title: More evidence on proneurocognitive effects of add-on mirtazapine in schizophrenia.
abstract: Enhancement of neurocognition is essential in the treatment of schizophrenia. In our previously reported six-week randomized controlled trial (RCT) mirtazapine added to conventional antipsychotics improved not only negative, but also positive symptoms and neurocognition in difficult-to-treat schizophrenia. The present study aimed to explore whether a prolonged exposure to mirtazapine could further improve neurocognition. Completers of the RCT who were able and willing to proceed to the extension phase received open label mirtazapine for an additional 6 weeks. During the extension phase, both groups (i.e., patients who previously received mirtazapine and those who received placebo) and the whole population showed improvement on a number of neurocognitive tests. Patients who shifted to open label mirtazapine from placebo achieved in the six following weeks similar results as their initially mirtazapine-treated counterparts did during their first 6 weeks of mirtazapine exposure. Middle-term mirtazapine treatment (12 weeks) demonstrated an advantage over short-term mirtazapine treatment (6 weeks) on Stroop Dots time and Trail Making Test, part B, number of mistakes (t = -2.562, p = 0.035 and t = -2.42, p = 0.043, correspondingly). Mirtazapine added to antipsychotics consistently shows desirable effects on neurocognition. Lengthy treatment seems worthwhile. Mirtazapine may become a safe and cost-saving neurocognitive enhancer in schizophrenia, yet more studies are needed.
authors.affiliation: Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. jan-henry.stenberg@hus.fi
authors.forename: Jan-Henry
authors.initials: JH
authors.lastname: Stenberg
authors.forename: Viatcheslav
authors.initials: V
authors.lastname: Terevnikov
authors.forename: Marina
authors.initials: M
authors.lastname: Joffe
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.forename: Evgueni
authors.initials: E
authors.lastname: Tchoukhine
authors.forename: Mark
authors.initials: M
authors.lastname: Burkin
authors.forename: Grigori
authors.initials: G
authors.lastname: Joffe
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D056344:Executive Function / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000187:drug effects; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000187:drug effects; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D057190:Stroop Test; D014145:Trail Making Test; D014705:Verbal Behavior; D014796:Visual Perception / Q000187:drug effects; D014888:Wechsler Scales
chemical_list: D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D008803:Mianserin; D000078785:Mirtazapine