Does Mirtazapine Have a More Rapid Onset Than SSRIs?
J Clin Psychiatry 2001;62(5):358-361
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: A single study utilizing a
cross-sectional analysis of scores on the Hamilton Rating Scale
for Depression (HAM-D) suggested that mirtazapine has a more
rapid onset than selective serotonin reuptake inhibitors (SSRIs).
Analysis based on the HAM-D may favor drugs with sleep-producing
effects. The purpose of the present study was to determine if a
review of all studies comparing an SSRI with mirtazapine,
utilizing persistent improvement as the dependent variable, would
suggest that mirtazapine had a more rapid onset than SSRIs.
Method: All double-blind studies comparing
mirtazapine with SSRIs were analyzed. Included in the analysis to
determine speed of onset were 298 patients taking mirtazapine and
285 taking an SSRI. Pattern analysis, which has been described
and used by other researchers, was employed to study speed of
Results: At the end of each of the 3 studies,
the total number of responders for each of the drugs did not
differ. However, the proportion of responders with onset of
persistent improvement in week 1 was greater for mirtazapine
(13%, 38/298) than for the SSRIs (6%, 18/285; chi2 =
6.95, df = 1, p = .008).
Conclusion: These data support the possibility
that mirtazapine may have a more rapid onset than SSRIs. This
observation should be considered preliminary because of the
retrospective nature of the analysis and the absence of a placebo