Comparative Effects of Mirtazapine and Fluoxetine on Sleep Physiology Measures in Patients With Major Depression and Insomnia
J Clin Psychiatry 2003;64(10):1224-1229
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Sleep complaints are common in
patients with major depressive disorder (MDD). Both MDD and
antidepressant drugs characteristically alter objective sleep
measures. This study compares the effects of mirtazapine and
fluoxetine on sleep continuity measures in DSM-IV MDD patients
Method: Patients (N = 19) received initial
baseline polysomnography evaluations over 2 consecutive nights.
Subjects were randomly assigned to either fluoxetine (20-40
mg/day) or mirtazapine (15-45 mg/day) treatment for an 8-week,
double-blind, double-dummy treatment trial. Single-night
polysomnograms were conducted at weeks 1, 2, and 8, with
depression ratings assessed at baseline and weeks 1, 2, 3, 4, 6,
and 8. Statistical analysis was performed by repeated-measures
analysis of variance followed by Dunnet's post hoc analyses.
Results: Patients receiving mirtazapine (N = 8)
had significant improvement in objective sleep physiology
measures at 8 weeks. Improvements in sleep latency, sleep
efficiency, and wake after sleep onset were significant after
only 2 weeks of mirtazapine treatment. No significant changes in
sleep continuity measures were observed in the fluoxetine group
(N = 11). Both groups improved clinically in mood and subjective
sleep measures from baseline, with no differences between groups.
Conclusion: These data demonstrate the
differential effects of mirtazapine and fluoxetine, with
significant improvement in favor of mirtazapine, on objective
sleep parameters in MDD patients with insomnia.