title: Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine.
abstract: OBJECTIVE
  This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms.
  
  
  METHODS
  Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit.
  
  
  RESULTS
  There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients.
  
  
  CONCLUSIONS
  Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.
authors.affiliation: Ankara Oncology Training and Research Hospital, Psychiatry Clinic, Ankara, Turkey. eylemcankurtaran@yahoo.com
authors.forename: Eylem Sahin
authors.initials: ES
authors.lastname: Cankurtaran
authors.forename: Elvan
authors.initials: E
authors.lastname: Ozalp
authors.forename: Haldun
authors.initials: H
authors.lastname: Soygur
authors.forename: Derya Iren
authors.initials: DI
authors.lastname: Akbiyik
authors.forename: Levent
authors.initials: L
authors.lastname: Turhan
authors.forename: Necati
authors.initials: N
authors.lastname: Alkis
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000188:drug therapy* / Q000209:etiology; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000209:etiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009369:Neoplasms / Q000523:psychology*; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement; D011594:Psychometrics; D012647:Self-Assessment; D016037:Single-Blind Method; D012890:Sleep / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology
chemical_list: D000317:Adrenergic alpha-Antagonists; D000929:Antidepressive Agents, Tricyclic; D006634:Histamine H1 Antagonists; D008803:Mianserin; D000078785:Mirtazapine; D007099:Imipramine