Table 38Summary of included studies. Comparison 37. Augmenting with mirtazapine versus continuing with antidepressant (+/− placebo)

StudyPopulationInterventionComparisonDetails of inadequate response/treatment resistanceComments

Carpenter 2002

RCT

US

N=26

Mean age (years): 46.3

Gender (% female): 62

Ethnicity (% BME): NR

Baseline severity: HAMD 22.3 (more severe)

Mirtazapine (final dose: 31% 15mg/69% 30mg) + SSRI/SNRIPlacebo + SSRI/SNRIInadequate response (HAMD total score>12) after at least 4 weeks of standard antidepressant monotherapy at maximum recommended or tolerated doses

Treatment length (weeks): 4

Outcomes:

  • Depression symptomatology endpoint
  • Depression symptomatology change score
  • Remission
  • Response
  • Discontinuation due to any reason
  • Discontinuation due to side effects
  • Global functioning endpoint

Kato 2018

RCT

Japan

N=1088

Mean age (years): 41.8

Gender (% female): 53

Ethnicity (% BME): NR

Baseline severity: PHQ-9 12.7 (less severe)

Mirtazapine 7.5-45mg/day + sertraline 50mg/day or 100mg/daySertraline 50mg/day or 100mg/day (mean final dose 71.7mg)Inadequate response (non-remission as defined by PHQ-9 score>4) to 2 weeks of treatment with sertraline (50mg or 100mg)

Treatment length (weeks): 6

Outcomes:

  • Depression symptomatology at:
    • Endpoint
    • 4-month follow-up
  • Remission at:
    • Endpoint
    • 4-month follow-up
  • Response at endpoint
  • Discontinuation due to any reason

Kessler 2018a/2018b

RCT

UK

N=480

Mean age (years): 50.2

Gender (% female): 69

Ethnicity (% BME): 3

Baseline severity: BDI-II 31.05 (more severe)

Mirtazapine 30mg/day + SSRI/SNRIPlacebo + SSRI/SNRIInadequate response to an SSRI or SNRI antidepressant at an adequate dose for at least 6 weeks

Treatment length (weeks): 12

Outcomes:

  • Depression symptomatology endpoint
  • Remission
  • Response
  • Discontinuation due to any reason
  • Quality of life endpoint
  • Quality of life physical component score
  • Quality of life mental component score

Xiao 2020

RCT

China

N=136

Mean age (years): 39.3

Gender (% female): 53

Ethnicity (% BME): NR

Baseline severity: HAMD 20.95 (more severe)

Mirtazapine 30mg/day + paroxetine 20mg/dayParoxetine 20mg/dayInadequate response: early non-response (HAMD score improved by less than 20%) to prospective open-label treatment with paroxetine (10-20mg/day) for 2 weeks

Treatment length (weeks): 6

Outcomes:

  • Depression symptomatology endpoint
  • Depression symptomatology change score
  • Remission
  • Response
  • Discontinuation due to any reason
  • Discontinuation due to side effects

BDI-II: Beck depression inventory; BME: black and minority ethnic; HAMD: Hamilton depression scale; NR: not reported; PHQ-9: patient health questionnaire-9 item; RCT: randomised controlled trial; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor

From: Further-line treatment

Cover of Further-line treatment
Further-line treatment: Depression in adults: Evidence review D.
NICE Guideline, No. 222.
Copyright © NICE 2022.

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