Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss.
OBJECTIVE
To explore the effects and mechanism of action of antidepressant mirtazapine in functional dyspepsia (FD) patients with weight loss.


METHODS
Sixty depressive FD patients with weight loss were randomly divided into a mirtazapine group (MG), a paroxetine group (PG) or a conventional therapy group (CG) for an 8-wk clinical trial. Adverse effects and treatment response were recorded. The Nepean Dyspepsia Index-symptom (NDSI) checklist and the 17-item Hamilton Rating Scale of Depression (HAMD-17) were used to evaluate dyspepsia and depressive symptoms, respectively. The body composition analyzer was used to measure body weight and fat. Serum hormone levels were measured by ELISA.


RESULTS
(1) After 2 wk of treatment, NDSI scores were significantly lower for the MG than for the PG and CG; (2) After 4 or 8 wk of treatment, HAMD-17 scores were significantly lower for the MG and PG than for the CG; (3) After 8 wk of treatment, patients in the MG experienced a weight gain of 3.58 ± 1.57 kg, which was significantly higher than that observed for patients in the PG and CG. Body fat increased by 2.77 ± 0.14 kg, the body fat ratio rose by 4%, and the visceral fat area increased by 7.56 ± 2.25 cm(2); and (4) For the MG, serum hormone levels of ghrelin, neuropeptide Y (NPY), motilin (MTL) and gastrin (GAS) were significantly upregulated; in contrast, those of leptin, 5-hydroxytryptamine (5-HT) and cholecystokinin (CCK) were significantly downregulated.


CONCLUSIONS
Mirtazapine not only alleviates symptoms associated with dyspepsia and depression linked to FD in patients with weight loss but also significantly increases body weight (mainly the visceral fat in body fat). The likely mechanism of mirtazapine action is regulation of brain-gut or gastrointestinal hormone levels.
Shu-Man Jiang, Lin Jia, Jing Liu, Man-Man Shi, Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China.
Shu-Man
SM
Jiang
Shu-Man Jiang, Lin Jia, Jing Liu, Man-Man Shi, Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China.
Lin
L
Jia
Shu-Man Jiang, Lin Jia, Jing Liu, Man-Man Shi, Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China.
Jing
J
Liu
Shu-Man Jiang, Lin Jia, Jing Liu, Man-Man Shi, Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China.
Man-Man
MM
Shi
Shu-Man Jiang, Lin Jia, Jing Liu, Man-Man Shi, Department of Gastroenterology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China.
Ming-Zhi
MZ
Xu
D050154:Adiposity / Q000187:drug effects; D000328:Adult; D000339:Affect / Q000187:drug effects*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D057189:Checklist; D002681:China; D003863:Depression / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004415:Dyspepsia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D050152:Intra-Abdominal Fat / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects*
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D006728:Hormones; D008803:Mianserin; D017374:Paroxetine; D000078785:Mirtazapine
Depression; Functional dyspepsia; Mirtazapine; Weight loss