The effect of mianserin hydrochloride on delirium

Abstract

Mianserin HCI (1&60 mg/day) was administered orally before bedtime to 46 patients (mean age: 63 years) with delirium at Kurume University Hospital. The therapeutic effects of mianserin were assessed pre-and post-treatment using the Delirium Rating Scale (DRS: Trzepacz et al., 1988). The mean pre-treatment DRS score was 21. This score decreased significantly (p <0-05) to 14 on treatment day 1 and 10 on day 3. Mianserin was observed to be effective in 85 per cent of the cases (marked improvement in 67 per cent of the patients and slight improvement in 17 per cent). Of the 46 patients, 28 were classified with delirium due to direct causes such as a brain turnour or cerebrovascular disease, and 18 due to facilitating factors such as hospitalization or physical restraint. In the former group, marked improvement was observed in 54 per cent of the patients, and slight improvement in 21 per cent. The latter group demonstrated marked improvement in 89 per cent of the patients, and slight improvement in 11 per cent. In control subjects receiving haloperidol, marked improvement was observed in 62 per cent of I7 delirious patients. The plasma concentration of mianserin reached a therapeutic level within 24 h of the initiation of treatment. Hence, based on these clinical results and on measurements of plasma mianserin concentrations, mianserin can be considered effective in the treatment of delirium in elderly patients due to its rapid onset and few side-effects. Mianserin may offer an efficacy similar to that of haloperidol in the treatment of delirium while being safer.

Mianserin suppositories in the treatment of post-operative delirium

“…However, in elderly patients neuroleptics frequently cause (1997) dangerous oversedation, severe extrapyramidal symptoms or activity and sleep disturbances. In this study, the clinical eectiveness of MS and the therapeutic plasma concentrations of mianserin were observed in the early stages of treatment, as has been observed for mianserin tablets (Nakamura et al, 1995). The prompt eect of mianserin against delirium contrasts with its delayed antidepressant eects.…”

“…We have reported previously that mianserin, a tetracyclic compound, may eectively treat delirium in elderly patients as it has a rapid onset and few side-eects (Nakamura et al, 1995).…”

Antipsychotics in the Treatment of Delirium

“…Nine of the 14 studies were single agent trials, [59][60][61][62][63][64][65][66][67] and 5 were comparison trials [68][69][70][71][72] (Table 1). Drugs used in single agent trials included haloperidol, 59 olanzapine, 60,61 risperidone, [62][63][64] and quetiapine.…”

“…Drugs used in single agent trials included haloperidol, 59 olanzapine, 60,61 risperidone, [62][63][64] and quetiapine. [65][66][67] Comparison trials included 1 with haloperidol, chlorpromazine and lorazepam 69 ; 1 with haloperidol and olanzapine 71 ; 1 with haloperidol and mianserin 68 ; and 2 with haloperidol and risperidone. 70,72 Patients were selected to participate in trials from a variety of populations.…”

Drug treatment of delirium: Past, present and future

“…Melatonin supplementation has been postulated to be of benefit, [74] but supporting evidence is limited to a single case report [75]. Open studies of mianserin have reported efficacy comparable to haloperidol [38,39], with particular benefits for sleep-wake disturbances with few adverse effects [51]. A case series report suggested marked improvement in delirium symptoms, including sleep-wake disturbances in elderly patients administered trazodone [76].…”