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Cost-effectiveness of cyclic antidepressants in a developing country

Razali SM, Hasanah CI

Aust N Z J Psychiatry, 1999 Apr;33(2):283-4.
PMID: 10336231
Matched MeSH terms: Antidepressive Agents, Tricyclic/therapeutic use*
Fulltext Employing mirtazapine to aid benzodiazepine withdrawal

Chandrasekaran PK

Singapore Med J, 2008 Jun;49(6):e166-7.
PMID: 18581012

Insomnia and depression are frequently encountered in patients during withdrawal from substances. While there are no approved medications for treating them, off-label attempts to address these phenomena with mirtazapine have shown some promising results. This case describes the use of mirtazapine as an aid in benzodiazepine withdrawal and its potential benefits in alleviating insomnia and depression in a 32-year-old man. It was found to ameliorate sleep myoclonus that was thought to be associated with his withdrawal syndrome. It is hoped this report will generate interest and stimulate further research in this area of psychopharmacology.

Matched MeSH terms: Antidepressive Agents, Tricyclic/therapeutic use*
Mirtazapine for anorexia nervosa with depression

Jaafar NR, Daud TI, Rahman FN, Baharudin A

Aust N Z J Psychiatry, 2007 Sep;41(9):768-9.
PMID: 17687663

To report the use of Mirtazapine in the treatment of anorexia nervosa with depression primarily regarding its propensity for weight gain.

Matched MeSH terms: Antidepressive Agents, Tricyclic/therapeutic use*
Fulltext Antidepressant Prescription Pattern in the Presence of Medical Co-morbidity: REAP-AD 2013 Study

Grover S, Avasthi A, Tripathi A, Tanra AJ, Chee KY, He YL, et al.

East Asian Arch Psychiatry, 2015 Sep;25(3):99-107.
PMID: 26429836

Objective: To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia.
Methods: The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort.
Results: Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries.
Conclusion: Although selective serotonin reuptake inhibitors formed the bulk of antidepressant
prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.
Key words: Antidepressive agents; Asia; Comorbidity

Matched MeSH terms: Antidepressive Agents, Tricyclic/therapeutic use
Fulltext Efficacy of Tianeptine 25-50 mg in Elderly Patients With Recurrent Major Depressive Disorder: An 8-Week Placebo- and Escitalopram-Controlled Study

Emsley R, Ahokas A, Suarez A, Marinescu D, Dóci I, Lehtmets A, et al.

J Clin Psychiatry, 2018 07 03;79(4).
PMID: 29995359 DOI: 10.4088/JCP.17m11741

OBJECTIVE: The present placebo-controlled study evaluated the efficacy and safety of 8 weeks of treatment with tianeptine 25-50 mg/d in elderly patients suffering from major depressive disorder (MDD) according to DSM-IV-TR. Escitalopram 5-10 mg/d was used as an active comparator.
METHODS: Elderly outpatients aged at least 65 years with a primary diagnosis of moderate to severe episode of recurrent MDD were recruited by psychiatrists in 44 clinical centers in 10 countries from October 2013 to January 2016. Patients were randomly assigned to receive tianeptine (n = 105), placebo (n = 107), or escitalopram (n = 99) for 8 weeks. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS₁₇) total score.
RESULTS: Tianeptine improved depressive symptoms, as evaluated by the HDRS₁₇ total score in terms of absolute change from baseline (week 0) to week 8 (placebo-tianeptine difference [SE] of 3.84 [0.85] points, P < .001, using a last-observation-carried-forward approach) and response to treatment (tianeptine: 46.7%; placebo: 34.0%, estimate [SE] = 12.70% [6.70], P = .06). A sensitivity analysis using a mixed model for repeated measures confirmed the main results on HDRS total score. The placebo-tianeptine difference (SE) was 0.66 (0.15) for Clinical Global Impressions-Severity of Illness (95% CI, 0.37 to 0.96; P < .001) and 0.57 (0.14) for Clinical Global Impressions- Improvement (95% CI, 0.30 to 0.83; P < .001). Positive results were also obtained with the active control escitalopram (HDRS₁₇ total score placebo-escitalopram difference of 4.09 ± 0.86 points, P < .001), therefore validating the sensitivity of the studied population. Tianeptine was well tolerated, with only minimal differences in tolerability from placebo.
CONCLUSIONS: The present study provides robust evidence that an 8-week treatment period with tianeptine 25-50 mg is efficacious and well tolerated in depressed patients aged 65 years or older.
TRIAL REGISTRATION: EudraCT identifier: 2012-005612-26.

Matched MeSH terms: Antidepressive Agents, Tricyclic/therapeutic use