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Mirtazapine versus other antidepressive agents for depression

Major depression is characterised by a persistent low mood and loss of interest and pleasure. These symptoms are often accompanied by loss of appetite, insomnia, fatigue, poor concentration, inappropriate guilty feelings and even suicide. Depression was the third leading cause of disease burden among all diseases experienced by humankind in 2002. Antidepressants are used in treatment for major depression. They are the mainstay of treatment. Among them, mirtazapine is known to have a unique pharmacological profile and thus is supposed to differ in its efficacy and adverse effects profile in comparison with other antidepressants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Depression: Can the antidepressants bupropion, mirtazapine and reboxetine help?

Bupropion and mirtazapine can relieve depression. Reboxetine has not been shown to work. Mirtazapine and reboxetine often cause side effects.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 10, 2011

Bupropion, mirtazapine, and reboxetine in the treatment of depression: Executive summary of final report A05-20C, Version 1.1

The aim of this research is to assess the benefit of treatment with bupropion, mirtazapine or reboxetine in treating the acute phase of depression, in maintenance therapy (relapse prevention), and in recurrence prevention compared to treatment with placebo each other treatment with other antidepressants in each case in adult patients with depression. The focus of the investigation was on patient-relevant outcomes.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 30, 2011

The efficacy and safety of mirtazapine and fluoxetine for depression: a meta-analysis

Bibliographic details: Zhou R, Xu WP, Wang L, Xu TJ, Hu SL, Yan G, Wei W, Li YP.  The efficacy and safety of mirtazapine and fluoxetine for depression: a meta-analysis. Chinese Journal of Evidence-Based Medicine 2010; 10(2): 196-202

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Remission with mirtazapine and selective serotonin reuptake inhibitors: a meta-analysis of individual patient data from 15 controlled trials of acute phase treatment of major depression

Antidepressants that enhance both serotonergic and noradrenergic neurotransmission may be more effective than selective serotonin reuptake inhibitors (SSRIs) for acute-phase therapy of major depressive disorder. Mirtazapine in particular has been suggested to have a faster onset of action than reuptake inhibitors. The aim of this study is to compare the remission rates and time to remission in patients with major depression taking either mirtazapine or an SSRI in an all-inclusive set of studies. Data were obtained from all eligible randomized controlled studies contrasting mirtazapine and SSRIs. Meta-analyses of remission rates and time to remission, together with a supportive analysis of mean change from baseline Hamilton Depression Rating Scales-17 were performed, using individual patient data from 15 randomized controlled trials of mirtazapine (N = 1484) versus various SSRIs (N = 1487) across 6 weeks of double-blind therapy. Analyses were repeated for the eight studies that lasted at least 8 weeks. Remission rates for patients treated with mirtazapine were significantly higher when compared with those treated with an SSRI after 1 (3.4 vs. 1.6%, P = 0.0017), 2 (13.0 vs. 7.8%, P<0.0001), 4 (33.1 vs. 25.1%, P<0.0001), and 6 weeks (43.4 vs. 37.5%, P = 0.0006) of treatment. Mirtazapine-treated patients had a 74% higher likelihood of achieving remission during the first 2 weeks of therapy compared with patients treated with SSRIs. In conclusion, the findings indicate that mirtazapine may be a more rapidly effective antidepressant than SSRIs.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

A review of therapeutic uses of mirtazapine in psychiatric and medical conditions.

OBJECTIVE: To review the literature examining the use of mirtazapine with an emphasis on its therapeutic benefits for psychiatric patients with comorbid medical conditions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The effects of mirtazapine on sleep in patients with major depressive disorder

BACKGROUND: Mirtazapine is a commonly used antidepressant with a well-known ability to produce sedation. At the same time, its sleep-promoting effects in patients with major depressive disorder (MDD) are relatively unclear. The purpose of this article is to provide clinicians with a detailed review of mirtazapine's sleep effects in patients with MDD.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Efficacy and tolerability of mirtazapine versus paroxetine in the treatment of major depressive disorder

The authors concluded that mirtazapine was effective earlier, but at six to eight weeks, paroxetine was equally effective for the treatment of major depressive disorder. There were some methodological limitations, and no validity assessment, leaving the reliability of the conclusions uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Comparing Antidepressants

How do newer antidepressants compare in depression?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: May 16, 2011

Medicines for Treating Depression: A Review of the Research for Adults

This summary will tell you what research found about the possible benefits and side effects of antidepressants. You can use this information to talk with your doctor about which medicine may be best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: July 30, 2012

Drug Class Review: Second-Generation Antidepressants: Final Update 5 Report [Internet]

We compared the effectiveness and harms of second-generation antidepressants in the treatment of major depressive disorder (MDD), dysthymia, subsyndromal depression, seasonal affective disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.

Drug Class Reviews - Oregon Health & Science University.

Version: March 2011
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Depression: The Treatment and Management of Depression in Adults (Updated Edition)

This clinical guideline on depression is an updated edition of the previous guidance (published in 2004). It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage depression in adults.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD) [Internet]

To assess efficacy, comparative effectiveness, and harms of psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013
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Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet]

Depression causes significant suffering and is commonly seen in primary care. Because primary care providers sometimes fail to identify patients as depressed, systematic screening programs in primary care may be of use in improving outcomes in depressed patients. Depression screening is predicated on the notion that identification will allow effective treatments to be delivered and that the benefits of treatment will outweigh the harms. Treatment efficacy of antidepressants and psychotherapy in general adult populations was established in a previous United States Preventive Services Task Force (USPSFT) review on depression screening, but treatment in older adults was not examined specifically. Additionally, harms of screening and treatment were not previously examined in detail.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2009
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Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults [Internet]

This review from the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) provides a comprehensive summary of the available data addressing the comparative effectiveness of four nonpharmacologic treatments as therapies for patients with treatment-resistant depression (TRD): electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and cognitive behavioral therapy or interpersonal psychotherapy (CBT or IPT).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2011
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Diagnosis and Treatment of Obstructive Sleep Apnea in Adults [Internet]

Methods for diagnosing and treating obstructive sleep apnea (OSA) are cumbersome, resource-intensive, and often inconvenient for the patient.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2011
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Drug Class Review: Atypical Antipsychotic Drugs: Final Update 3 Report [Internet]

Atypical antipsychotic agents are used to treat the symptoms of schizophrenia and bipolar disorder. The purpose of this review is to help policy makers and clinicians make informed choices about their use. Given the prominent role of drug therapy in psychiatric disease, our goal is to summarize comparative data on efficacy, effectiveness, tolerability, and safety. Ten atypical antipsychotics are currently available in the United States and Canada. Clozapine, the prototypic atypical antipsychotic, was introduced in 1989. Since then, 9 other atypical antipsychotics have been brought to market: risperidone (1993), risperidone long-acting injection (2003), olanzapine (1996), quetiapine (1997), ziprasidone (2001), aripiprazole (2002), extended-release paliperidone (2006), asenapine (2009), iloperidone (2009), and paliperidone long-acting injection (2009).

Drug Class Reviews - Oregon Health & Science University.

Version: July 2010
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

This guideline has been developed to advise on the identification and management of depression in children and young people in primary, community and secondary care. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, carers, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high-quality care for children and young people with depression while also emphasising the importance of the experience of care for patients and their families.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2005
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Systematic Reviews in PubMed

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