title: Mirtazapine, in orodispersible form, for patients with preoperative psychological distress: A pilot study.
abstract: BACKGROUND
  Perioperative psychological distress is associated with preoperative anxiety, depression, and postoperative pain. Mirtazapine is effective as an antidepressant, anxiolytic agent, and sleep enhancer. Moreover, mirtazapine can be made as orodispersible tablets with a fast onset for patients in nil per os status. This study is to determine whether mirtazapine can help psychologically distressed patients reduce perioperative anxiety, depression, and postoperative pain.
  
  
  METHODS
  Patients with preoperative psychological distress, undergoing major abdominal surgery, were inquired and assigned to two groups according to their own choice. In the treatment group, patients could choose to take orodispersible mirtazapine 30 mg at each night from Preoperative Day 0 to Postoperative Day 3. There was no other intervention in the nontreatment group. Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), and pain scores were accessed on the day before operation (Day 0), and on the 1(st) day (Day 2) and 3(rd) day (Day 4) after operation. We compared the HADS, AIS, and pain scores, and morphine consumptions between the two groups on a daily basis. Marginal regression models were fitted to our correlated longitudinal data alone with the generalized estimating equations method to estimate the population average effects of time-varying mirtazapine usage on the mean values of HADS, AIS, and pain scores, and daily morphine consumptions.
  
  
  RESULTS
  From September 2007 to December 2008, 86 patients agreed to be enrolled and 79 of them completed the study. Propensity scores and multivariate analysis showed that mirtazapine reduced HADS scores of patients in 2 days. Trial results indicated that mirtazapine lowered the AIS day index and tended to decrease night index as well. Mirtazapine may reduce patients' morphine consumption, but this effect was not statistically significant (p = 0.2).
  
  
  CONCLUSIONS
  Mirtazapine helps reduce anxiety, depression, and insomnia scores for patients with perioperative psychological distress.
authors.affiliation: Department of Anesthesiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Chou
authors.affiliation: Department of Anesthesiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Feng-Sheng
authors.initials: FS
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Chih-Peng
authors.initials: CP
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, Jin-Shan Branch of National Taiwan University Hospital, New Taipei City, Taiwan.
authors.forename: Jr-Chi
authors.initials: JC
authors.lastname: Yie
authors.affiliation: Department of Anesthesiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan. Electronic address: wzsun@ntu.edu.tw.
authors.forename: Wei-Zen
authors.initials: WZ
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D010865:Pilot Projects; D057234:Preoperative Period; D057216:Propensity Score
chemical_list: D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D000078785:Mirtazapine
keywords: antidepressant; insomnia; mirtazapine; perioperative anxiety; perioperative depression