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On the basis of the results of a benefit assessment of the test drugs venlafaxine, duloxetine, bupropion, and mirtazapine, the aim of the present investigation is to conduct a health economic evaluation of these test drugs in order to derive a recommendation for a reimbursement price. The relevant comparators of the therapeutic area (tricyclic antidepressants [TCAs] plus maprotiline, selective serotonin reuptake inhibitors [SSRIs], agomelatine, and trazodone) were included in the health economic evaluation. The study population consisted of previously untreated adult patients with depression.

Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 3, 2013

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: 2011

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

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

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

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

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

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

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

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

The purpose of this report is to analyze the clinical effectiveness and safety of antidepressants prescribed for the treatment of patients with dementia and co-morbid depression and in addition to describe any current certified clinical guidelines associated with their use.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 24, 2015

Major depressive disorders (MDD) and anxiety disorders fall within a spectrum of psychiatric disorders that are characterized by severe and/or persistent symptoms of sadness and irritability that can cause considerable distress and interfere with daily activities. Untreated, they may lead to serious developmental, personal and societal difficulties that may prejudice school success, work productivity, adult development and the forming of relationships. In Canada, it is estimated that approximately 5% of male youth and 12% of female youth have experienced a major depressive episode during their childhood or adolescent years.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 11, 2015

Depression among youth is a relatively common, disabling condition that is associated with serious long-term morbidities and risk of suicide. The majority of depressed youth, however, are undiagnosed and untreated, despite opportunities for identification in settings such as primary care.

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

Version: April 2009

The study found that in adults with obsessive–compulsive disorder (OCD), psychological interventions, clomipramine, selective serotonin reuptake inhibitors (SSRIs) or combinations of these are all effective, whereas in children and adolescents with OCD, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective.

Health Technology Assessment - NIHR Journals Library.

Version: June 2016

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

Social anxiety disorder is very common and often coexists with other mental health problems. It can be severely detrimental to quality of life, with far-reaching consequences for education, employment and relationships. Only a minority of people with social anxiety disorder receive help, but this guideline demonstrates that effective treatments exist and it aims to increase identification and assessment so that people can access interventions to help them overcome this disabling condition.

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

Version: 2013

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

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

Suicide is the tenth leading cause of death in the United States (US), with nearly 100 suicides occurring each day and over 36,000 dying by suicide each year. Among Veterans and current military, suicide is a national public health concern. Recent estimates suggest current or former military represent 20 percent of all known suicides in the US and the rate of suicides among Veterans utilizing Veterans Health Administration (VHA) services is estimated to be higher than the general population. The enormity of the problem has led to several major public health initiatives and a growth in research funding for suicide prevention.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: March 2012

Symptoms of amphetamine withdrawal during the initial days of abstinence from chronic amphetamine use can prompt individuals to return to regular drug use. No medications demonstrate significant effects over placebo in reducing symptoms of acute amphetamine withdrawal.

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

Version: 2009

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