title: More evidence on additive antipsychotic effect of adjunctive mirtazapine in schizophrenia: an extension phase of a randomized controlled trial.
abstract: OBJECTIVE
  Adjunctive mirtazapine improved negative symptoms of schizophrenia in several studies. Recently, we found an improvement also in positive symptoms when mirtazapine was added to first generation antipsychotics (FGAs) in a 6 week randomized controlled trial (RCT). The short duration of that trial was its limitation. This study aimed to explore whether longer treatment is worthwhile.
  
  
  METHODS
  Completers of the RCT (n = 39) received open-label add-on mirtazapine for additional 6 weeks. The Positive and Negative Syndrome Scale (PANSS) total score (primary outcome) and several other clinical parameters were measured prospectively.
  
  
  RESULTS
  During the open-label phase, significant improvement was achieved in all parameters, with an effect size of 0.94 (CI 95% = 0.45-1.43) on the primary outcome and an impressive additive antipsychotic effect. Patients who received mirtazapine during both phases demonstrated greater improvement in positive symptoms (29.6% versus 21.2%, p = 0.027) than those who received mirtazapine during open-label extension phase only.
  
  
  CONCLUSIONS
  These findings support our previous data on the additive antipsychotic effect of mirtazapine in FGAs-treated schizophrenia. Mirtazapine may be effective in other symptom domains, too. Longer duration of mirtazapine treatment may yield additional benefits. If these results will be confirmed in larger studies, add-on mirtazapine may become a feasible option in difficult-to-treat schizophrenia.
authors.affiliation: Kellokoski Hospital, Kellokoski, Finland. viacheslav.terevnikov@hus.fi
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Terevnikov
authors.forename: Jan-Henry
authors.initials: JH
authors.lastname: Stenberg
authors.forename: Marina
authors.initials: M
authors.lastname: Joffe
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.forename: Mark
authors.initials: M
authors.lastname: Burkin
authors.forename: Evgueni
authors.initials: E
authors.lastname: Tchoukhine
authors.forename: Grigori
authors.initials: G
authors.lastname: Joffe
mesh_terms: D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D008803:Mianserin; D000078785:Mirtazapine