Chris Berrie

The antidepressants fluvoxamine and mirtazapine provide similar benefits in the treatment of patients with chronic war-related posttraumatic stress disorder (PTSD), researchers reported at the 29th Congress of the European College of Neuropsychopharmacology (ECNP).

The current first-line treatment for patients with PTSD is a selective serotonin reuptake inhibitor, such as fluvoxamine. This can be followed by various agents, such as mirtazapine, a noradrenergic and specific serotonergic antidepressant.

“Searching the literature, we found no studies comparing these 2 precise antidepressants for people with posttraumatic stress disorders,” noted lead author Maja Vilibic, PhD, University Psychiatric Hospital Vrapce, Zagreb, Croatia, presenting a rater-blinded study here on September 20.

From their outpatient population, Dr. Vilibic and colleagues randomised 42 patients with chronic war-related PTSD in a one-to-one fashion to receive fluvoxamine 150 mg/day (mean patient age, 48.3 years) or mirtazapine 45 mg/day (mean patient age, 50.1 years), over a stable dosing period of 12 months.

After the 12 months of treatment, the team decided on a primary outcome using the Clinician Administered PTSD Scale according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (CAPS-DX). For the CAPS-DX total scores at 12 months, there was no significant difference between fluvoxamine and mirtazapine (69.4 vs 71.2).

“For each antidepressant, we found significant differences between baseline and 12 months of treatment,” said Dr. Vilibic. On this basis, fluvoxamine and mirtazapine both provided significant, but similar, improvements in the CAPS-DX total scores, as -1.5 (P < .01) and -1.8 (P < .01), respectively.

The researchers also compared the PTSD symptom clusters within the CAPS-DX results for these treatments. Although they observed no significant differences between fluvoxamine and mirtazapine for re-experiencing (20.3 vs 21.6; P = .14), avoidance (29.0 vs 30.0; P = .21), and hyperarousal (20.8 vs 19.6; P = .31), Dr. Vilibic added, “There are some implications that, if we enlarged the treatment groups, some differences would be found, even for some of the clusters.”

The researchers noted the need for further studies across such treatments in the future.

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