Key Takeaways

From the Authors As published in the article
  1. Higher dosages of mirtazapine are primarily prescribed to patients with depression and insomnia.
  2. Mirtazapine is a strong H1 receptor antagonist, providing sedative and hypnotic effects.
  3. Ultra–low-dose mirtazapine may be used as monotherapy for insomnia and can be an alternative in patients for whom cognitive-behavioral therapy for insomnia is contraindicated.
Extended Takeaways
  1. In this VA outpatient cohort, mirtazapine 3.75 mg was used after lack of efficacy with traditional sleep aids, supporting it as a practical next-step option for treatment-resistant insomnia rather than a first-line intervention.
  2. Among all 53 veterans evaluated, 47% had an ISI reduction of greater than 7 points and 32% reached recovery with an ISI score of 7 or lower, suggesting that a meaningful minority may achieve remission within 1–3 months.
  3. For patients with follow-up data after completing treatment, mean ISI decreased from 20.4 [4.58] at baseline to 8.9 [6.76] at 1–3 months, and the mean change was 11.3 [6.46], indicating a large short-term improvement in perceived insomnia severity.
  4. All veterans who completed treatment had either a constant or decreased ISI score at 1–3 months, which may help clinicians frame expectations that early worsening was not observed in treatment completers in this sample.
  5. Interpret response estimates cautiously because 17 of the 53 veterans evaluated did not complete treatment, and the study lacked a control group, limiting conclusions about comparative efficacy and long-term benefit.
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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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