Comparison of Side Effect Profiles between Mirtazapine and Selective Serotonin Reuptake Inhibitors; A Naturalistic Setting

Chae, Jeong Ho; Lee, Kyoung Uk; Shin, Yoon Kyung; Bahk, Won Myong; Jun, Tae Youn; Kim, Kwang Soo; Lew, Tae Yul

Abstract

OBJECTIVES
Since the efficacy is similar among different antidepressants, side effects, costs, and overdose toxicity are considered preferentially as factors to choose antidepressant. Recently, selective serotonin reuptake inhibitors (SSRIs) are more frequently prescribed than tricyclic antidepressants because of their less frequent side effects. Also the use of noradrenergic and specific serotonergic antidepressants (NaSSA) are increasing. These new antidepressants have characteristic side effect profiles in terms of gastrointestinal side effects, weight gain and sexual dysfunction which serve as direct cause of noncompliance. In the present study, we compared the drug side effects of patients with major depressive disorder who have taken either mirtazapine or SSRIs. METHODS: Among those patients who were treated at Department of Psychiatry, St. Mary's Hospital, The Catholic University of Korea, from Jun, 2002 to July, 2002, we included patients who met DSM-IV criteria for major depressive disorder. Patients who reveive either mirtazapine or SSRIs (fluoxetine, paroxetine) monotherapy as an antidepressant were enrolled. Patients with physical illnesses or poor drug compliance were excluded. A self-rating questionnaire was used to assess the drug side effects. RESULTS: Total 86 patients (mirtazapine;24, SSRIs;62 (fluoxetine 18, paroxetine 44)) were participated in this study. There was no difference at age (mirtazapine;48.0+/-14.0 years, SSRIs;43.3+/-15.6 years), sex ratio (mirtazapine;male 12: female 12, SSRIs;male 24: female 38), and mean duration of administration (mirtazapine;20.2+/-21.5 weeks, SSRIs;32.1+/-50.9 weeks) between two groups. Patients taking mirtazapine have significantly less side effects in terms of decreased appetite, yawn, decreased libido, and anorgasmia. Patients taking SSRIs have significantly less side effects in terms of peripheral edema than mirtazapine. CONCLUSION: Mirtazapine and SSRIs showed differences in some side effects. Mirtazapine showed more favorable side effect profiles in the gastrointestinal and sexual side effects than SSRIs. This data was thought to be useful guidelines in selecting antidepressants hereafter.