Off-label use of mirtazapine for anxiety

Abstract

Introduction: Currently, mirtazapine is only approved for use in patients with major depressive disorder, yet the unique dual mechanism of action for this agent has led many to inquire about potential alternative uses. The purpose of this article is to review the evidence available and evaluate the efficacy and tolerability of mirtazapine for use in patients presenting with various forms of anxiety. Methods: A search of the medical literature using Ovid Medline and the search terms ''mirtazapine'' and ''anxiety disorders'' resulted in the identification of 12 trials and 1 meta-analysis investigating off-label mirtazapine use in various subsets of anxiety. Results: Upon review of the literature, mirtazapine was found to perform significantly better than placebo at controlling symptoms of anxiety with comorbid depression, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder; and with comparable efficacy, in some cases with significantly better response rates, to more current standard treatments such as tricyclic antidepressants and selective serotonin reuptake inhibitors. Discussion: The observed efficacy of mirtazapine in these trials for the various forms of anxiety and the relatively small side-effect profile warrant consideration for further research into this alternative indication as another option for the treatment of symptoms of anxiety.