Mirtazapine relieves post-heart attack depression

NEW YORK (Reuters Health) - The antidepressant drug mirtazapine (sold under the trade name Remeron) may relieve depression in patients who have had a heart attack, without causing any cardiac side effects, according to findings published in the journal Psychosomatic Medicine.

Antidepressants used in well-designed trials of depressed heart attack patients have been limited to selective serotonin reuptake inhibitors (SSRIs), Dr. Adriaan Honig, of St. Lucas Andreas Hospital Amsterdam, and colleagues write. "Antidepressant effects have been limited."

SSRIs include drugs such as Prozac and Zoloft, which have good side effect profiles compared with antidepressants in other drug classes.

The researchers examined the antidepressant efficacy of mirtazapine, which has serotonergic activity like SSRIs and also has noradrenergic activity, in patients with post-heart attack depressive disorder. (Previous studies have suggested that individuals with depression have abnormal or ineffective noradrenergic systems.)

A total of 2,177 patients were evaluated for depressive disorder during the first year after a heart attack. Overall, 91 patients who met the criteria for major or minor depression were included in a 24-week clinical trial.

The trial randomly assigned patients to one treatment or another, included a placebo group as a comparison, and "blinded" the researchers and patients, i.e., they didn't know who received placebo and who received the drug.

After 24 weeks of treatment, mirtazapine was superior to placebo on the Hamilton-Depression Rating Scale. It was also superior to placebo on the Beck Depression Inventory and Clinical Global Impression, but not on the depression subscale of the Symptom Checklist.

Side effects were reported by patients in both groups, but none of the differences between the two groups were statistically significant.

The most commonly reported side effects were fatigue, appetite changes, dizziness, and headache.

Serious adverse events included one case each of heart failure, angina, and irregular heart beat in the mirtazapine-treated group and one instance of angina among placebo-treated patients.

"Besides SSRIs that have proven efficacy and safety in other trials, mirtazapine should be considered in the treatment of patients with major or minor depression in the first year post heart attack," Honig and colleagues conclude.

"These data may help the clinician to safely reduce depression in the post-heart attack period and aim for improvement of cardiac outcome."

SOURCE: Psychosomatic Medicine, September 2007.