The role of mirtazapine in patients with fibromyalgia: a systematic review


Mirtazapine is commonly used to treat major depressive disorder. Due to its effects on multiple neurotransmitters, it has been investigated for possible benefits in patients with fibromyalgia. The objective of this systematic review is to assess the efficacy and safety of mirtazapine in the treatment of patients with fibromyalgia. Pubmed (1946-May 2018), Embase (1947-May 2018), CENTRAL, and were queried using the search term combination: fibromyalgia, pain, chronic pain, neuralgia, neuropathic pain, chronic widespread pain, or chronic pain syndrome and mirtazapine. Studies appropriate to the objective were evaluated, including three randomized, placebo-controlled trials and one open-label trial, investigating the effect of mirtazapine in patients with fibromyalgia. In patients with fibromyalgia, treatment with mirtazapine resulted in improvements in pain, sleep, and quality of life. Study durations ranged from 6 to 13 weeks and studies used varying dosing strategies for mirtazapine. Minor occurrences of somnolence, weight gain, nasopharyngitis, dry mouth, and increased appetite were reported with mirtazapine use. Based on the reviewed literature, mirtazapine appears to be a promising therapy to improve pain, sleep, and quality of life in patients with fibromyalgia. These benefits were demonstrated in patients that were treatment naïve and those that had failed previous therapies. Additional clinical evidence through larger and longer length trials would be of benefit to further define the role of mirtazapine for patients with fibromyalgia.

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All authors substantially contributed to the concept and design, acquisition of the data, or analysis and interpretation; drafting or revision of the manuscript for important intellectual content; and gave final approval for submission and publication.

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Correspondence to Andreina A. Ottman.

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Ottman, A.A., Warner, C.B. & Brown, J.N. The role of mirtazapine in patients with fibromyalgia: a systematic review. Rheumatol Int 38, 2217–2224 (2018).

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  • Pain
  • Chronic pain
  • Fatigue
  • Sleep
  • Quality of life
  • Depression