Whether to increase or maintain dosage of mirtazapine in early nonimprovers with depression.
OBJECTIVE
To compare outcomes between increasing versus maintaining the dose of mirtazapine in patients with depression without initial improvement.


METHODS
Data from a 6-week double-blind randomized placebo-controlled trial of mirtazapine in major depressive disorder (DSM-IV) conducted from November 2004 to December 2005 were used. Percentages of remitters (ie, a score of ≤ 7 in the 17-item Hamilton Depression Rating Scale [HDRS-17]) and HDRS-17 score changes from baseline to week 6 were compared in the following 2 pairs, using Fisher exact test or mixed-effects model for repeated measures: (1) subjects who failed to show a ≥ 20% decrease in the HDRS-17 total scores at week 1 but were assigned to continue 15 mg/d (stay(15) group) versus those who were assigned to increase the dose to 30 mg/d (increase(30) group) and (2) subjects who failed to show a ≥ 20% decrease in the HDRS-17 total scores with 30 mg/d at week 2 but were assigned to continue 30 mg/d (stay(30) group) versus those who were assigned to increase the dose to 45 mg/d (increase(45) group).


RESULTS
The increase(30) group showed a numerically but not significantly higher remission rate and a significantly greater decrease in the HDRS-17 total score at week 6 than the stay(15) group (34.7% [8 of 23 patients] vs 14.3% [3 of 21 patients], P = .2; least squares mean, -15.8 vs -10.9, P = .003). No significant differences were found between the increase(45) and stay(30) groups.


CONCLUSIONS
Dose increase of mirtazapine from 15 mg/d to 30 mg/d may be effective for patients with depression without initial improvement. However, effectiveness may not be the case beyond 30 mg/d.


BACKGROUND
JapicCTI identifier: 152830.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Fumihiko
F
Ueno
Shinichiro
S
Nakajima
Takefumi
T
Suzuki
Takayuki
T
Abe
Yuji
Y
Sato
Masaru
M
Mimura
Hiroyuki
H
Uchida
D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000009:adverse effects; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008875:Middle Aged; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D017211:Treatment Failure
D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D000078785:Mirtazapine