A double‐blind multicentre comparison of mirtazapine and amitriptyline in elderly depressed patients

Abstract

A total of 115 elderly patients (60-85 years of age) with DSM III diagnosis of major depressive episode were randomly assigned to 6 weeks of treatment with either mirtazapine, 15-45 mg/day, or amitriptyline, 30-90 mg/day. Efficacy was assessed biweekly, using the Hamilton Rating Scale for Depression (HRSD) and Montgomery and Asberg Depression Rating Scale (MADRS) as primary outcome variables. The treatment with both drugs resulted in a similar reduction of total HRDS and MADRS scores, with no statistically significant differences between treatment groups at any assessment point or at endpoint. Statistically significant differences favouring amitriptyline were present according to CGI-Global Improvement Scale at endpoint, HRDS cognitive disturbance factor at weeks 2, 4 and 6 and endpoint and retardation factor at week 6. Adverse events were reported by a similar number of patients in both treatment groups. Additional research is needed to assess further the efficacy and tolerability of mirtazapine among elderly depressed patients.

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

“…Other than this one study, there are no other published placebo-controlled trials of mirtazapine in the elderly. Mirtazapine has also been compared with amitriptyline (Hoyberg et al, 1996) and paroxetine (Schatzberg et al, 2002). Although both studies found comparable efficacy between agents, in the paroxetinemirtazapine comparison, the mirtazapine group appeared to have a faster decrease in mean HAM-D (17 item) scores.…”

MAOA gene polymorphisms and response to mirtazapine in major depression

“…Unlike other pharmacogenetic studies involving antidepressants, this study used a single antidepressant rather than multiple medications, which may reduce the variation in the pharmacological mechanism of action among individuals (Behnke et al, 2003;Bruijn et al, 1999;Hoyberg et al, 1996;Leinonen et al, 1999) and minimize the effects of other biological differences (Haapasalo-Pesu et al, 2004;Murphy et al, 2004). Depression is a multifactoral disorder and probably involves multiple genes.…”

Late-Life Depression: Rationalizing Pharmacological Treatment Options

“…Reboxetine showed similar efficacy to imipramine in depressed elderly patients [103,104]. Mirtazapine has shown similar efficacy to amitriptyline in elderly depressed patients [44]. In a placebo-controlled study in depressed patients over the age of 55, mirtazapine was superior to trazodone [105].…”

“…Efficacy A number of placebo-controlled and active comparator studies, mainly using amitriptyline or imipramine, have demonstrated the efficacy of tricyclic antidepressants (TCAs) in the elderly [40][41][42][43][44][45][46][47]. In patients with depression and Alzheimer's disease, clomipramine [48], but not imipramine [49], has shown superiority to placebo.…”