The addition of mirtazapine to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor was more effective in treating generalised anxiety in patients with treatment-resistant depression (TRD) and severe anxiety symptoms.
Mirtazapine may also be more effective in treating depressive symptoms and improving social functioning in those with higher levels of anxiety.
Conversely, there appears to be little clinical utility in adding mirtazapine in patients with TRD and without any concurrent anxiety.
Why this matters
Findings warrant further research to assess the benefits of mirtazapine in treating TRD with severe symptoms of generalised anxiety.
A secondary analysis of MIR trial including 480 patients with TRD.
All patients were stratified into 3 groups based on generalized anxiety disorder score (GAD-7): mild (GAD-7, ≤10), moderate (GAD-7, 11-15) and severe (GAD-7, ≥16).
The effect of baseline anxiety on the response of patients to mirtazapine was measured using 12-week GAD-7 and Beck Depression Inventory II (BDI-II) scores.
Funding: None disclosed.
At 12 weeks, baseline generalised anxiety moderated the efficacy of mirtazapine as measured by GAD-7 (P=.041) and BDI-II (P=.088).
Patients with severe generalised anxiety receiving mirtazapine vs placebo had:
lower GAD-7 score (adjusted difference between means [ADM], 2.82, 95% CI, −0.69 to −4.95); and
larger reductions in BDI-II score (ADM, −6.36; 95% CI, −1.60 to −10.84).
In patients with no/mild generalised anxiety, no anxiolytic (ADM, 0.28; 95% CI, −1.05 to 1.60) or antidepressant benefit (ADM, −0.17; 95% CI, −3.02 to 2.68) was seen with mirtazapine vs placebo.
Post hoc analysis.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
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Cite this: Sarfaroj Khan. Treatment-resistant Depression: Does Anxiety Moderate the Efficacy of Mirtazapine? - Medscape - Nov 11, 2020.