Mirtazapine for treatment of depression and comorbidities in Alzheimer disease

BACKGROUND: Depression in patients with Alzheimer disease is a treatable ca use of functional decline, caregiver burden, and mortality. It is often ass ociated with severe weight loss, insomnia, and anxiety. These symptoms inde pendently and collaboratively further worsen the prognosis of these vulnera ble patients. An antidepressant medication with good adverse effect profile and salutary effects on these comorbid symptoms may be of significant ther apeutic value in these patients. OBJECTIVE: To describe the role of mirtazapine in the treatment of depresse d Alzheimer patients with comorbid weight loss, insomnia, and anxiety. CASE SUMMARY:. Three patients with dementia and depression complicated by w eight loss, insomnia, and anxiety were treated with mirtazapine at an outpa tient memory loss clinic of a university hospital. DISCUSSION: Despite the persistence of memory loss, the patients experience d a prompt and sustained response to mirtazapine. There was a complete remi ssion of poor appetite, weight loss, sleep disturbances, and anxiety. Other depression symptoms, Including sad mood, anhedonia, and energy level, were also substantially improved. CONCLUSIONS: The clinical response of our patients underscores the usefulne ss of mirtazapine in the treatment of the comorbid symptoms of weight loss, insomnia, and anxiety. The effectiveness of mirtazapine in depressed Alzhe imer patients may be a reflection of its enhancement of brain serotonergic and noradrenergic neurotransmission. The usefulness of mirtazapine in depre ssed Alzheimer patients merits further study in a large randomized, control led, clinically comparative trial.