Lunchtime 12:30 - 13:30, OS6 (Seminar Room), Oakfield House, Oakfield Grove, Bristol, BS8 2BN - All welcome
MIR: a trial of mirtazapine for treatment resistant depression
MIR is a double blind placebo-controlled randomised trial of the addition of the antidepressant mirtazapine for patients with depression in primary care who have not responded to at least 6 weeks of treatment with a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor.
Depression is common in primary care and antidepressants are widely prescribed, but many depressed people do not respond to treatment. We recently completed CoBaLT, a trial of the addition of cognitive behavioural therapy to antidepressants in the same group of treatment-resistant patients. The results were encouraging, but a substantial number of those treated remain depressed, and we need to develop other treatment strategies.
There is a rationale for adding a second antidepressant with a different and complementary mode of action to SSRIs or SNRIs. Mirtazapine, a presynaptic alpha2-adrenoreceptor antagonist, increases central noradrenergic and serotonergic neurotransmission. Thus treatment with mirtazapine in combination with either an SSRI or SNRI may produce a sustained increase in both 5-HT and NA synaptic availability. There is the potential for a synergistic action and this could enhance clinical response compared to those patients receiving only an SSRI or SNRI.
The trial is funded by the NIHR HTA. It has just started recruiting and is due to run for a 42 months; we aim to recruit 470 patients form primary care in 4 centres, Bristol Exeter, Manchester and York.