Depressed in-patients respond differently
to imipramine and mirtazapine

by
Bruijn JA, Moleman P, Mulder PG, van den Broek WW
Department of Psychiatry,
"Dijkzigt" University Hospital,
Rotterdam, The Netherlands.
Pharmacopsychiatry 1999 May; 32(3):87-92


ABSTRACT

Tricyclic antidepressants and more recent antidepressants are generally considered to have equivalent efficacy in the treatment of depression. After a previous report of a marked difference in the response to mirtazapine compared to imipramine, we report here an analysis of different symptom clusters. One hundred seven consecutive in-patients with major depression (Diagnostic and Statistical Manual III-R, DSM-III-R) and a Hamilton Rating Scale for Depression (HRS-D) score of 18 points or more were randomly assigned to double-blind treatment. Two and four weeks after predefined blood levels had been obtained, the severity of depression was assessed using the HRS-D. The mean dosages used were 235 mg/day of imipramine and 77 mg/day of mirtazapine, the latter being in excess of the 15-45 mg/day range currently advised. Total HRS-D scores and seven symptom clusters were analyzed in the 85 patients (79%) who were not receiving any co-medication. Imipramine was more effective against the clusters related to core symptoms of depression: "depression and guilt", "retardation", and "melancholia", respectively. Mirtazapine showed a biphasic response with regard to the clusters "sleep" and "anxiety/agitation", respectively, which consisted of a marked response after two weeks of predefined blood level, but with a waning of this effect at four weeks. Imipramine produced a more gradual response on these clusters, which was more pronounced at four weeks than with mirtazapine. Two aspects of the present study could be related to this finding: blood level control resulted in optimal treatment with imipramine but not mirtazapine, and - most importantly - the patients were not receiving any anxiolytic or hypnotic co-medication. These findings suggest that mirtazapine may have anxiolytic and sedative properties and fewer antidepressant properties than imipramine in severely depressed in-patients.
TCAs
SSRIs
Options
Anhedonia
Imipramine
Melancholy
Mirtazapine
Mirtazapine v SSRIs
Mirtazapine: overview
Mirtazapine: structure
Mirtazapine v venlafaxine
Imipramine and depression
Mirtazapine and depression
Antidepressant mechanisms
Mirtazapine and the receptors
Mirtazapine: pharmacokinetics
Mirtazapine and sexual behaviour
Amitriptyline (Elavil) plus mirtazapine (Remeron)
Mirtazapine as an antidepressant: safety and efficacy
How effective are commonly prescribed antidepressants?


Refs
and further reading

HOME
HedWeb
Nootropics
Cocaine.org
Future Opioids
BLTC Research
MDMA/Ecstasy
Superhapiness?
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family