake inhibitors (SSRIs) for acute-phase therapy of major depressive disorder. Mirtazapine in particular has been suggested to have a faster onset of action than reuptake inhibitors. The aim of this study is to compare the remission rates and time to remission in patients with major depression taking either mirtazapine or an SSRI in an all-inclusive set of studies. Data were obtained from all eligible randomized controlled studies contrasting mirtazapine and SSRIs. Meta-analyses of remission rates and time to remission, together with a supportive analysis of mean change from baseline Hamilton Depression Rating Scales-17 were performed, using individual patient data from 15 randomized controlled trials of mirtazapine (N = 1484) versus various SSRIs (N = 1487) across 6 weeks of double-blind therapy. Analyses were repeated for the eight studies that lasted at least 8 weeks. Remission rates for patients treated with mirtazapine were significantly higher when compared with those treated with an SSRI after 1 (3.4 vs. 1.6%, P = 0.0017), 2 (13.0 vs. 7.8%, P<0.0001), 4 (33.1 vs. 25.1%, P<0.0001), and 6 weeks (43.4 vs. 37.5%, P = 0.0006) of treatment. Mirtazapine-treated patients had a 74% higher likelihood of achieving remission during the first 2 weeks of therapy compared with patients treated with SSRIs. In conclusion, the findings indicate that mirtazapine may be a more rapidly effective antidepressant than SSRIs.

• Authors: Michael E Thase, Andrew A Nierenberg, Peter Vrijland, Helga J J van Oers, Albert-Jan Schutte, John H Simmons
• Journal: International clinical psychopharmacology (Int Clin Psychopharmacol) Vol. 25 Issue 4 Pg. 189-98 (Jul 2010) ISSN: 1473-5857 [Electronic] England
• PMID: 20531012 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Antidepressive Agents, Tricyclic
• Serotonin Uptake Inhibitors
• Fluoxetine
• Citalopram
• Mianserin
• Paroxetine
• Mirtazapine
• Fluvoxamine
• Sertraline

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antidepressive Agents, Tricyclic (administration & dosage, therapeutic use)
• Citalopram (administration & dosage, therapeutic use)
• Depressive Disorder, Major (diagnosis, drug therapy)
• Double-Blind Method
• Female
• Fluoxetine (administration & dosage, therapeutic use)
• Fluvoxamine (administration & dosage, therapeutic use)
• Humans
• Male
• Mianserin (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Middle Aged
• Mirtazapine
• Paroxetine (administration & dosage, therapeutic use)
• Patient Dropouts (statistics & numerical data)
• Psychiatric Status Rating Scales
• Randomized Controlled Trials as Topic
• Remission Induction
• Selective Serotonin Reuptake Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Sertraline (administration & dosage, therapeutic use)
• Treatment Outcome
• Young Adult