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Title: Mirtazapine Betters Major SSRIs for Treatment of Depression

"Mirtazapine Betters Major SSRIs for Treatment of Depression"

By Bruce Sylvester ATLANTA, GA -- May 27, 2005 -- A meta-analysis of clinical trials involving more than 2,500 subjects suggests that treatment of depression with mirtazapine (Remeron) results in a more rapid onset of clinical improvement compared to treatment with fluoxetine, paroxetine, and sertraline (all SSRIs), researchers reported here May 24[^th at the 158^th Annual Meeting of the American Psychiatric Association (APA).

"Mirtazapine is mechanistically a different kind of antidepressant than the more widely prescribed SSRIs or selective serotonin reuptake inhibitors," said presenter and lead investigator Michael Thase, MD, professor of psychiatry at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, United States. "One of the consequences of a mechanistic difference is that it may follow a different temporal characteristic. … There is about a one week earlier onset of benefit with mirtazapine."

The investigators conducted a meta-analysis of data from 12 double-blind, randomized, controlled trials of mirtazapine versus SSRIs, involving more than 2,500 depressed patients. They compared remission rates (Hamilton Rating Scale for Depression -17 Item [HAMD-17] less than or equal to 7 or Montgomery-Asberg Depression Rating Scale [MADRS] less than or equal to 12) at weeks 1-6 and time-to-sustained remission using Kaplan-Meier graphing. They also calculated values of early response at week 6 as predictive of later remission.

After 6 weeks, remission rates were 38.8% for mirtazapine and 34.7% for SSRI-treated groups. "The difference between the two groups was statistically significant in favor of mirtazapine at all assessments and across time (P less than or equal to .03; Logrank test). This advantage was largely explained by the onset of remission during the first three weeks of treatment (P less than or equal to .001)," according to the authors.

They added that the results demonstrate that mirtazapine patients show a "significantly higher probability of response compared to SSRI-treated patients in the first three weeks of therapy" and that the sustained response indicated the same tendency.

The study was supported by Organon International, Inc., which manufactures Remeron.

[Presentation title: Remission With Mirtazapine Versus SSRIs: A Meta-Analysis. Abstract NR386.]

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