, Volume 127, Issue 3, pp 231–237

A double-blind, fixed blood-level study comparing mirtazapine with imipramine in depressed in-patients


  • J. A. Bruijn
    • Department of PsychiatryUniversity Hospital Rotterdam “Dijkzigt”
  • W. W. van den Broek
    • Department of PsychiatryUniversity Hospital Rotterdam “Dijkzigt”
  • A. M. van Hulst
    • Department of PsychiatryUniversity Hospital Rotterdam “Dijkzigt”
  • R. C. van der Mast
    • Department of PsychiatryUniversity Hospital Rotterdam “Dijkzigt”
  • B. J. M. van de Wetering
    • Department of PsychiatryUniversity Hospital Rotterdam “Dijkzigt”
  • P. Moleman
    • Moleman Research
  • P. G. H. Mulder
    • Department of Epidemiology and BiostatisticsErasmus University Rotterdam
Original Investigation

DOI: 10.1007/BF02246131

Cite this article as:
Bruijn, J.A., van den Broek, W.W., van Hulst, A.M. et al. Psychopharmacology (1996) 127: 231. doi:10.1007/BF02246131


Antidepressant effects of mirtazapine and imipramine were compared in a randomized, double blind, fixed blood-level study with in-patients in a single centre. Patients with a DSM-III-R diagnosis of major depression and a Hamilton (17-item) score of ≥18 were selected. After a drug-free and a placebowashout period of 7 days in total, 107 patients still fulfilling the HRSD criterion of ≥18, started on active treatment. The dose was adjusted to a predefined fixed blood level to avoid suboptimal dosing of imipramine. Concomitant psychotropic medication was administered only in a few cases because of intolerable anxiety or intolerable psychotic symptoms. Eight patients dropped out and two were excluded from analyses because of non-compliance; 97 completed the study. According to the main response criterion (50% or more reduction on the HRSD score) 11/51 (21.6%) patients responded on mirtazapine and 23/46 (50%) on imipramine after 4 weeks' treatment on the predefined blood level. Such a dramatic difference in efficacy between antidepressants has not often been reported before. The selection of (severely ill) in-patients, including those with suicidal or psychotic features, may have significance in this respect. Optimization of treatment with the reference drug imipramine through blood level control, exclusion of non-compliance for both drugs, exclusion of most concomitant medication and a low drop-out rate may also have contributed. It is concluded that imipramine is superior to mirtazapine in the patient population studied.

Key words

MirtazapineImipramineFixed blood-level monitoringStudy designAntidepressant effectMajor depressionIn-patients

Copyright information

© Springer-Verlag 1996