Double-Blind, Randomized Comparison of Mirtazapine and Paroxetine in Elderly Depressed Patients

Schatzberg, Alan F.; Kremer, C.M.E.; Rodrigues, H.; Murphy, Greer M.

doi:10.1097/00019442-200209000-00007

Cited by 177 publications

(52 citation statements)

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“…The methods for recruiting the study population and collecting the clinical data have been previously described [Schatzberg et al, 2002; Murphy et al, 2003]. Briefly, the study group included 246 outpatients from 18 clinics in the U.S. with major depressive disorder who were treated with either mirtazapine or paroxetine in an 8‐week, double‐blind, randomized trial.…”

Section: Methodsmentioning

confidence: 99%

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FKBP5 polymorphisms and antidepressant response in geriatric depression

Sarginson

Lazzeroni

Ryan

et al. 2010

American J of Med Genetics Pt B

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Genetic variation at the FKBP5 locus has been reported to affect clinical outcomes in patients treated with antidepressant medications in several studies. However, other reports have not confirmed this association. FKBP5 may regulate the sensitivity of the hypothalamic–pituitary–adrenal axis. We tested two FKBP5 single nucleotide polymorphisms (rs1360780 and rs3800373) in a sample of 246 geriatric patients treated for 8 weeks in a double-blind randomized comparison trial of paroxetine and mirtazapine. These two polymorphisms had previously been reported to predict efficacy in depressed patients treated with selective serotonin reuptake inhibitors such as paroxetine, and those treated with mirtazapine, an agent with both serotonergic and noradrenergic actions. However, we found no significant associations between these FKBP5 genetic variants and clinical outcomes. Neither mean Hamilton Depression Rating Scale scores nor time to remission or response were predicted by FKBP5 genetic variation. These results suggest that FKBP5 is unlikely to play a major role in determining antidepressant treatment outcomes in geriatric patients.

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Section: Methodsmentioning

confidence: 99%

“…A comparison across the genotype groups for demographic and clinical characteristics was carried out using Chi‐squared tests or ANOVA. A complete comparison of demographic and clinical characteristics between drug treatment groups can be found in Schatzberg et al 2002.…”

Section: Methodsmentioning

confidence: 99%

FKBP5 polymorphisms and antidepressant response in geriatric depression

Sarginson

Lazzeroni

Ryan

et al. 2010

American J of Med Genetics Pt B

Self Cite

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“…A small, open trial also showed fluvoxamine to be effective in older patients with GAD, panic disorder, or OCD [1362]. Data in patients with MDD, suggest that mirtazapine may have beneficial anxiolytic effects in the elderly [1363,1364]. …”

Section: Special Populationsmentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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“…None of the RCTs were powered or designed to capture adverse events and SOE was most frequently downgraded due to imprecision and suspected selective outcome reporting. Any AE, bleed-UGI, blood pressure, cognitive function, falls, fracture, mortality, seizures, serious AEs, hyponatremia, suicide/attempt, weight, withdrawal due to AE SSRI vs. TCA 3 RCTs [16][17][18] Any AE, cognitive impairment, hospitalization, mortality, serious AE, withdrawal due to AE SSRI vs. SSRI 4 RCTs 7-9, 21 1 OBS 27 Any AE, blood pressure, cognitive function, hospitalization, mortality, serious AE, suicide/attempt, withdrawal due to AE SNRI vs. placebo/no antidepressant 4 RCTs 10,19,24,25 1 OBS 26 Any AE, bleed-UGI, blood pressure, cognitive function, ECG-arrhythmia, ECG-QTc, falls, fractures, mortality, serious ADEAE, seizures, sodium/hyponatremia, suicidal thoughts, suicide/attempt, weight, withdrawal due to AE SNRI vs. SSRI 2 RCTs 10,20 Any AE, blood pressure, falls, fractures, mortality, serious AE, weight, withdrawal due to AE Bupropion vs. placebo 1 RCT 23 Any AE, blood pressure, ECG-arrhythmia, mortality, seizures, serious AE, suicidal thoughts, withdrawal due to AE Mirtazapine vs. no antidepressant 1 OBS 26 Any AE, bleed-UGI, falls, fractures, mortality, seizures, hyponatremia, suicide attempt Mirtazapine vs. SSRI 1 RCT 22 Any AE, blood pressure, hospitalization, serious AE, weight, withdrawal due to AE Trazodone vs. no antidepressant 1 OBS 26 Any AE, bleed-UGI, falls, fractures, mortality, seizures, hyponatremia, suicide attempt Vortioxetine vs. placebo 1 RCT 25 Any AE, blood pressure, cognitive function, ECG-QTc, fractures, serious AE, sodium, suicidal thoughts, suicide/attempt, weight, withdrawal due to AE Vortioxetine vs. SNRI 1 RCT 25 Any AE, blood pressure, cognitive function, ECG-QTc, fractures, serious AE, sodium, suicidal thoughts, suicide/attempt, weight, withdrawal due to AE Abbreviations: AE=adverse event; ECG=electrocardiogram; OBS=observational; RCT=randomized controlled trial; SNRI=selective norepinephrine reuptake inhibitor; SSRI= selective serotonin reuptake inhibitor; TCA=tricyclic antidepressant; UGI=upper gastrointestinal Key Question (KQ) 1 aimed to evaluate the adverse events and comparative adverse events of antidepressants. Results for KQ 1 are presented in Tables C and D. Although we aimed to evaluate SSRIs and SNRIs on a class basis, data for few individual drugs within the classes were identified.…”

Section: Resultsmentioning

confidence: 99%

Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults

Sobieraj¹

2019

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Purpose of Review To assess adverse events of antidepressants in the treatment of major depressive disorder in adults 65 years of age or older. Key Messages In people 65 years of age or older: • Serotonin norepinephrine reuptake inhibitors (SNRIs) (duloxetine and venlafaxine) cause adverse events more often than placebo and most likely lead to discontinuation of therapy during treatment of up to 12 weeks. • Selective serotonin reuptake inhibitors (SSRIs) (escitalopram and fluoxetine) most likely cause adverse events at a similar frequency to placebo therapy but still may lead to discontinuation of therapy during treatment of up to 12 weeks. • Duloxetine most likely increases the risk of falls over longer treatment (<24 weeks) • Adverse events contributing to discontinuation of therapy were rarely reported in a way that allowed clear characterization of what adverse events to expect. • Few studies compared other antidepressants to placebo or to each other, or reported other outcomes. Trial data were sparse, and trials were short in duration, underpowered, and studied low doses of antidepressants. Observational studies had limitations related to their design. Long-term, rigorous comparative studies are needed. iii This report is based on research conducted by the University of Connecticut Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00012-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help healthcare decision makers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be develo...

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Double-Blind, Randomized Comparison of Mirtazapine and Paroxetine in Elderly Depressed Patients

Cited by 177 publications

References 28 publications

FKBP5 polymorphisms and antidepressant response in geriatric depression

FKBP5 polymorphisms and antidepressant response in geriatric depression

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults

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